Posted by: Chris Maloney | October 31, 2011

Frankenstein: Coping With The Mental Effects of Multiple Transplants

Legendary transplantation of a leg by Saints C...

Image via Wikipedia

Happy Halloween!

Since I’ve already talked about Dracula (Vlad the Impaler) and zombies (Haitian zombie poison), I felt a need on this fine Halloween to dip briefly into the trauma associated with waking up the Frankenstein monster (referred to hereafter as Frank).

We now know that the different parts of Frank’s body could not have been dug up.  That would lead to irreversible necrosis.  So a modern Frank would have to be created on-the-spot from fresh-frozen parts.

Like all modern transplant patients, Frank would have a variety of issues.  The first is immune rejection of his various transplants.  A single lung or kidney can face terrible reactions, so I cannot imagine Frank will have all his organs working together.  In the best case scenario, he’s looking at multiple organ failure during a fairly short period.  At worst case, he’ll go directly into shock as his histamine levels generate a cascade into a deadly allergic reaction to himself.

But let us wave our scientific wand and overcome Frank’s initial issues.  How is he to cope with the donation of so many parts?  What does he owe to his donors, and will he be the man he was (in his brain) or be more of a conglomeration of the personalities of his donors?

The processing and assessment of dealing with a donation is a real issue for transplant patients.  They have the entire spectrum of emotions, and I have seen donors experience a similar spectrum of responses.

But the processing of those emotions is interpreted by many medical professionals as “magical” thinking.  A person might experience a craving of the donor, or a particular like or dislike they did not have before.  Because we do not have a clear picture of what a donation does to a person, such reactions are relegated to the realm of psychiatry.

Is there clearly a response on a physical level?  Of course.  In multiple cases we can document viral transferral and/or an immune system reaction.  Since the donor’s nerve endings are continuing to work, it makes some sense that the organ would continue to “request” input that is familiar.  If the donor ate meat but the recipient does not, a mild craving for meat as the donor’s organ senses a drop in protein or iron levels is not terribly far fetched.  We simply do not understand our bodies’ chemistry at this level.

But in a deeper way, it doesn’t matter if it’s “all in the mind.”  The focus on integration of organs on every level will lead to a greater level of compliance with the necessary drugs and an increased motivation on the part of the recipient.  Recipients bogged down by guilt or unworthiness need support from every member of their transplant teams.  And donors need more than a cursory thank you and a pat on the back as they walk out the door.

We might imagine a thankful, functional Frank meeting with the families of all his donors.  He could take time to get to know all the parts of himself, and find the belonging and the family, the sense of self, that he lacked in Shelly’s novel.

I’m attaching some studies on transplant patients and one of the discussions of near-death experiences.  Unlike the skeptical view that such experiences are brain oxygen deprivation, this discussion talks about those experiencing near death experiences with brain death.  What would Frank’s experience have been?

Clin Transplant. 2003 Aug;17(4):391-400.

Transplant recipients’ conceptions of three key phenomena in
transplantation: the organ donation, the organ donor, and the organ transplant.

Sanner MA.

Source

Department of Public Health and Caring Sciences, Unit of Health
Services Research, Uppsala Science Park, Uppsala, Sweden.
Margareta.Sanner@pubcare.uu.se

Abstract

Thirty-five heart and kidney transplant patients were interviewed on
five separate occasions during the first 2 yr after transplantation. The aim
was to explore their experiences of phenomena that distinguish the
transplantation from other kinds of medical treatment. The selection of
informants was designed to permit comparisons between recipients with heart and
kidney transplants and with living and necro-transplants. The qualitative
analysis of the informants’ reactions was focused on three themes; nine
categories emerged. The first theme concerned general aspects of the donation
and the donor and was differentiated in four categories: joy and sorrow,
gratefulness and indebtedness, guilt, and inequity. The second theme related to
the donor as a unique individual and included three categories: recognition and
identification with the donor, influences of the donor, and relationship to the
living donor. The third theme pertained to incorporation of the transplant and
included two categories related to the naturalness of having a transplant, and
the benevolent transplant. The informants’ reactions were discussed in terms of
primary and secondary processes. All informants were in an emotionally charged
situation after transplantation and warded off anxiety-provoking impulses, most
intensively during the first 6 months. Avoidance, suppression, and denial were
the most common defence mechanisms, all of which seemed to be supported by the
medical context. Other, more constructive strategies are suggested. The
recipients’ own interpretations of causes to possible personality changes are
discussed. There were few differences between heart and necro-kidney patients
concerning the reactions to the donation, the donor, and the transplant; the
dividing line was more prominent between recipients with living and
necro-transplants.

PMID: 12868998

Ann Transplant. 2005;10(1):9-12.

Living with a stranger’s organ–views of the public and transplant
recipients.

Sanner MA.

Source

Department of Public Health and Caring Sciences, Uppsala Science Park,
Uppsala, Sweden. margareta.sanner@pubcare.uu.se

Abstract

This comprehensive article is based on three previous studies on
people’s reactions on receiving transplants of various kinds: a survey of the
public, in-depth interviews with informants recruited from this survey and two
other surveys, and in-depth interviews with heart and kidney recipients. The
ideas and reactions of the public, when confronted with the issue of receiving
a transplant in a hypothetic situation, vary from magical thinking to a
conception of the body as an object in need of repair. The actual recipients
show a similar variation in their reactions as the public. However, there are
some differences between the two groups that probably depend on the patient
selection for transplantation, reality factors, acclimatization factors, and
defense strategies to master anxiety-provoking thoughts about the donor and
transplant. The most constructive of the ideas about the donor seems to be
identification with positive traits, such as generosity and solidarity.

PMID: 15926744

Soc Sci Med. 2001 May;52(10):1491-9.

Exchanging spare parts or becoming a new person? People’s attitudes
toward receiving and donating organs.

Sanner MA.

Source

Department of Public Health and Caring Science, Social Medicine,
Uppsala Science Park, Sweden. margareta.sanner@socmed.uu.se

Abstract

The present study explored the public’s feelings and ideas about
receiving organs, and how this influenced their attitudes toward accepting a
transplant themselves. Also the willingness to donate was examined in order to
provide a complementary perspective. The main aim was to identify consistent
attitude patterns that would include attitudes toward both receiving and
donating organs and the motives behind this. Sixty-nine individuals with
varying socio-demographic background, selected from samples who had responded
to a questionnaire on receiving and donating organs and tissues, were
interviewed in-depth. The approach to analyse the interviews was hermeneutic.
Seven typical attitude patterns emerged. By an ‘attitude pattern’ was meant a specific
set of attitudes and motives, that formed a consistent picture that was logical
and psychologically meaningful. In the discussion, two different conceptions of
the body were focused. One of them meant that the body was easily objectified
and conceived as machine-like, and did not represent the self. This machine
model paved the way for the understanding that body parts needed to be replaced
by spare parts. The other conception meant that a new organ would transfer the
donor’s qualities, i.e. influence the identity of the recipient with regard to
behaviour, appearance, and personality. This belief may be explained by
‘analogy thinking’ based on our everday experience of how mixed entities take
on the qualities of all components. Another explanation would be a kind of
magical thinking and ‘the law of contagion’, which is often connected to oral
incorporation. The consequences of these conceptions when patients are
confronted with the factual situation of a transplantation, were discussed.

Comment in

Evid Based Nurs. 2002 Jan;5(1):31.

PMID: 11314846

Aust N Z J Psychiatry. 2010 Oct;44(10):883-7.

Organ transplantation and magical thinking.

Vamos M.

Source

Centre for Brain and Mental Health Research, University of Newcastle,
Psychiatry, John Hunter Hospital, New Lambton, NSW 2305, Australia.
mvamos@mail.newcastle.edu.au

Abstract

Organ transplantation can provide important treatment benefits in a
variety of situations. While a number of live donor procedures are now
possible, procurement of organs from dead donors remains the mainstay of
transplant programmes. However, cadaveric donation rates remain much lower than
anticipated, and some patients who receive organs struggle to adapt to their
new body. The reasons for this are not entirely explained by rational or
logical means. This paper uses concepts drawn from magical thinking to try to
explain some of the less apparent issues at play within the process of
cadaveric organ transplantation, including both the donation and receiving of
organs. Three themes are explored as potentially relevant: superstitions and
rituals around death and the dead body, incorporation and the meanings attached
to the transplanted organ, and survivor guilt. All three are shown to be
relevant for some part of the transplantation process in at least a minority of
cases. It is therefore suggested that focusing not only on the logical and
scientific, but also on the ambiguous and magical may enhance the organ
donation process and thus increase donation rates and the psychological
adjustment of transplant recipients.

PMID: 20932201

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