title: Dilemmas across different overseas liver transplant stages: Taiwan transplant recipient families' perspectives.
abstract: OBJECTIVE
  This study aimed to explore the dilemmas of Taiwanese overseas liver transplant recipient families (OLTRF) across three overseas liver transplant (OLT) stages in Taiwan and Mainland China.
  
  
  METHODS
  An exploratory qualitative method was employed using a purposive sample of OLTRF, who received guided face-to-face, semistructured interviews. Data were subjected to content analysis.
  
  
  RESULTS
  Nineteen OLTRF (15 female, 4 male) aged between 29 and 71 years (mean 55.1) for 19 patients with end-stage liver diseases were interviewed. OLT stages including predeparture stage (first stage), stay in China stage (second stage), and reentry to Taiwan stage (third stage). Ten kinds of dilemmas were encountered: (1) unable to get transplantation immediately (first to second stages); (2) dilemma of choosing overseas transplantation (first to second stages); (3) uncertainty about the transplantation outcomes (second to third stages); (4) care pressure (second to third stages); (5) poor diet adaptation (second to third stages); (6) lack of trust in the medical care quality (second stage); (7) worry about not fulfilling family responsibilities (second stage); (8) lack of information (all stages); (9) financial pressure (all stages); and (10) frustration when seeking medical care (all stages).
  
  
  CONCLUSIONS
  Taiwanese OLTRF's perspectives of their dilemmas through the OLT process were first revealed in this study. Both Western and Eastern health professionals might be empowered by better understanding of OLTRF's living experiences and concerns during the stages of overseas liver transplantation.
authors.affiliation: Department of Nursing, Tri-Service General Hospital, and Department of Information Management, Chang Gung University of Science and Technology, Taipei, Taiwan.
authors.forename: H-M
authors.initials: HM
authors.lastname: Chen
authors.forename: R-H
authors.initials: RH
authors.lastname: Hu
authors.forename: F-Jong
authors.initials: FJ
authors.lastname: Shih
authors.forename: F-J
authors.initials: FJ
authors.lastname: Shih
mesh_terms: D022126:Access to Information; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology; D002681:China; D017281:Cost of Illness; D003466:Cultural Characteristics; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000191:economics / Q000523:psychology* / Q000601:surgery*; D005190:Family / Q000523:psychology*; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000331:legislation & jurisprudence / Q000523:psychology*; D008297:Male; D057193:Medical Tourism / Q000191:economics / Q000331:legislation & jurisprudence / Q000523:psychology*; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D011787:Quality of Health Care; D012720:Severity of Illness Index; D013624:Taiwan; D035502:Trust; D035501:Uncertainty