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Le virus de l‘hépatite E (VHE) est endémique mondialement. Dans les pays en voie de développement, le VHE est une cause majeure d'hépatite aiguë et l'hépatite E est une maladie du péril fécal, transmise par la consommation d'eau contaminée. Le taux de mortalité de l'hépatite E aiguë en situation d'épidémie est estimé entre 0,2 et 4%. Dans les pays développés, l'hépatite E d'origine autochtone a émergé au début du XXIème siècle et un réservoir porcin à l'origine de transmissions zoonotiques du VHE a été établi. En 2008, pour la première fois, des formes chroniques de l'hépatite E ont été décrites révélant que le VHE était également une cause d'hépatite chronique et de cirrhose. Ces nouvelles formes d'hépatite E ont été rapportées chez des patients immunodéprimés pour transplantation d'organes solides, par le virus de l'immunodéficience humaine ou par des hémopathies malignes ou les traitements de ces hémopathies. Les travaux de cette Thèse ont eu pour objectifs de décrire les aspects cliniques puis épidémiologiques de l'hépatite E, d'étudier certains aspects immunologiques de l'hôte et certains aspects virologiques des VHE dans le but de comprendre les mécanismes conduisant au développement d'une hépatite E chronique dans la population des patients transplantés d'un rein suivis au CHU de Marseille. Nous avons décrit dans une étude rétrospective les caractéristiques et l'histoire naturelle de 16 infections autochtones diagnostiquées devant une hépatite inexpliquée. Nous avons décrit une évolution majoritairement chronique de l'hépatite E et son potentiel cirrhogène. / Hepatitis E virus (HEV) is endemic worldwide. In developing countries, HEV is a major cause of acute hepatitis and hepatitis E is a disease transmitted by the faecal-oral route through contaminated water. The estimated mortality rate of acute hepatitis E in the setting of outbreaks ranges from 0.2 to 4%. In developed countries, hepatitis E of autochthonous origin emerged at the beginning of twenty-first century and a porcine reservoir for HEV has been established that is a source for zoonotic transmission. In 2008, for the first time, chronic forms of hepatitis E have been reported showing that HEV was also a cause of chronic hepatitis and cirrhosis. These new forms of hepatitis E have been reported in immunocompromised patients due to solid organ transplantation, infection by human immunodeficiency virus, hematological malignancies or treatment of these malignancies. The objectives of this Thesis have been to describe the clinical and epidemiological features of hepatitis E, to examine some immunological aspects of the host and some virological aspects of HEV in order to understand the mechanisms leading to the development of chronic hepatitis E in the population of kidney transplant recipients followed at the University Hospital of Marseille. In a retrospective study, we described the characteristics and natural history of 16 HEV infections diagnosed in patients presenting with unexplained hepatitis. We described that hepatitis E progressed the most frequently towards chronicity and possibly towards liver cirrhosis. We showed that after dose reduction of immunosuppressants, more than half of the chronic infections resolved.

A escassez de órgãos para transplante representa um problema mundial. No Brasil, apenas um sexto dos potenciais doadores que chegam às Unidades de Terapia Intensiva tornam-se doadores efetivos. A negativa das famílias representa o principal obstáculo para o processo de doação e transplante de órgãos. OBJETIVOS: Explorar os fatores associados com a decisão de doar entre as famílias de potenciais doadores de órgãos sólidos e correlacioná-los com a taxa de consentimento. MÉTODOS: No período de novembro de 2004 a maio de 2006, 243 famílias de potenciais doadores foram entrevistadas pela Organização de Procura de Órgãos do Hospital das Clínicas para se manifestarem quanto à possibilidade de doação de órgãos. Após um ano do óbito, respeitando-se o luto, todas as famílias foram convocadas para uma nova entrevista, objeto do presente estudo. Para tanto, utilizou-se um questionário fechado com entrevista devidamente estruturada. Os dados coletados foram analisados quantitativamente. Todas as análises estatísticas foram realizadas com auxílio do programa SPSS para Windows 13.0. Significância estatística foi assumida para o valor de p < 0,05. RESULTADOS: Dos 56 familiares que concordaram em participar do projeto, 57% haviam concordado com a doação e 43% recusado. Entre outros fatores, gênero, etnia, escolaridade, renda e religião não influenciaram no processo de doação. Diferentes variáveis foram associadas à decisão de doar na análise bivariada, por exemplo: idade mais avançada do potencial doador (p=0,007), morte encefálica causada por doença (p=0,004), satisfação familiar com o profissionalismo da abordagem para doação (p=0,004), crenças funcionais como fazer o bem antecedentes à decisão (p=0,001), sentimento de conforto durante a abordagem da Organização de Procura de Órgãos (0,027), e opinião e atitude de maior peso no processo decisório foram dos descendentes ou colaterais do potencial doador (p=0,005). Porém na análise multivariada somente idade do potencial doador e opinião de maior peso no processo decisório emergiram como variáveis significativas correlacionadas positivamente com o consentimento da doação. CONCLUSÕES: Quando irmãos, tios ou filhos do potencial doador estão diretamente envolvidos no processo de tomada de decisão, normalmente o potencial doador tem idade mais avançada e a probabilidade de consentir a doação é estatisticamente maior. Aspectos que dificultam a aceitação da perda como: morte violenta; estreito vínculo afetivo; idade prematura; inversão da ordem natural, isto é, filho morrer antes dos pais; e principalmente negação da morte são fatores que também dificultam o consentimento para a doação de órgãos. Estratégias no campo da captação de órgãos devem ser aprimoradas e desenvolvidas visando uma abordagem cada vez mais humana e educativa para os coordenadores e membros das Organizações de Procura de Órgãos. / Organs transplant shortage is a global problem. In Brazil, only a sixth of potential donors who come to the Intensive Care Units become effective donors. The main obstacle to the organs donation and transplantation process is the refuse of families. OBJETIVES: to determine the donors profile, in order to understand which are the most determinant features related to positive or refuses donation decisions. METHODS: From November 2004 to May 2006, Organ Procurement Organization (OPO) approached 243 next-of-kin of brain-dead patients to ask about the organs donation from these potential donors. After a year, in respect for their mourning, all families were summoned to a new interview, object of this study. However, to assess the donors profile, a structured interview was used. The data was analyzed quantitatively. All statistical analysis was performed with the SPSS software for Windows 13.0. Statistical Significance was assumed for the p < 0.05. RESULTS: 56 relatives (57% donors and 43% non-donors) participated in the study. This research observed that gender, ethnicity, education, income and religion did not influence the donation process. Different variables were associated with the donation decision in bivariate analysis, for example, older age of the potential donor (p=0,007), brain death caused by disease (p=0,004), family satisfaction with the professionalism of the approach to donation (p=0,004), functional beliefs as I must do well record the decision (p=0,001), feeling of comfort during the OPO approached (0,027) and relevant opinion and attitude in decision-making was collateral relative (sibling/uncle) or a son of the potential donor (p=0,005). Otherwise in multivariate analysis only the potential donor age and relevant opinion in decision-making emerged as positive significant variable correlated with the consent of the donation. CONCLUSIONS: When brothers, uncles or son of potential donors are involved directly in decision-making process, the potential donor is always older and the probability to consent donation is statistically higher. Aspects that make difficult to accept the loss as a violent death, strong emotional bond, early age, reversing natural order, like when a son die before their parents, and especially denial of death are factors that difficult the consent for organs donation. Strategies in the field of donation should be developed, aiming to improve human and educational levels for coordinators and members of OPO.

En transplantation d’organes, la réponse immunitaire de l’hôte contre son donneur reste une cause très importante de perte de greffons. Ainsi, un meilleur contrôle de la réponse par induction d’une tolérance spécifique reste une priorité en transplantation humaine. Dans ce travail, nous avons exploré les effets de l’acide mycophénolique (MPA, immunosuppresseur couramment utilisé en transplantation) sur les cellules dendritiques (DC) humaines. Nous avons mis en évidence que le MPA diminue la capacité des DC à activer des lymphocytes T CD8+ cytotoxiques allogéniques en diminuant la synthèse d’interféron gamma dans les DC. Par ailleurs, les DC traitées par MPA sont capables d’induire des lymphocytes T CD4+ régulateurs antigène-spécifiques (iTreg) qui peuvent reprogrammer des DC matures en DC aux propriétés tolérogènes. Enfin, ces iTreg entraînent une réduction de la sécrétion d’IFN-γ par les cellules T CD8+ et une inhibition de leur fonction cytotoxique en réponse à une stimulation allogénique. L’ensemble de ces résultats obtenus in vitro suggèrent que les DC-MPA humaines pourraient être potentiellement utilisés en thérapie cellulaire afin de promouvoir une tolérance d’allogreffe. / In organ transplantation, host immune response against donor still remains a major cause of graft loss. A better control of allogeneic response through the induction of specific tolerance is a major goal in human transplantation. In this work, we explored the effects of mycophenolic acid (MPA, an immunosuppressive drug currently used in transplantation) on dendritic cell (DC) functions. We demonstrated that MPA inhibits DC ability to induce allogeneic cytotoxic CD8+ T cells through inhibition of interferon gamma synthesis in DC. Moreover, mycophenolic acid-treated dendritic cells (MPA-DC) are able to induce antigen-specific regulatory CD4+ T lymphocytes (iTreg) which can convert fully mature DC into tolerogenic DC. These iTreg decrease the expression of proteins associated with cytotoxic function (perforin and granzymes A and B), reduce IFN-γ production by CD8+ T cells and inhibit their cytotoxic function in response to allogeneic stimulation. These results taken together suggest that human MPA-DC could be use in cellular therapy in order to promote allograft tolerance.

Introdução: a escassez de órgãos e tecidos continua sendo um dos maiores obstáculos para as equipes de transplantes em todos os países. Diante desse cenário, ressalta-se a importância do trabalho realizado pelos enfermeiros na viabilização de órgãos e tecidos para transplante. Objetivo: esta pesquisa teve como objetivo compreender o significado da ação de enfermeiros no processo de doação para viabilizar órgãos e tecidos para transplante. Método: optou-se por realizar uma pesquisa qualitativa, com a abordagem da fenomenologia social de Alfred Schutz. Os dados foram coletados entre setembro de 2011 e junho de 2012, por meio de entrevistas com as seguintes questões norteadoras: você poderia me contar sua experiência no processo de doação de órgãos e tecidos para transplante? O que você espera com sua atuação nesse processo? Como você considera que deve ser esse processo? Participaram do estudo dez enfermeiros com diferentes tempos de formação e atuação de três Serviços de Procura de Órgãos e Tecidos da cidade de São Paulo. Após a obtenção dos discursos, estes foram analisados individualmente, seguindo procedimentos organizados de modo sistemático, preconizados por pesquisadores da Fenomenologia Social. Resultados: o contexto do significado da ação dos enfermeiros no processo de doação foi desvelado, tendo como base a vivência desses profissionais nesse cenário, representado pelas categorias: obstáculos vivenciados, intervenções realizadas e contribuição do trabalho. A intencionalidade da ação para viabilizar órgãos e tecidos para transplante está descrita pelas categorias: mudar paradigmas, humanizar o processo de doação, ser reconhecido, aumentar a doação e salvar vidas. Para os enfermeiros participantes do estudo, o processo de doação é marcado por obstáculos nas diversas etapas e frente a essas dificuldades realizam intervenções para aperfeiçoar esse campo da saúde, reconhecendo a importância do trabalho no âmbito pessoal, profissional e social. Ao refletirem sobre seus atos, os enfermeiros percebem que seu papel como agentes de transformação é essencial, e as ações são projetadas com o intuito de mudar os paradigmas da equipe multidisciplinar, e a educação é utilizada, como um instrumento relevante na promoção de um novo modo de ver e pensar essa especialidade da área da saúde. Diante da possibilidade de mudança de atitude, esses atores sociais vislumbram a oportunidade de humanizar a assistência oferecida aos familiares do doador falecido e esperam ser reconhecidos como interlocutores, articuladores e facilitadores no processo de doação e transplante, intencionando com suas ações aumentar a doação e, com isso, salvar vidas. Considerações finais: o que se mostrou como típico na ação social dos enfermeiros, com base nos dados obtidos da vivência desses sujeitos, indicou caminhos para superar as barreiras no processo de doação e para a realização de futuras pesquisas, que possibilitarão a construção do conhecimento nesse campo da enfermagem. / Introduction: the shortage of organs and tissues remains a major obstacles for transplant teams in all countries. Given this scenario, it emphasizes the work done by nurses in the viability of organs and tissues for transplantation. Objective: this research aimed to understand the significance of the nurses actions in the donation process for procuring organs and tissues for transplantation. Method: a qualitative research approach, with the social phenomenology of Alfred Schutz, was selected. Data was collected from September 2011 to June 2012, through interviews containing the following questions: could you tell me your experience in the process of donating organs and tissues for transplantation? What do you expect in your performance in this process? How do you think this process should be? Ten nurses participated in this study from different graduation timeframes and working at three Services for Procurement of Organs and Tissues in the city of São Paulo. After obtaining the statements, each was individually analyzed, following procedures systematically organized, and advocated by researchers of Social Phenomenology. Results: The context of the significance of the nurses actions in the donation process was revealed, based on the experience of these professionals, in this scenario, represented in categories: obstacles experienced, interventions and labor contribution. The intentionality of actions to procure organs and tissues for transplantation is described through the following categories: changing paradigms, humanizing the donation process, recognition, increasing donations and saving lives. For nurses participating in this study, the donation processes is marked by obstacles in the various stages and in order to face these difficulties, perform interventions to improve this field of health, recognizing the importance of their work in a personal, professional and social context. When reflecting on their actions, nurses perceive their role as agents of change and essential and therefore actions are designed to change the paradigms of the multidisciplinary team, and that education should be used as an important tool in promoting a new way of seeing and thinking for this healthcare specialty. Facing the possibility of attitude changes, these social actors envision an opportunity to humanize the assistance offered to the families of the deceased donor and expect to be recognized as speakers, organizers and facilitators in the process of donation and transplantation with the intention, through these actions, to establish a new way of increasing donations and thereby saving lives. Final Considerations: What proved to be typical in the social action of these nurses, derived from the data obtained about their experiences with this subject, indicated ways to overcome barriers in the donation process as well as indicated a necessity to conduct further research, to aid in the construction of a knowledge base in this particular field of nursing

O uso da internet mediada pelo ambiente virtual de aprendizagem (AVA) no processo de ensino-aprendizagem em saúde é fundamental. No entanto, a má utilização deste pode gerar desmotivação do usuário. As normas ISO/IEC 25010 e ISO/IEC 9126 definem a avaliação de um software com base em suas qualidades técnicas como sua funcionalidade, usabilidade, confiabilidade, eficiência e portabilidade. A Interação Humano Computador (IHC), área interdisciplinar, se preocupa com o design, implementação e avaliação da interface. Ela envolve diversos profissionais cujo objetivo em comum é o de aperfeiçoar a funcionalidade do sistema. Com o intuito de auxiliar os estudantes de enfermagem a ampliarem seu conhecimento acerca do tema, este estudo teve por objetivo avaliar a qualidade e usabilidade de um AVA protótipo sobre doação e transplante de órgãos, junto a especialistas e usuários. A metodologia baseia-se na avaliação da interface por especialistas em informática utilizando as dez heurísticas de usabilidade propostas por Nielsen em IHC, bem como avaliação de conteúdo junto a expertises utilizando um instrumento para avaliar os aspectos pedagógicos de conteúdo, interação e atividades e os aspectos técnicos de tempo de resposta e qualidade da interface e, em termos de pertinência, clareza, aplicabilidade, usabilidade, quantidade e consistência por alunos da área da enfermagem. Para análise dos dados, utilizou-se estatística descritiva simples. Como resultado, o AVA protótipo foi desenvolvido de acordo com as fases do modelo ADDIE, estruturado no Moodle e apresentado em cinco grandes unidades, cada qual, com seus respectivos tópicos, tratando de assuntos acerca do tema. Os aspectos pedagógicos de conteúdo foram avaliados satisfatoriamente por 73,3% dos enfermeiros, os aspectos da interação por 53,3% e atividades 63,6%. Em relação aos aspectos técnicos, avaliou-se satisfatoriamente com 83,3% o tempo de resposta e 66,6% a qualidade da interface. Em relação à usabilidade, os especialistas em IHC encontraram cinco heurísticas violadas, com variação no grau de severidade de 1 a 4. Os alunos de enfermagem avaliaram o AVA satisfatoriamente, 94% concordaram com sua funcionalidade e confiabilidade. Em relação à usabilidade, o AVA foi avaliado 100% satisfatório na navegação, organização de conteúdo, padronização e clareza, enquanto 88% em design agradável e padronização de cor e 56% na acessibilidade. Eficiência, compatibilidade e segurança também foram avaliadas positivamente. Após as avaliações, o protótipo foi adequado de acordo com as sugestões, para que seja utilizado futuramente como ferramenta auxiliar para construção de conhecimento e aprendizagem sobre a temática. Conclui-se que as avaliações do protótipo foram fundamentais para o processo de desenvolvimento do produto final, que atendeu aos objetivos pedagógicos e técnicos, constituindo-se uma tecnologia inovadora e adequada para a educação à distância no tema / The use of internet mediated by the Learning Virtual Environment (LVE) in the process of teaching learning at heath is significant. However, the miss utilization can discouraged the user. The stands ISO/IEC 25010 and ISO/IEC 9126 define software evaluation based in technical qualities as their functionality, usability, reliability, efficiency and portability. The Human Computer Interaction (HCI), interdisciplinary area, worries about design, implementation and interface evaluation. It involve several professionals whose common goals is improve system functionality. With the aim of help nursing students to grow their knowledge about the subject, this study has the evaluation of a LVE prototype about organ donation e transplantation as their goal, users and specialists together. The methodology based in informatics specialists evaluating the interface using the ten Nielsen heuristic\'s in HCI, as well as nurses evaluating the pedagogic aspects of content, interaction and activities besides the technical aspects of response time and interface quality, the nursing students checked the pertinence terms, clarity, applicability, usability, quantity and consistency. The dada analyze used the simple descriptive statistic. As result, the LVE prototype was develop according to the ADDIE model phases, based on Moodle and presented as five big units, each one with their respective topics, treating of subjects of the theme. The pedagogical aspects of content were satisfactory for 73.3% of nurses, the interaction aspects for 53.3% and activities 63.6%. Regarding the usability, the HCI\'s specialists found five violated heuristics, varying from severity level from 1 to 4. The nursing students evaluated satisfactorily the LVE, 94% agreed with their functionality and reliability. Regarding usability, the LVE scored 100% satisfactory at navigation, content organization, standardization and clarity, while 88% at enjoyable design and color standardization and 56% at accessibility. Efficiency, compatibility and security were well evaluated too. After the evaluation, the prototype was suitable according to the suggestions, to be used as auxiliary tool for knowledge building e learning about the subject in the future. It conclude that evaluations of the prototype were fundamental for the process of developing of final product, which met the technical and pedagogical goals, constituting an innovative and appropriate technology for distance education in the subject

This thesis contends that technologically-derived resurrections of human bodies and bodily fragments can be viewed as indicative of a 'post-biological' ontology. Drawing from examples in which human bodies are resurrected, both figuratively and actually, this thesis puts forward the term 'post-biological subject' as an ideological framework for conceptualising the reconfiguration of human ontology that results from various medical technologies that 'resurrect' the human body. In this instance, the term 'postbiological', borrowed from Hans Moravec who uses it denote a future in which human being is radically disembodied and resurrected within a digital realm, is used somewhat ironically: where Moravec imagines an afterlife in which the body is discarded as so much 'meat', the post-biological afterlife of the body in this thesis centres around a form of corporeal resurrection. Corpses, living organs and excreta may all be resurrected, some of them in digital format, yet this kind of resurrection departs radically from the disembodied spiritual bliss imagined in many conceptualisations of resurrection. The post-biological subject resists ontological delineation and problematises boundaries defining self and other, living and dead, and human and nonhuman and is fraught with a number of cultural anxieties about its unique ontological status. These concerns are analysed in the context of a number of phenomena, including melancholy, horror, monstrosity and the uncanny, all of which similarly indicate an anxious fixation with human ontology. The purpose of discussing post-biological bodies in relation to phenomena such as melancholy or the uncanny is not to reinstate as ideological frameworks the psychoanalytic models from which these concepts are derived, but rather to use them as starting points for more complex analyses of postbiological ontology. The first and second chapters of this thesis discuss instances in which the human body is posthumously modified, drawing on Gunther von Hagens's Body Worlds exhibition and the Visible Human Project. The Body Worlds plastinates are situated in a liminal and ambiguous ontological space between life and death, and it is argued that their extraordinary ontological status evokes a form of imagined melancholy, wherein the longed-for and lost melancholic object is a complete process of death. In the case of the Visible Human Project, it is argued that the gruesome and highly technologised process of creating the Visible Male, wherein the corpse is effectively dehumanised and iv rendered geometric, evokes the trope of horror, while at the same time being fraught with a nostalgic longing for a pre-technological, anatomically 'authentic' body. The third and fourth chapters of this thesis discuss instances in which the living human body is reconfigured, focusing on immortal cell lines and organ transplantation, and on medical imaging technologies such as computed tomography and magnetic resonance imaging. In the third chapter it is argued that organ transplantation and the creation of immortal cell lines give rise to profound anxieties about ontological contamination through their capacity to render permeable the imagined boundaries defining self, and in this way invoke the monstrous. The fourth chapter interrogates the representation of medical imaging in Don DeLillo?s novel White Noise, arguing that the medical representation of the body functions as a form of double, a digital doppelganger that elicits an uncanny anxiety through its capacity to presage death.

<p>Bakgrund: Få områden inom dagens medicin står inför så många och svåra etiska problem som transplantationskirurgin. De svårt sjuka människor som får möjligheten att genomgå en transplantation får chansen till ett nytt liv. Det är viktigt att sätta sig in i hur patienten upplever väntan för att som vårdpersonal kunna ge ett bra bemötande och en god omvårdnad. Syfte: Syftet med litteraturstudien var att ur ett patientperspektiv beskriva den känslomässiga upplevelsen av att vänta på en organtransplantation.Metod: Litteraturstudien bygger på åtta kvalitativa vetenskapliga artiklar. Resultat: Att vänta på en organtransplantation beskrevs som smärtsamt samtidigt som det gav patienterna tid att förbereda sig. Sjukvården kunde hjälpa till att hantera väntan genom att anpassa informationen till varje individs tempo och behov. Stöd från familj,sjukvårdspersonal och medpatienter var viktigt för att orka vänta på transplantationen. Att bli placerad på transplantationslistan gav patienterna en ny chans och ett nytt hopp. Patienterna pratade om betydelsen av att göra varje dag meningsfull. Diskussion:Resultatet har knutits samman med Aaron Antonovskys hälsoteori KASAM som utgårfrån de tre centrala begreppen, Begriplighet, Hanterbarhet och Meningsfullhet. Slutsats:För att omvårdnaden kring transplantationspatienterna ska kunna utvecklas ochförbättras krävs det idag mer forskning. Forskningen är begränsad gällande patientensupplevelse av tiden före en organtransplantation.</p> / <p>Background: Few areas in medicine today are facing so many difficult ethical problems as transplant surgery. The seriously ill people who get the opportunity to undergo a transplant surgery will get the chance for a new life. It is important that health care professionals understand how patients experience waiting so that they can give good treatment and good care. Aim: The aim of the literature study was to describe the emotional experience of waiting for an organ transplant from a patient perspective. Method: The literature study was based on eight research articles with qualitative method. Result: To wait for an organ transplant was described as painful, but at the same time it gave the patients time to prepare. Health care professionals could help the patients deal with the wait by adapting the information to each individual's pace and needs. Support from family, medical staff and fellow-patients were important to get the energy while waiting for the transplantation. To be placed on the transplant list, gave the patients a new chance and new hope. Patients talked about the importance ofmaking each day meaningful. Discussion: The results have been linked together with Aaron Antonovsky’s health theory, KASAM wich is based on three key concepts: Comprehensibility, Manageability and Meaningfulness. Conclusion: Research is limited concerning how patients experience time before an organ transplant. To develop and improve the care to this patient’s requires further research.</p>

Bakgrund: Få områden inom dagens medicin står inför så många och svåra etiska problem som transplantationskirurgin. De svårt sjuka människor som får möjligheten att genomgå en transplantation får chansen till ett nytt liv. Det är viktigt att sätta sig in i hur patienten upplever väntan för att som vårdpersonal kunna ge ett bra bemötande och en god omvårdnad. Syfte: Syftet med litteraturstudien var att ur ett patientperspektiv beskriva den känslomässiga upplevelsen av att vänta på en organtransplantation.Metod: Litteraturstudien bygger på åtta kvalitativa vetenskapliga artiklar. Resultat: Att vänta på en organtransplantation beskrevs som smärtsamt samtidigt som det gav patienterna tid att förbereda sig. Sjukvården kunde hjälpa till att hantera väntan genom att anpassa informationen till varje individs tempo och behov. Stöd från familj,sjukvårdspersonal och medpatienter var viktigt för att orka vänta på transplantationen. Att bli placerad på transplantationslistan gav patienterna en ny chans och ett nytt hopp. Patienterna pratade om betydelsen av att göra varje dag meningsfull. Diskussion:Resultatet har knutits samman med Aaron Antonovskys hälsoteori KASAM som utgårfrån de tre centrala begreppen, Begriplighet, Hanterbarhet och Meningsfullhet. Slutsats:För att omvårdnaden kring transplantationspatienterna ska kunna utvecklas ochförbättras krävs det idag mer forskning. Forskningen är begränsad gällande patientensupplevelse av tiden före en organtransplantation. / Background: Few areas in medicine today are facing so many difficult ethical problems as transplant surgery. The seriously ill people who get the opportunity to undergo a transplant surgery will get the chance for a new life. It is important that health care professionals understand how patients experience waiting so that they can give good treatment and good care. Aim: The aim of the literature study was to describe the emotional experience of waiting for an organ transplant from a patient perspective. Method: The literature study was based on eight research articles with qualitative method. Result: To wait for an organ transplant was described as painful, but at the same time it gave the patients time to prepare. Health care professionals could help the patients deal with the wait by adapting the information to each individual's pace and needs. Support from family, medical staff and fellow-patients were important to get the energy while waiting for the transplantation. To be placed on the transplant list, gave the patients a new chance and new hope. Patients talked about the importance ofmaking each day meaningful. Discussion: The results have been linked together with Aaron Antonovsky’s health theory, KASAM wich is based on three key concepts: Comprehensibility, Manageability and Meaningfulness. Conclusion: Research is limited concerning how patients experience time before an organ transplant. To develop and improve the care to this patient’s requires further research.

Die Organtransplantation hat sich in den letzten 20 Jahren zu einem Standardverfahren in der Therapie schwerer, anders nicht mehr behandelbarer Organerkrankungen entwickelt. In Deutschland werden jährlich etwa 3000 Transplantationen durchgeführt. Über 13 000 Menschen stehen auf der Warteliste für einen solchen Eingriff. Sowohl die Wartezeit als auch die verschiedenen Phasen nach dem Eingriff fordern erhebliche psychische Anpassungsleistungen von Patienten und Angehörigen, was häufig zu psychischen Störungen führt. Das Transplantationsgesetz von 1997 fordert daher ausdrücklich eine psychosomatische Mitbetreuung in den Transplantationszentren. Trotz dieses Therapiebedarfs fehlt es bisher an empirisch gesicherten therapeutischen Strategien. In der Transplantationsmedizin ist ein methodenübergreifender Betreuungsansatz sinnvoll. Kognitiv-verhaltenstherapeutische Therapieelemente scheinen aufgrund ihres pragmatischen und lösungsorientierten Ansatzes für diese Patientengruppe besonders geeignet. Ziel dieses Artikels ist es, auf Basis klinischer Erfahrungen und der wissenschaftlichen Literatur eine Übersicht über die unterschiedlichen Phasen der Transplantation solider Organe, ihre spezifischen Belastungen und therapeutische Strategien für Patienten und ihre Angehörigen zu geben. Der Bedarf an empirischer Forschung auf diesem Gebiet, gerade was die Wirksamkeit verhaltensmedizinischer Interventionen angeht, wird deutlich. / About 3,000 patients per year receive a transplant in Germany and some 13,000 patients are on waiting lists. Waiting period and the different stages of recovery demand special coping strategies from patients and their families. Psychological disorders are frequent before and after the transplantation and psychological risk factors are relevant for the outcome of the transplantation. Therefore special psychosomatic care for patients and their families is necessary. However, evidence based knowledge on appropriate therapeutic interventions is still scarce. In transplantation medicine, an overall approach is reasonable. Cognitive-behavioral aspects seem to be especially promising. The article describes strategies and techniques for the psychosomatic assessment of patients before transplantation and psychotherapeutic interventions for patients and their families before and after solid organ transplantation. More research on the effects of psychotherapeutic interventions in this field is necessary. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.