What Hand Transplantation Teaches Us About Embodiment

Abstract

While stakeholders in hand transplantation (HTx) recognize the importance of assessing quality of life (QoL), QoL has historically been inadequately defined and measured in such assessment procedures. Current conversations related to QoL in HTx could be enhanced by a phenomenological account of the lived body-namely, by illuminating the ways in which humans develop a holistic QoL through meaningful orientation in their interactions with the world and others. This meaningful orientation involves many factors; this essay considers how QoL is shaped by temporality (how past and future inform present satisfaction), embodiment (habituated, generally unconscious, meaningful attunement to the world), and intersubjectivity (how our identity as selves is constructed through social relationships). Hands-on PhenomenologyStakeholders in vascularized composite allotransplantation-specifically, hand transplantation (HTx)-acknowledge that standard assessment of quality of life (QoL) and providing long-term enhancement of QoL to hand transplant recipients is essential for the future of HTx. 1,2 However, there is ongoing debate regarding how QoL is to be defined and measured in such assessment procedures and, furthermore, how assessments can be standardized across the unique circumstances of individual transplant recipients. 2,3 Concerns over how to assess QoL are magnified by the tendency among stakeholders and the media to overemphasize cases that have been particularly successful and without incident. 2,3 For example, the website for the Louisville program 4 provides links to the success stories of its 10 HTx patients but does not mention that one recipient completed suicide, 2 have had their hand transplants removed, or that another feels that his hand transplant is effectively useless. 2,3 Furthermore, current tools that are used to track the progress of HTx patients (Carroll; Disabilities of the Arm, Shoulder and Hand, or DASH; and Hand Transplantation Score System, or HTSS, which still needs validation 1,5 ) are primarily concerned with functionality of the hand and lack adequate metrics for evaluating QoL.Current QoL assessments of hand transplant recipients fail to appreciate how our habituated, multifaceted, and generally unconscious facilitation of our Citation

Education for patients with limb loss or absence: Aging, overuse concerns, and patient treatment knowledge gaps

“…Patient satisfaction, for example, is one aspect of quality of life that is significantly related to function (Hautz et al, 2020), but other aspects, such as psychosocial function, wellbeing, and meaning making, are less commonly assessed. Bahler (2019) has commented on factors essential to quality of life that are currently not included in most patient assessments: ". .…”

“…Patient satisfaction, for example, is one aspect of quality of life that is significantly related to function ( Hautz et al, 2020 ), but other aspects, such as psychosocial function, wellbeing, and meaning making, are less commonly assessed. Bahler (2019) has commented on factors essential to quality of life that are currently not included in most patient assessments: “…our capacity to make meaning, particularly in relation to temporality, embodiment, and intersubjectivity. Without attention to these features of the human condition, assessment of hand transplant recipients’ functional capacity and psychological sense of satisfaction will remain incomplete”( Bahler, 2019 ).…”

“… Bahler (2019) has commented on factors essential to quality of life that are currently not included in most patient assessments: “…our capacity to make meaning, particularly in relation to temporality, embodiment, and intersubjectivity. Without attention to these features of the human condition, assessment of hand transplant recipients’ functional capacity and psychological sense of satisfaction will remain incomplete”( Bahler, 2019 ).…”

On body and culture - medicine and embodiment.

“…A graft testiesülése és integrációja hosszú folyamat, amely kezdetben az idegen szövet/szerv és a test folyamatos intenzív megfigyelésével, továbbá szorongással jár majd kedvező esetben a transzplantált szövet/szervkülönböző mértékbenkikerül a kihegyezett figyelem fókuszából és a "szokott", a "normál" testi észlelés részévé válik (De Pasquale, Veroux, Indelicato, Sinagra, Giaquinta, Fornaro, Veroux és Pistorio 2014). A transzplantáció embodied tapasztalatát gyakran jellemzik idegenség/másság érzéssel, ami hangsúlyos a kommunikációban, az észlelésben, az önkifejezésben használt testrészek/szervek testiesülése esetén (Bahler 2019;Lafrance 2010).…”

Testet öltött kultúra – orvostudomány és embodiment

“…A graft testiesülése és integrációja hosszú folyamat, amely kezdetben az idegen szövet/szerv és a test folyamatos intenzív megfigyelésével, továbbá szorongással jár, majd kedvező esetben a transzplantált szövet/szerv -különböző mértékben -kikerül a kihegyezett figyelem fókuszából, és a "szokott", "normál" testi észlelés részévé válik (De Pasquale et al 2014). A transzplantáció embodied (megtestesült) tapasztalatát gyakran jellemzik idegenség-/ másságérzéssel, ami hangsúlyos a kommunikációban, az észlelésben, az önkifejezésben használt testrészek/szervek testiesülése esetén (Bahler 2019;Lafrance 2010).…”