Back on the Road to Life: Iranian Patients’ Experience of Heart Transplantation

Document Type : Original Article

Authors

1 Associate Professor, Department of Community Health and Geriatric, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2 Professor, Research Center of Quran, Hadith and Medicine, Spiritual Health Group, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Assistant Professor, Department of Critical Care Nursing, Nursing and Midwifery Care Research Center, Spiritual Health Group, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 PhD Candidate, Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Heart transplantation is a standard treatment for end-stage cardiac disease. In addition to inducing physical changes and improving the quality of life, it causes unique mental and psychological changes in transplant recipients. Therefore, this study sought to explain and interpret the experience of heart transplant recipients in Iran.
Methods: Using a qualitative content analysis approach, this study was performed on 13 heart transplant recipients in Tehran. The data were collected through observation and semi-structured interviews. The participants were selected using purposive sampling, and the interviews continued until data saturation. After obtaining informed consent, interviews were recorded, transcribed, and analyzed using conventional and concurrent content analysis.
Results: The analysis of the data revealed two stages experienced by heart transplant recipients. The transition stage was categorized into two concepts of "emotional turmoil" and "feeling of duality". The emotional turmoil was subcategorized into feeling guilty, alienation with the new heart, and gratitude. Besides, the "feeling of duality" was subdivided into personality change and lifestyle changes. The stabilization stage was conceptualized into “self-acceptance” which was subcategorized into three concepts of the acceptance of the new heart, feeling of unity with the donor, and normalization.
Conclusion: Adaptation to the new heart is a multistage process in heart transplant recipients. Based on the insights from this study, it can be concluded that healthcare professionals need to improve their knowledge of post-transplant changes, recipients’ feelings, and their adaptation strategies. They are also advised to address the physical needs and mental concerns of transplant recipients.

Keywords


Golbus JR, Adie S, Hanigan S, Dorsch M, Rooks B, Aaronson KD, et al. Higher intensity statin therapy reduces clinical endpoints after heart transplantation independent of lipid levels. The Journal of Heart and Lung Transplantation 2019; 38(4): S76.
Thakkar SJ, Grayburn PA, Hall SA, Roberts WC. Orthotopic heart transplantation for ankylosing spondylitis masquerading as nonischemic cardiomyopathy. Am J Cardiol 2019; 123(10): 1732-5. doi:10.1016/j.amjcard.2019.02.034.
Sher Y, Maldonado JR. History of Heart Transplantation. Psychosocial Care of End-Stage Organ Disease and Transplant Patients. Springer; 2019. p. 225-6.
Abedi HA, Monemiyan S, Naji SA. Spiritual-psychological experiences of heart transplant recipients. Journal of Qualitative Research in Health Sciences 2012; 1(1):52-8. [In Persian].
Mandegar MH, Bagheri J, Chitsaz S, Jebelli M, Javidi D, Sarzaeem MR, et al. Heart transplantation in Iran: a comprehensive single-center: a review of 15-Year performance. Arch Iran Med 2009; 12(2):111-5.
Morton PG, Fontaine DK, Hudak CM, Gallo BM. Critical Care Nursing: A Holistic Approach. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
Almgren M. Uncertainty after heart transplantation. A new perspective on self-efficacy and self-management [dissertation]. Sweden: Lund University; 2018.
Dornelas EA, Sears SF. Living with heart despite recurrent challenges: Psychological care for adults with advanced cardiac disease. Am Psychol 2018; 73(8):1007-18. doi:10.1037/amp0000318.
Kim J, Kim K, Jang I. Symptom experience, self-care adherence, and quality of life among heart transplant recipients in South Korea. Clin Nurs Res 2019; 28(2):182-201. doi: 10.1177/1054773817740531.
Raiesdana N, Peyrovi H, Mehrdad N. Exploring challenges of living after heart transplantation in heart recipients in Iran. Koomesh 2017; 19(2):492-504. [In Persian].
Anthony SJ, Nicholas DB, Regehr C, West LJ. The heart as a transplanted organ: unspoken struggles of personal identity among adolescent recipients. Can J Cardiol 2019; 35(1):96-9. doi: 10.1016/j.cjca.2018.10.006.
Abbey SE, De Luca E, Mauthner OE, McKeever P, Shildrick M, Poole JM, et al. Qualitative interviews vs standardized self-report questionnaires in assessing the quality of life in heart transplant recipients. J Heart Lung Transplant 2011; 30(8):963-6. doi: 10.1016/j.healun.2011.03.017.
Schneekloth TD, Hirschfeld MJ, Jowsey-Gregoire SG, Petterson TM, Dunlay SM, Niazi SK, et al. Psychosocial risk predicts new episode depression after heart transplant. Psychosomatics 2019; 60(1):47-55. doi:10.1016/j.psym.2018.06.003.
Kraft IA. Psychiatric complications of cardiac transplantation. Semin Psychiatry 1971; 3(1):58-69.
Shapiro PA, Pereira LF, Taylor KE, Wiener I. Post-transplant Psychosocial and Mental Health Care of the Cardiac Recipient. In: Sher Y, Maldonado JR. Psychosocial Care of End-Stage Organ Disease and Transplant Patients. Springer; 2019. p. 237-44.
Almgren M, Lennerling A, Lundmark M, Forsberg A. The meaning of being in uncertainty after heart transplantation–an unrevealed source to distress. Eur J Cardiovasc Nurs 2017; 16(2):167-74. doi:10.1177/1474515116648240.
Shemesh Y, Peles‐Bortz A, Peled Y, HarZahav Y, Lavee J, Freimark D, et al. Feelings of indebtedness and guilt toward donor and immunosuppressive medication adherence among heart transplant (HT x) patients, as assessed in a cross‐sectional study with the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS). Clin Transplant 2017; 31(10). doi:10.1111/ctr.13053.
Peyrovi H, Raiesdana N, Mehrdad N. Living with a heart transplant: a phenomenological study. Prog Transplant; 24(3):234-41. doi: 10.7182/pit2014966.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures, and measures to achieve trustworthiness. Nurse Educ Today 2004; 24(2):105-12. doi:10.1016/j.nedt.2003.10.001.
Morse JM. Critical Issues in Qualitative Research Methods. USA: Sage; 1994.
Dehghan Nayeri N, Varaei S, Azizi-Fini I. The outcomes of heart transplantation: a qualitative study. Nursing and Midwifery Studies 2017; 6(4):196-203. doi: 10.4103/nms.nms_67_17.
Stolf NA, Sadala ML. Experiencing heart transplantation: the patients' perspective. Brazilian Journal of Cardiovascular Surgery 2006; 21(3):314-23. doi:10.1590/S0102-76382006000300011.
Kuhn WF, Davis MH, Lippmann SB. Emotional adjustment to cardiac transplantation. General Hospital Psychiatry 1988; 10(2):108-13. doi: doi.org/10.1016/0163-8343(88)90095-3.
Bunzel B, Schmidl-Mohl B, Grundböck A, Wollenek G. Does changing the heart mean changing personality? a retrospective inquiry on 47 heart transplant patients. Qual Life Res 1992; 1(4):251-6. doi: 10.1007/BF00435634.
Song H, Qiao J, Li Y, Han M. Exploring the experiences of chinese patients waiting for heart transplantation. World Journal of Cardiovascular Diseases 2021; 11(03):153-66. doi:10.4236/wjcd.2021.113017.
Pearsall P, Schwartz GE, Russek LG. Changes in heart transplant recipients that parallel the personalities of their donors. Integr Med 2000; 2(2):65-72. doi:10.1016/s1096-2190(00)00013-5.
Raiesdana N, Peyrovi H, Mehrdad N. Spiritual experience in heart transplant recipients in Ira. Cardiovascular Nursing Journal 2013; 2(3):44-53. [In Persian].