title: Transformational experiences in adult-to-adult living-donor liver transplant recipients.
abstract: OBJECTIVE
  This paper is a report of a study conducted to explore the transformational experiences of adult-to-adult living-donor liver transplant recipients.
  
  
  BACKGROUND
  Living-donor liver transplant was developed to overcome the shortage of cadaveric livers available for transplantation. However, living-donor liver transplant generates multifaceted psychosocial problems for recipients.
  
  
  METHODS
  Data were collected from 2002 to 2004 through in-depth interviews and participant observations. We adopted a phenomenological approach that examined the experience of 30 recipients.
  
  
  RESULTS
  We classified the experiences into three types: common, innate and unrealized. Analysis of the transcripts revealed four themes, all with associated sub-themes. The first theme, guilt and concrete issues, includes anguish when thinking about survival by hurting a potential donor and problems associated with donor and cost. The second theme, let it happen includes leave it to fate; ambivalence; and worry about the donor candidate and whether he/she will change their mind. The third theme, pain, includes extreme physical and mental pain for me and the donor; and worry about cost. The fourth theme, balancing gains and losses, includes grateful for and hoping to enjoy my new life; burden of new body; difficulty in adapting to modified life plan; and changes in family relationships.
  
  
  CONCLUSIONS
  Nursing practice should be developed to (1) give support to patients and their families during decision-making; (2) give support for the dramatic life change; (3) help recipients accept the reality of the transplant; and (4) help achieve the essential balance between feelings of attainment and loss.
authors.affiliation: Department of Critical and Invasive-Palliated Care Nursing, Graduate School of Health Sciences, Tokyo Medical and Dental University, Japan. tinoue.cc@tmd.ac.jp
authors.forename: Akemi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Tomoko
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety; D001294:Attitude to Health; D005239:Fear; D005260:Female; D006167:Guilt; D006801:Humans; D008019:Life Style; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000523:psychology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D055815:Young Adult