Fig. 15.1B. Pretransplant alcohol-dependence assessment II. From Beresford et al. A Rational Approach to Liver Transplantation Psychosomatics. 31(3):241-254. Reproduced with permission.

(patients need to stay on top of funding sources for transplant medications by contacting their social worker), chaotic lifestyles, personality disorders and other mental problems. Also, these patients may be suffering from medical consequences of their primary disease. Only with very careful evaluation and demonstration by the patient that poor self-care is clearly behind them would one consider re-transplantation.


These patients are distinguishable by the fact that they most often have a history of being brittle diabetics from childhood. The dynamics of having an early, unpredictable and often dramatic chronic disease can interfere with normal sepa-ration/individuation and emotional development in some patients. Many of these patients have underlying low self-esteem and issues of control with authority figures like parents and physicians. Some are and will continue to have to deal with other end organ damage like retinal hemorrhage and neuropathy. Quality of life series suggest that this group may have a more protracted recovery period before their quality of life changes. Frequently it may be up to a year before patients really see the positive risk/benefit to the surgery. It is important to express hope that the procedure will arrest the disease process, but not to oversell the procedure to the point that patients are not prepared for complications.

Heart, Lung Transplants

Many of these patients have history of depressive disorders, anxiety and substance abuse. Heart and lung transplants also can raise ethical concerns of transplanting patients who may have had knowledge that their alcohol or smoking could contribute to disease. Heart and lung failure patients can have such impaired quality of life and low survival rates that transplant is the only option. The selection process with these patients is conducted with the same general principles as described above.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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