Just Reach Out and Touch Someone: Transplant
Frequently, patients on the transplant list are, to an extent, accepting of their lot, while pinning all their hopes on the promise of a transplant. While languishing on the list, they are in a sense in “lung limbo land.” Not only do they have to deal with the physical and psychological aspects of their end-stage lung disease, but there is the additional psychological overlay surrounding the uncertainty of their receiving a possible transplant. During this period, a significant number of candidates will drop off the list due to death or other reasons. This number might be as high as 24% per annum.6 This large percentage further underscores the need to focus on improvements in QOL prior to transplant, since there is no guarantee that any listed patients will receive a transplant. And, indeed, if they do, there is no assurance that a favorable outcome will result.
There are a number of issues that warrant further investigation. First, is there any subgroup of patients that benefits most or needs more support pretransplant? Who is best suited and what level of qualification is needed to provide such telephonic support? Do those patients who receive this method of support cope or do better posttransplant? And last, are there other techniques that can be utilized to provide support for these patients? Squier et al have shown that the quality of well-being in lung transplant candidates might be a predictor of survival for patients who are listed for transplantation. This held true for patient survival both before and after transplantation. Although the numbers from this study were relatively small (n = 74), the results serve to magnify the implications of the intervention described by Blumenthal and associates.
Viewed in this context, the article by Blumenthal et al should provide the impetus for lung transplant programs to accept a greater share of the burden for pretransplant support. To further add to this impetus, there should be a greater emphasis on outcomes after the patient is listed for transplantation. Such results would be of greater utility to patients and referring physicians as they encompass not only the uncertainty of transplant, but also the often-overlooked uncertainty of being on the list waiting for a transplant. There are obvious issues of time, personnel, and cost in implementing this strategy, especially for those transplant centers that maintain large waiting lists. However, lung transplantation is still lagging all other organ transplants in terms of outcomes, and any advantage that can be realized, especially one with little apparent downside, should be enthusiastically embraced.