Perceived Success of Upper Extremity Transplantation: A Qualitative Study

Emma Williams, BA
Department of Orthopedics
Poster Overview

Since hand transplantation first became possible, extensive research has focused on improving transplant outcomes. However, there has been relatively little research done to investigate the psychosocial, or non-biological, factors that may influence the likelihood of a successful transplant. To address this research gap, we interviewed hand transplant recipients, their primary caregivers, and transplant providers about their experiences with and perspectives on the transplant process. Each interview was conducted by moderators who asked a structured set of questions. Interviews with the recipients and their caregivers focused on their personal experience with transplantation while interviews with the providers focused on their observations of factors that might contribute to a successful transplant. We used a technique called thematic analysis to identify psychosocial factors that participants considered important in either improving or worsening the transplant experience or outcome. Recipients described having realistic expectations, support systems with a primary caregiver, and a positive outlook as factors that made transplant success more likely. Providers shared that recipients with experience adapting to challenging circumstances were better able to overcome post-transplant limitations. Similar to recipients, they also described strong support systems, a positive attitude, and realistic expectations as contributing to transplant success.

Scientific Abstract

Purpose: To understand psychosocial factors associated with perceived success of upper extremity transplantation (UET), we interviewed transplant recipients, their primary caregivers, and transplant providers. Methods: We recruited four UET recipients, primary caregivers for three of these recipients, and 13 transplant providers. We conducted two sets of semi-structured face-to-face interviews, one with recipients and their caregivers and the other with providers. The recipient interviews explored the transplantation experience while the provider interviews examined their perceptions of recipient qualities that influence transplant outcome. We performed a thematic analysis for each set of interviews, producing lists of themes, subthemes, and proposed hypotheses that explain how themes relate to the study’s guiding questions.

Results: Recipients described several factors as contributing to transplant success, including having realistic expectations about post-transplant function and immunosuppression, support from one’s community and primary caregiver, an optimistic outlook, and strong motivation.

Providers shared that recipients with prior trauma experiences are better able to adapt to post-transplant limitations and that recipients who take an active role in their recovery and have strong social support may experience better outcomes. Conclusions: Both recipients and providers cited realistic expectations, positive attitude, and strong social support as contributing to transplant success.

Clinical Implications
Findings from this work may help providers to identify optimal candidates for hand transplantation and to structure the transplantation process in such a way that maximizes recipients’ chances of a successful transplant.
Research Areas
Authors
Emma E. Williams, BA; Nora K. Lenhard, BA; Sarah E. Kinsley, PA-C; Emma C. Lape, BA; Sejal Shah, MD; Robert R. Edwards, PhD; Jeffrey N. Katz, MD, MSc; and Simon G. Talbot, MD
Principal Investigator
Simon G. Talbot, MD

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