The Meaning of Surviving Three Years after a Heart Transplant—A Transition from Uncertainty to Acceptance through Adaptation

Abstract

The rationale was to longitudinally follow-up interviews performed with heart recipients at their one-year examination in order to deepen the understanding of the meaning of surviving a heart transplant. The aim was to explore the meaning of surviving three years after a heart transplant compared to one year and to identify what constitutes the change process. A phenomenological–hermeneutic method was used. This multicenter study was carried out at the two hospitals in Sweden where heart transplants are performed. A total of 13 heart recipients who survived three years after a heart transplant were invited to participate in this three-year follow-up study and 12 accepted, 3 women and 9 men, with a mean age of 51.25 years. The naïve understanding revealed that the heart recipients strongly accepted their life situation and that time had enabled this acceptance of limitations through adaptation. The thematic structural analyses cover six themes illustrating the meaning of acceptance and adaptation, i.e., accepting life as it is, adapting to post-transplant limitations, adapting to a changed body, social adaptation, showing gratitude and trusting oneself and others. In conclusion, achieving acceptance and a solid sense of self-efficacy after heart transplantation is a time-consuming process that involves courage to face and accept the reality and adapt in every life dimension.

Symptom Distress Before and After Heart Transplantation – A Longitudinal 5‐Year Follow‐Up

“…It takes around 1 year to feel mentally alert. Mental fatigue is a distressing symptom after HTx, which was also confirmed by a previous qualitative longitudinal study [7]. Longitudinal interventions focusing on mental fatigue are warranted and the issue should be emphasized at the yearly follow-up sessions in the outpatient clinic.…”

“…in the everyday lives of HTRs [7]. Adapting to a changed body after HTx is a time-consuming and stepwise process involving accepting physical limitations and persistent difficulties with mental fatigue [8].…”

“…Heart recipients (HTRs) with poor psychological well‐being report higher symptom distress compared to those with good psychological well‐being [6]. They also report more fear of graft rejection, which is ever present in the everyday lives of HTRs [7]. Adapting to a changed body after HTx is a time‐consuming and stepwise process involving accepting physical limitations and persistent difficulties with mental fatigue [8].…”

El proceso de transición y capacitación de la persona trasplantada al corazón y familia: ensayo teórico

“…Os focos de atenção, numa fase preparatória centram-se na diminuição da ansiedade (pela espera pelo transplante), manutenção funcional e preparação/capacitação para a sua nova condição de saúde. Na fase pós-transplante o foco é muito dirigido à vigilância de complicações e à preparação para a promoção de comportamentos saudáveis, adequada adesão e gestão do regime terapêutico, nos domínios medicamentoso, dietético e de exercício físico, envolvendo a educação da pessoa transplantada e do seu cuidador (família), a fim de obter-se um comportamento adequado de autocuidado terapêutico, permitindo às pessoas transplantadas realizar a transição da doença para um estado saudável (Lindberg, et al, 2020).…”

“…Nesta lógica, também é possível que pessoa e vivenciem uma transição situacional (Meleis, 2019), em que a pessoa transplantada passe a ser cuidada e um dos elementos da família assuma o papel de cuidador. As transições de desenvolvimento (Meleis, 2019), poderão decorrer com a cronicidade do transplante, não se podendo esquecer que podem ser transplantadas crianças até adultos com cerca de 65 anos (idade limite normalizada), estando sob influência também deste tipo de transições (Lindberg, et al, 2020. Deve-se por isso, ter-se em consideração que a mesma pessoa pode viver diferentes transições no mesmo momento (Meleis, 2019) e que deve ser esclarecida sobre as mesmas para decidir de forma consciente, esclarecida e autónoma.…”