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A delicate balance: negotiating renal transplantation, immunosuppression and adherence to medical regimen

Queensland University of Technology, p2.cook{at}qut.edu.au

Alexandra McCarthy

Griffith University, Australia

Despite the volume of biomedical and psychosocial discourse surrounding both renal transplantation and the immune system, there is a limit to current understandings of immunosuppression in the context of kidney transplantation. For example, we do not know how the immunosuppressed renal transplant recipient experiences and understands their immune system and body. In addition, we do not know if the patient is as fixated on `graft survival' as their healthcare team or whether other concerns are more relevant. What is missing is the discourse of those who actually `live' the medically altered immune system in the context of renal transplantation.

We propose that this gap in knowledge is bound to an acknowledged problem among renal transplant recipients and their healthcare teams — a lack of compliance with recommended medical regimens. Our argument here is that an exploration of patient intimacy with transplant-related immunosuppression might illuminate a different understanding of this experience that could enhance health professionals' understanding and their subsequent approach to treatment. We contend that the embodied and contextual experience of the patient needs to be equally valued in order to enhance patient outcomes.

Key Words: compliance • embodiment • immunosuppression • renal • transplantation.

References

• Baines, L.S., Zawada, E.T., Jr and Jindal, R.M. (2005). Psychosocial profiling: A holistic management tool for non-compliance . Clinical Transplantation, 19(1), 38—44 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Barber, N. (2002). Should we consider non-compliance a medical error? Quality and Safety in Health Care, 11(1), 81—4 .[Abstract/Free Full Text]
• Birke, L. (1994). Feminism, animals and science: The naming of the shrew. Buckingham: Open University Press .
• Birke, L., Bryld, M. and Lykke, N. (2004). Animal performances: An exploration of intersections between feminist science studies and studies of human/animal relationships . Feminist Theory, 5(2), 167—83 .[Abstract]
• Brenner, M.J., Tung, T.H., Jensen, J.N. and Mackinnon, S.E. (2002). The spectrum of complications of immunosuppression: Is the time right for hand transplantation? Journal of Bone and Joint Surgery, 84(10), 1861—70 .
• Bunzel, B. and Laederach-Hofmann, K. (2000). Solid organ transplantation: Are there predictors for posttransplant compliance? A literature review . Transplantation, 70(5), 711—16 .[Web of Science][Medline] [Order article via Infotrieve]
• Burke, A. (2003). Medical management of the liver transplant patient . Graft, 6(2), 136—44 .[CrossRef]
• Chisholm, M.A., Mulloy, L.L., Jagadeesan, M. and DiPiro, J.T. (2001). Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications . Clinical Transplantation, 15(5), 330—6 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Claeson, B., Martin, E., Richardson, W., Schoch-Spana, M. and Taussig, K.-S. (1996). Scientific literacy, what it is, why it's important, and why scientists think we don't have it: The case of immunology and the immune system. In L. Nader (Ed.), Naked science: Anthropological inquiry into boundaries, power, and knowledge, pp. 101—18. New York: Routledge .
• Dew, M.A., Myaskovsky, L., DiMartini, A.F., Switzer, G.E., Schulberg, H.C. and Kormos, R.L. (2004). Onset, timing and risk for depression and anxiety in family caregivers to heart transplant recipients . Psychological Medicine, 34(6), 1065—82 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Donovan, J.C.H., Rosen, C.F. and Shaw, J.C. (2004). Evaluation of sun-protective practices of organ transplant recipients . American Journal of Transplantation, 4(11), 1852—8 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Dwyer, J. (1993). The body at war: The story of our immune system , 2nd edn. St Leonards: Allen & Unwin .
• Fireman, M., DiMartini, A.F., Armstrong, S.C. and Cozza, K.L. (2004). Immunosuppressants . Psychosomatics, 45(4), 354—60 .[Abstract/Free Full Text]
• Fukunishi, I., Sugawara, Y., Takayama, T., Makuuchi, M., Kawarasaki, H. and Surman, O.S. (2001). Psychiatric disorders before and after living-related transplantation . Psychosomatics, 42(4), 337—43 .[Abstract/Free Full Text]
• Green, C.J. (2003). Organ transplantation. In W.J. Phipps, F.D. Monahan, J.K. Sands, J.F. Marek and M. Neighbors (Eds.), Medical-surgical nursing: Health and illness perspectives, 7th edn, pp. 1686—716. St Louis: Mosby .
• Haraway, D.J. (1991). Simians, cyborgs, and women: The reinvention of nature. New York: Routledge .
• Jowsey, S.G., Taylor, M.L., Schneekloth, T.D. and Clark, M.M. (2001). Psychosocial challenges in transplantation . Journal of Psychiatric Practice, 7(6), 404—14 .[CrossRef][Medline] [Order article via Infotrieve]
• Kelly, M.P. and Field, D. (1996). Medical sociology, chronic illness and the body . Sociology of Health and Illness, 18(2), 241—57 .[CrossRef]
• Kreiger, N.R. and Emre, S. (2004). Novel immunosuppressants . Pediatric Transplantation, 8(6), 594—9 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Laederach-Hofmann, K. and Bunzel, B. (2000). Noncompliance in organ transplant recipients: A literature review. General Hospital Psychiatry, 22(6), 412—24 .
• Levenson, J.L. and Olbrisch, M.E. (2000). Psychosocial screening and selection of candidates for organ transplantation. In P.T. Trzepacz and A.F. DiMartini (Eds.), The transplant patient: Biological, psychiatric and ethical issues in organ transplantation, pp. 21—41. Cambridge: Cambridge University Press .
• Lundin, S. (1999). The boundless body: Cultural perspectives on xenotransplantation . Ethnos, 64(1), 5—31 .
• McCarthy, A. (2005). A rebellious distemper: A Foucaultian history of breast cancer to 1900. Unpublished PhD thesis, Queensland University of Technology .
• Martin, E. (1994). Flexible bodies: Tracking immunity in American culture — from the days of polio to the age of AIDS. Boston, MA: Beacon Press .
• Martins, D.S. (2005). Compliance rhetoric and the impoverishment of context . Communication Theory, 15(1), 59—77 .[CrossRef][Web of Science]
• Merck manual. (2006a). Biology of the immune system. Merck manual home edition. Retrieved 7 March 2006 from http://www.merck.com/mmhe/print/sec16/ch183/cha183a.html
• Merck manual. (2006b). Immunology of rejection. The Merck manual of diagnosis and therapy. Retrieved 7 March 2006 from http://www.merck.com/mrkshared/mmanual/section12/chapter149/149b.jsp
• Merck manual. (2006c). Kidney transplantation. The Merck manual of diagnosis and therapy. Retrieved 7 March 2006 from http://www.merck.com/mrkshared/mmanal/section12/chapter149/149c.jsp
• Merck manual. (2006d). Transplantation. The Merck manual of diagnosis and therapy. Retrieved 7 March 2006 from http://www.merck.com/mrkshared/mmanual/section12/chapter149/149a.jsp
• Moloney, F.J., de Freitas, D., Conlon, P.J. and Murphy, G.M. (2005). Renal transplantation, immunosuppression and the skin: An update . Photodermatology, Photoimmunology & Photomedicine , 21(1), 1—8 .[CrossRef][Web of Science]
• Otis, L. (1999). Membranes: Metaphors of invasion in nineteenth-century literature, science and politics. Baltimore, MD: Johns Hopkins University Press .
• Rauch, J.B. and Kneen, K.K. (1989). Accepting the gift of life: Heart transplant recipients' post-operative adaptive tasks . Social Work in Health Care, 14(1), 47—59 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Sherwood, L. (1993). Human physiology: From cells to systems, 2nd edn. Minneapolis, MN: West Publishing Company .
• Shildrick, M. (2001). Vulnerable bodies and ontological contamination . In A. Bashford and C. Hooker (Eds.), Contagion: Epidemics, history and culture from small pox to anthrax, pp. 153—67. London: Routledge .
• Wilkins, F., Bozik, K. and Bennett, K. (2003). The impact of patient education and psychosocial supports on return to normalcy 36 months post-kidney transplant . Clinical Transplantation, 17(supp. 9), 78—80 .[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

Health:, Vol. 11, No. 4, 497-512 (2007)
DOI: 10.1177/1363459307080875


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Cook, P. S. Articles by McCarthy, A. Search for Related Content PubMed PubMed Citation Articles by Cook, P. S. Articles by McCarthy, A. Social Bookmarking                         What's this?