The kidney transplant failure experience: a longitudinal case study.
OBJECTIVE
To explore participants' experiences of kidney transplant failure.


BACKGROUND
Kidney transplants are effective and efficient but not without complications. About 7% to 12% of kidney transplants fail within a year, and rates of failure increase over time. Graft failure can have profound effects, often resulting in depression and, occasionally, suicidal feelings. Despite these issues, the personal dimensions of graft failure have been poorly researched.


METHODS
One donor-recipient couple experienced irreversible graft rejection immediately after a kidney transplant. This article is a longitudinal case study of this family's experiences. Data were collected through 3 semistructured interviews, conducted before the transplant and at 3 and 10 months after the transplant. Interviews were recorded, transcribed verbatim, and data coded into categories arising from the participants' accounts.


RESULTS
Transplantation represented a significant source of hope. Fear of transplant failure was a major concern, but was dealt with by using emotion-focused coping mechanisms. Graft rejection was devastating, causing feelings of grief, loss, suicide, and depression. Depression improved as physical health and a sense of personal control improved. The recipient felt inadequately prepared for graft failure and poorly supported by health professionals.


CONCLUSIONS
The primary source of grief and depression appeared to be related to the recipient's "loss of imagined future" (ie, the life that she anticipated after transplant). Study findings have potential implications for the provision of care, information, and support for patients and their families before and after transplantation and for future related research.
Gill
Paul
P
Faculty of Health, Sport & Science, University of Glamorgan, Pontypridd, United Kingdom CF37 1DL. PWGill@glam.ac.uk
Lowes
Lesley
L
D000223:Adaptation, Psychological; D001294:Attitude to Health; D003863:Depression / Q000523:psychology; D004739:England; D005260:Female; D006084:Graft Rejection / Q000523:psychology*; D006117:Grief; D006301:Health Services Needs and Demand; D006801:Humans; D007389:Internal-External Control; D016030:Kidney Transplantation / Q000009:adverse effects / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D015404:Nursing Methodology Research; D036301:Qualitative Research; D012649:Self Concept; D012944:Social Support; D011795:Surveys and Questionnaires; D017211:Treatment Failure