The main purpose of this study was to assess outcomes (i.e., inpatient mortality, transplant failure or rejection, colectomy, and hospital length of stay) of clostridium difficile infection (CDI) and the association of expenditures (i.e., charges and costs) and CDI in pediatric solid organ transplant (SOT) recipients. Data from the 2000, 2003, 2006, and 2009 Kids’ Inpatient Database (KID) files were used to identify events with SOT- related ICD-9-CM diagnosis codes. Logistic regression was used to assess the association of CDI and dichotomous outcome variables, while log-linked gamma regression models were used to assess the association of CDI and continuous outcome variables. Methods accounting for the complex survey sample design of the KID were used when performing all statistical analyses. The total number of pediatric SOT hospital events was 48,286. The overall prevalence of CDI for pediatric SOT hospitalizations was 1.76%. For SOT hospitalizations with CDI, inpatient mortality was 1.63%; the prevalence of transplant failure or rejection events was 27.71%; the prevalence of a colectomy was 4.86%. The median hospital length of stay was seven days; the median charge and cost for each hospitalization was $48,409 and $17,412, respectively. The results showed that CDI was not significantly associated with inpatient mortality or transplant failure/ rejection in pediatric SOT hospitalizations. SOT patients with CDI were 2.6 times more likely to have a colectomy than SOT patient without CDI. The mean hospital length of stay (LOS) for a SOT admission with CDI was approximately 2 times the mean LOS for a SOT admission without CDI. The mean charges and the mean costs for a SOT admission with CDI was approximately 2 times that for a SOT admission without CDI. In conclusion, CDI diagnoses were not significantly associated with higher inpatient mortality or transplant failure/ rejection for pediatric SOT hospitalizations. But CDI was significantly associated with a higher prevalence of a colectomy, longer hospital LOS, higher charges, and higher costs (all p<0.05). To avoid substantially higher expenditures and health care utilization, CDI in pediatric SOT recipients should be prevented when possible and promptly diagnosed and treated when it occurs. / text

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The dissertation is an ethnographic study of religion as conceived and experienced by organ transplant recipients. It is also a cultural study of North America’s collective expressions of transplant as found in Christian journals, popular media, advocacy literature and public policy statements. The study finds evidence that religious metaphors and directives, cosmological figures and theological arguments, rituals, scriptures and places of worship are actively, vociferously, and consciously engaged with organ transplant discourse and with the experience of giving or receiving organs. While the transplant recipients under study cannot be considered representative (being largely advocates for transplant and almost exclusively of Christian background or affiliation), this group was articulate about the ways their new organ invoked the sacred: they described new metaphysical understandings, they spoke of a closer relationship with God, the universe and other human beings, they divulged inexplicable incidents and mystical states of being, they articulated a complex set of ethical prescripts. “Thinking how many times you should have been dead and you’re still here” was for many an imperative to “start to find out why.” I argue that these spiritual seekers traverse a 21st century terrain shaped by the practices and discourses of what Foucault termed “biopower”. The private and public production of sanctified donors and ‘redeemed’ recipients is inextricably bound to the desires of transplant professionals and government officials, and cannot hope to escape the very real commodification of the body that transplant represents. This seeming paradox of ‘the sacred in the secular’ does not make transplant’s religious constructions inauthentic or irrelevant. Religion remains an active and inventive register for the recording of potent bodily experiences of illness, loss and conditional regeneration. Further, the religious activity around transplant affords a window on emerging rites, on contemporary understandings of death and immortality, and on new conversations about miracles and morality. Circuits of biotechnology are not immune to religious influence and inflection – but, simultaneously, contemporary religious meanings, practices and experiences are indelibly shaped by our newfound ability to transplant organs.

The dissertation is an ethnographic study of religion as conceived and experienced by organ transplant recipients. It is also a cultural study of North America’s collective expressions of transplant as found in Christian journals, popular media, advocacy literature and public policy statements. The study finds evidence that religious metaphors and directives, cosmological figures and theological arguments, rituals, scriptures and places of worship are actively, vociferously, and consciously engaged with organ transplant discourse and with the experience of giving or receiving organs. While the transplant recipients under study cannot be considered representative (being largely advocates for transplant and almost exclusively of Christian background or affiliation), this group was articulate about the ways their new organ invoked the sacred: they described new metaphysical understandings, they spoke of a closer relationship with God, the universe and other human beings, they divulged inexplicable incidents and mystical states of being, they articulated a complex set of ethical prescripts. “Thinking how many times you should have been dead and you’re still here” was for many an imperative to “start to find out why.” I argue that these spiritual seekers traverse a 21st century terrain shaped by the practices and discourses of what Foucault termed “biopower”. The private and public production of sanctified donors and ‘redeemed’ recipients is inextricably bound to the desires of transplant professionals and government officials, and cannot hope to escape the very real commodification of the body that transplant represents. This seeming paradox of ‘the sacred in the secular’ does not make transplant’s religious constructions inauthentic or irrelevant. Religion remains an active and inventive register for the recording of potent bodily experiences of illness, loss and conditional regeneration. Further, the religious activity around transplant affords a window on emerging rites, on contemporary understandings of death and immortality, and on new conversations about miracles and morality. Circuits of biotechnology are not immune to religious influence and inflection – but, simultaneously, contemporary religious meanings, practices and experiences are indelibly shaped by our newfound ability to transplant organs.

Background: Organ transplantation is an established form of treatment applied worldwide, which saves many lives. There is however, an imbalance between supply and demand for organs, which means that the patients on the waiting list for organs often have to stay there for a long time. In worst case, they die before a suitable organ is found. Patients waiting for vital organs are therefore in a very exposed situation and this causes many feelings. Aim: The aim of the study was to describe patients´ experiences while waiting for vital organs. Method: A literature based study analysing twelve qualitative studies, that based onpatient interviews describe the patients' experiences while waiting for vital organs. Results: The result showed that patients felt bound, both physically and mentally. They experienced anxiety and stress during the long wait for an organ but had also hope forrecovery and wished to be able to return to a normal life. Information and support were an important part of getting through the wait. Two themes appeared during the analysis; To hope and to understand, the mixed emotions and To be bound and to be in need. Conclusion: All patients' experiences were individual, although there are many similarities in how they experienced waiting for vital organs, especially regarding emotions. Hope was a prerequisite for patients while waiting for a vital organ, as it servesas a driving force to hold out during their uncertain life situation.

Background: Organ transplantation is seen as a treatment to save lives. There are great differences in the transplantation process between different countries. Patients have previously described the process of organ transplantation as restrictive and emotionally draining with an overhanging fear of death before transplant. Aim: The aim of this study was to describe patients’ experiences of waiting for organ transplantation.  Method: This literature-based study was conducted with analysis of qualitative research to gain knowledge about the patients’ experiences. Analysis of the eleven articles was performed by using Friberg’s five-step method. Results: Two main themes and six subthemes emerged from the analysis. The main themes The need for support and information highlighted the patients need for support and adequate information from both family and health care professionals. This was seen as a way to handle the uncertainty that the waiting time could bring. The other main theme The time on the waiting list described that waiting for an organ transplantation could bring restrictions to their daily life. Patients described the time on the waiting list as uncertain and many thoughts about the donor arose. Also, hope about their future was prominent throughout the time on the waiting list. At times this hope could turn to despair. Conclusion: Waiting for an organ transplantation is a multifaceted experience. Support from family was considered crucial and therefore should be included when possible. Nurses are responsible for giving enough and appropriate information and support to the patients during their wait.

Background: The history of transplantation goes back a long time and has been the last resort as a treatment to save a person's life. The availability of organs does not correspond to the need, there are also limited studies on how the patient's health processes are affected during the waiting time for a new organ. Aim: The aim of this study was to describe patientexperiences of waiting for an organ transplant. Method: This literature-based study was based on qualitative research to describe patient experiences of managing the waiting time for an organ transplant. 11 articles were analyzed according to Friberg's (2017) five step model. Results: The article analysis resulted in two main themes and six sub-themes. The main theme New Challenges highlighted that the patients are in need for both support and information during the time that they are waiting for an organ transplant. The second main theme, Emotional stress highlighted what feelings the patient can endure during the waiting time for a transplantation. The feelings of both hope and uncertainty are described by the patients. Conclusion: When nurses take responsibility for the caring and the six areas of competence, which means that patients who are on the waiting list for an organ transplant have their nursing needs met.

People who need a liver transplant must choose a hospital at which the transplant will be performed. The United Network for Organ Sharing (UNOS) allocates organs to patients based on patient characteristics and assumes all hospitals have equal skill. The question for a patient thus becomes, which hospital to choose? This thesis investigates whether the differences in liver transplant survival rates for hospitals are a result of differences in patients and/or differences in hospital-specific criteria. The findings in this thesis show that most of the differences in hospital survival rates are due to patient characteristics, and that, while not conclusive, hospital characteristics may have an impact on survival rates. However, the variable that is most significant to survival rates is the cold ischemic time, or transportation time of the organ. These results suggest that policies to allocate organs nationally are not optimal. / Master of Arts

There is limited research on music therapy for transplant recipients, yet board-certified music therapists working in medical settings often encounter individuals from the transplant population. The purpose of this study was to examine the current practices of music therapists working with bone marrow and organ transplant recipients. A total of 68 board-certified music therapists completed an online survey, providing information related to goal areas addressed in music therapy sessions and interventions frequently used with bone marrow and organ transplant patients. The most frequently reported goal areas included: coping skills, mood, and self-expression. The most frequently reported interventions included: singing, songwriting, and improvisation. Survey respondents also shared opinions related to the need for additional resources for music therapists working with transplant recipients, as well as the most rewarding and challenging aspects of working with transplant patients. Study limitations, suggestions for future research, and implications for clinical practice are included.