پریشانی روانی در بیماران در انتظار پیوند قلب

Heart transplantation has become an established procedure for the treatment of terminal heart failure. However, due to a shortage of donor organs, the waiting period for a donor organ is increasing. Cross-sectional and retrospective studies have indicated that there is tremendous psychological distress during this waiting period. The aim of this study was to assess this phase systematically and longitudinally. At the beginning of their waiting period, 62 patients at the Heidelberg Transplantation Centre were examined with regard to their physical complaints, quality of life, and level of depression. Four months later the remaining 42 patients were re-examined. The sample showed a significant increase (p<0.001) in subjective physical symptoms and an impairment in social activities (p<0.05) and everyday life (p<0.05), and a significant increase in depression (p<0.001), despite the relatively short time period. These results show the necessity of supportive psychotherapy for patients undergoing heart transplantation.

For patients suffering from terminal heart failure, orthotopic heart transplantation has become an established means of treatment. By the end of 1995, 34,300 heart transplantations [1] had been performed in 271 transplantation centers. Given that the acute surgical and immunological problems of the transplantation procedure have been largely resolved, interest in the psychosocial implications for the patient and the patient’s immediate environment has intensified. A number of studies have shown a considerable improvement in quality of life after successful heart transplantation 2, 3, 4 and 5. However, studies concerning the psychosocial aspects of the preoperative phase 6, 7 and 8 have demonstrated enormous distress in the patient and his environment prior to the operation. Considering that, during the waiting period, a majority of patients experience a marked worsening in their physical condition and 30% of patients die, it is not surprising that, in earlier studies [9], a prevalence of over 35% for anxiety disorders and over 20% for depression has been found. The already stressful situation for patients on waiting lists has grown worse in recent years due to the rising demand for organs and a coincidental stagnation or even decline in public willingness to provide them. As a consequence, the waiting period has lengthened and patient survival rate has decreased [10]. With the exception of a recently published study in children awaiting heart transplantation [11], the psychosocial stressors of the waiting period have only been examined in cross-sectional studies [12]. The objective of this study was to assess the psychosocial functioning of patients treated at the Heidelberg Transplantation Centre using a follow-up design. The present study aimed to answer the following questions: 1. What course do depression, quality of life, and physical symptoms take during the waiting period for a heart transplant? 2. Which psychological parameters can identify patients who require more intense psychotherapeutic care for severe depression during their waiting period?