{'fraction_non_alphanumeric': 0.023535302954431646, 'fraction_numerical': 0.003755633450175263, 'mean_word_length': 5.527777777777778, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The transplant journey: Psychosocial aspects of the different stages of the transplantation process

Recently there has been a marked increase in the number of articles addressing psychosocial aspects of pediatric transplantation, and this is also evident in this journal. Indeed, three of the eight most frequently cited Pediatric Transplantation articles published in 2010–2011 and cited in 2012 focused on adherence, transition and health-related quality of life. In the current issue, we publish the first in a series of seven review articles focusing on psychosocial aspects of the different stages of the transplant process, from time of referral, through the transplant itself and the years afterward, to re-transplantation and/or end of life care. The impact of various domains of psychosocial functioning on patient morbidity and mortality is now recognized within both pediatric and adult transplantation (1, 2), and there has been an increasing focus on the development of evidence-based interventions to ameliorate modifiable psychosocial risk factors. Traditionally, the majority of publications describing psychological or social factors associated with pediatric transplantation have focused on specific topics (e.g., factors influencing adherence, cognitive functioning after transplant) and/ or specific subsets of patients, such as kidney transplant patients. Our goals with this series of articles are threefold: (i) To provide a review of pertinent psychosocial topics, with considerations across all solid organ populations and age groups, (ii) to bring the various topics together in a consistent, unified format, akin to a “journey,” and (iii) to discuss best practices, providing recommendations for clinical care and policy. Why think of transplant as a “journey?” While the transplant surgery itself is a discrete event in time, the transplant course encompasses a variety of different stages prior to, during, and after transplant, each with its attendant critical psychosocial considerations. It is therefore not just about a series of isolated events, but rather is a fluid and dynamic process whereby previous experiences and outcomes are linked to, and can influence, present and future experiences and outcomes. Conceptualizing the process as a journey allows for a better understanding of different issues at different stages in the process, and also clarifies the linkages between these different stages. Furthermore, it importantly highlights developmental factors that are sometimes omitted from the literature. The transplant journey itself is a developmental process; there are various stages to be lived through and experienced, but the young person receiving the transplanted organ continues to grow and develop as well. It is this individual developmental process that often poses the challenges for patients, families, and clinicians when it has to be considered alongside the stage of the patient in the transplant journey. The first article in the series is entitled “The start of the transplant journey: Referral for pediatric solid organ transplantation (3).” In this article, Shellmer, Brosig, and Wray discuss the impact of referral for transplant evaluation on the pediatric patient and family. In doing so, they explore patient and family expectations (and misconceptions) about the transplant process, acquisition of transplant knowledge, and how these influence their decision making. While a child’s and family’s introduction to transplantation is often considered to begin with their arrival at the transplant center, for many, their journey will start well before that when transplantation is first considered as a possible treatment option. For some families, this can be at the diagnosis of congenital disease, where they may have the complexity and uncertainty associated with the condition explained and may be told that transplantation is in their child’s future. Despite the importance of understanding what brings a child and family