A Multisystemic Approach to Psychosocial Evaluations of Vascularized Composite Allotransplantation Candidates
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VASCULARIZED COMPOSITE ALLOGRAFTS (V GORANTLA, SECTION EDITOR)
A Multisystemic Approach to Psychosocial Evaluations of Vascularized Composite Allotransplantation Candidates Anneke Farías-Yapur 1
&
Martín Iglesias 2 & Alberto González-Chávez 3 & Guillermo Cantú-Quintanilla 1,4
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review This report seeks to shed light on multisystem domains of interest in vascularized composite allotransplantation (VCA) to improve patients’ psychosocial assessment and candidacy, to decrease environmental barriers to transplant success, and to add to the discussion concerning bioethical dilemmas associated to VCA. Recent Findings Psychosocial assessment tools cover availability, accessibility, and common sense of the treatment at microsystem and individual levels. However, macro-, exo-, and mesosystem risk factors remain unevaluated. Readers are invited to expand and complement the factors described in the review. Summary Psychosocial assessment of individual and microsystem domains in VCA is not enough for patients in developing countries where higher contextual barriers to treatment adherence are expected. To expand contextual domains of interest, Bronfenbrenner’s social-ecological theory and Ungar’s multisystemic social-ecological theory of resilience are taken into consideration. Keywords Psychosocial . Assessment . Vascularized Composite Allotransplantation . Social-ecological theory . Resilience . Developing country
Introduction Vascularized composite allotransplants (VCAs) are aimed at increasing patients’ quality of life, rather than saving it. However, such interventions imply high risks [1•]. A study [2•] shows that in developing countries, the transplant failure rate is 52.4%, as opposed to 10% for developed countries. More screenings of perioperative variables in developed countries could partially account for such a difference [2•]. According to this study, only 3 out of 12 developing countries This article is part of topical collection on Vascularized Composite Allografts * Anneke Farías-Yapur [email protected] 1
School of Psychology, Universidad Panamericana, Calle Valencia, 36, Insurgentes Mixcoac, Benito Juárez, 03920 Mexico City, Mexico
2
National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
3
Mexican Transplant Society, Mexico City, Mexico
4
National Institute of Nutrition Salvador Zubirán, Mexico City, Mexico
carried out psychological screenings, and only 1 out of 12 implemented a social support evaluation. By contrast, in developed countries, 19 out of 20 and 17 out of 20 performed such evaluations, respectively, before transplantation. The relevance of psychosocial evaluations in VCA is more frequently recognized due to their association to transplant outcomes as well as their reduction of transplant failure risk [3–8]. Psychosocial evaluations may improve the risk-benefit ratio of such procedures, thus adding to the discussion concerning bioethical dilemmas associated to VCA. Domains of interest in VCA i
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