Pediatric heart, heart-lung, and lung transplantation: Psychosocial, economic, and educational aspects

Abstract

Transplantation in a child presents a far greater challenge to the transplant team than that of an adult because of its intrinsic psychosociat complexity. The nurse coordinator and transplant social worker must, from the beginning, deal with the very different needs and levels of understanding of the patient, the parents, step-parents or adult significant others, and all siblings. The nurse and social worker quickly learn to allow far more time for pediatric cases than for adults. There are no shortcuts to establishing a relationship and building trust with each member of the family during the initial evaluation and decision-making process. This first phase is also a time for the staff to observe parenting styles and patterns of family interaction, not in a judgmental way, but to learn how to form viable working relationships. During the initial interviews, families are usually tempted to present a harmonious, problem-free facade, to try to transform themselves into the ideal televisionperfect image they believe the transplant team expects and requires. This effort, superimposed on the family's current state of crisis, as well as the pressure to make an immediate decision regarding