A Multisystemic Approach to Psychosocial Evaluations of Vascularized Composite Allotransplantation Candidates

Defining Success and Ethical Decision-Making in Vascularized Composite Allotransplantation: A Bioethical Deliberation Model

“…While there are existing psychosocial evaluation tools such as the PACT, TERS, and SIPAT instruments [27-30], we supplement their use with clinical interviews guided by a framework developed by Farías-Yapur et al [6], as these instruments mainly evaluate individual and some microsystem aspects, while neglecting others, such as those specific to developing countries (which is a risk factor for successful patient outcomes). The guide incorporates Bronfenbrenner's Theory of Social Ecology [11], which includes six proposed systems (individual, microsystem, mesosystem, exosystem, macrosystem, and chronosystem), along with Ungar's three resilience process components (availability, accessibility, and meaningfulness of resources necessary for preventing, resisting, and overcoming adversity).…”

“…A preliminary review of the multisystemic protective and risk factors is shown in Figure 4, taken from Farías-Yapur, A. [6]. Based on the developed classification mode, the factors of interest described in the literature, the risk factors that explain transplant failures, the semi-structured interviews conducted with arm transplant patients in Mexico, as well as the factors that are not described but correspond to proposed dimensions, a multisystemic psychosocial assessment guide was developed, where the factors to be evaluated corresponding to each proposed dimension in Farías-Yapur et al [6] are presented in the form of subitems and questions.…”

“…These challenges encompass various aspects, including the economic burdens associated with the procedure [1], the potential risks of long-term immunosuppressive therapy, such as increased susceptibility to malignancy [2], and the occurrence of acute and chronic rejection [3,4]. Moreover, the autonomy of patients in choosing a non-life-saving intervention [5] and the adequacy of psychosocial evaluation tools developed primarily in developed countries [6] are important considerations in the ethical discourse surrounding VCA. Additionally, bioethical concerns extend to the capacity of healthcare teams to effectively manage VCA cases and the need to balance patient suitability for the procedure with the capacity of the country and healthcare system to support such interventions.…”

Perspectivas bioéticas del trasplante de cara

“…11 Existe una relación entre los factores psicosociales, como la ansiedad, la depresión, el apoyo social y la adherencia al tratamiento, y los resultados del trasplante de órganos, incluyendo la supervivencia del órgano y del paciente. 12 También hay que considerar y abordar los factores psicosociales en la atención de los pacientes trasplantados, ya que pueden afectar significativamente su calidad de vida y sus resultados clínicos.…”

Are face transplant candidates choosing autonomously? A preliminary method to evaluate autonomous choosing in psychosocial and bioethical assessments

“…If the patient's main motivation to seek the transplant is to achieve real or imagined family expectations that would not be attained, or to increase his or her self-worth because it is dependent on public perception, then failing to achieve this through constant social rejection may result in significant grief, since face transplantation and its accompanying burdens are non-reversible. This could increase the likelihood of having depression, which—in addition to lacking material and social support [see ( 43 )]—would affect adherence [( 44 ); cf ( 45 )].…”