Psychological Distress in Caregivers of Liver and Lung Transplant Candidates

Although organ transplantation represents a stressful experience for the entire family, surprisingly little research has focused on the adjustment of caregivers. The purpose of this study was to examine what caregivers report to be the greatest benefits and stressors pretransplant, the prevalence of psychological distress and caregiver strain in pretransplant caregivers as compared to normative populations, and the physical, psychological, and demographic variables that predict distress. Fifty-two caregivers of transplant candidates (28 liver and 24 lung) completed a series of questionnaires, including the Psychosocial Adjustment to Illness Scale (PAIS-SR), SF-36 Health Survey, Caregiver Strain Index (CSI), and qualitative questions about benefits and stressors. The most commonly reported benefit of being a caregiver could be categorized as Helping the Patient, and the most common stressors were associated with Uncertainty/Waiting/Fears. Compared to normative samples of caregivers of patients with Alzheimer's disease, caregivers of liver transplant candidates reported more caregiver strain; there were no differences for lung transplant caregivers. Caregiver social functioning was found to be the only significant predictor of caregiver distress, with those caregivers who report greater distress also reporting extreme and frequent interference with normal social activities. Implications of these findings for psychological interventions are discussed.     

The interface between physical and mental disorders: The need to dismantle the biopsychosocialneuroimmunological model of disease

This article argues for the necessity of cognitive-behavioral assessment for a thorough understanding of how psychological factors mediate disease process across a wide range of diseases including coronary artery disease, breast cancer, and human immunodeficiency disease. Based on empirical data presented as part of the APA Presidential miniconvention, “To Your Health: Psychology through the Life Span,” the conclusion is that psychological treatment can help extend life. Stress management programs can positively influence adherence to treatment regimens and positively influence the human immune system response during the course of treatment and recovery from illness. Even in the face of life-threatening circumstances such as liver transplantation, Stage II and III breast cancer, and after HIV infection has been diagnosed, the quality of life can be remarkably improved. Physicians and psychologists must work together to produce the beneficial effects of the synergy between mind-body processes.     

人体器官“有偿”获取机制的伦理依据与法律观照

人体器官、组织无偿捐献是当今获取器官的主流模式, 有偿模式 (含经济补偿、捐赠激励) 被排斥在体制之外。创建符合国情的器官捐献和移植体系, 既遵循我国社会的普遍伦理法则, 又符合国际通行的器官移植伦理标准, 提倡无偿、允许有偿 (补偿、激励) 获取人体器官模式和机制可能成为一种切合实际的选择。这既是对多年来关于人体器官“无偿”还是“有偿”获取讨论的回应, 也是对器官捐献机制的一个重大改进。为使这一机制真正发挥效力, 需要法律与伦理的融通和观照。     

Uterus Transplantation: The Ethics of Using Deceased Versus Living Donors

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward.     

死亡与重生：器官移植手术中社会工作服务的拓展

社会工作作为医疗团队中的一员,不仅认识到器官移植对病人及其家属、移植医学以及社会风气的积极意义与消极限制,而且注重围绕移植手术的不同阶段为病患及其家属开展心理及社会评估、个案与家庭辅导、资源整合以及社会支持等服务。     

公众对活体大器官移植的认知态度与对策

对河南地区公众关于活体大器官移植态度进行的抽样调查结果显示：（1）公众赞成开展活体大器官移植;（2）多数公众反对器官买卖,但赞成器官买卖的也有相当大的比例;（3）亲情是亲属活体器官捐献者愿意捐献的主要原因。针对调查结果,我们在比较分析的基础上,提出了相关对策,促使活体大器官移植技术更好地造福于人类。     

老年原发性高血压晨峰现象与靶器官损害临床研究

应用24h动态血压监测(ABPM)了解老年原发性高血压晨峰现象对主要靶器官结构及功能的潜在损害。114例老年原发性高血压患者根据24h动态血压监测分为晨峰组和非晨峰组,均常规检查血脂谱,空腹血糖,放免法测定尿微量白蛋白,计算体重指数(BMI)、左室质量指数(LVMI)、颈总动脉(CCA-IMT)和颈内动脉内膜中层厚度(ICA-IMT)、心电图测量计算QT离散度(QTcd)。晨峰组的24h、白昼、夜间平均收缩压均显著高于非晨峰组动态血压监测水平(P<0.05),而且晨峰组的睡-谷晨峰变异幅度增高有统计学意义(P<0.05)。晨峰组的LVMI、CCA-IMT、ICA-IMT、QTcd和尿微量白蛋白指标均高于非晨峰组(P<0.01)。两组在BMI、血脂谱、血糖差异无统计学意义。清晨高血压是老年原发性高血压病的一个不可忽视的潜在危险因素。长期晨间血压负荷升高使得机体全天处于血压高负荷状态,更易使心肌重构肥厚和心电生理特征改变,增加心律失常发生率;加速动脉粥样硬化斑块形成。因此遏制老年原发性高血压患者的晨峰高反应是降压达标和减缓靶器官损害的关键环节。     

Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

移植免疫学的新突破与器官移植

现代器官移植是建立在移植免疫学基础上,移植免疫学基础研究的每一个进展都推动了器官移植的发展。９０年代以来,Ｓｔａｒｚｌ提出了移植排斥的“双向移植排斥理论”,反映了在临床应用免疫抑制药物的情况下,移植排斥的特点,是移植免疫学发展史上的一个重要理论地临床器官移植耐受的诱导具有重要的指导作用。