Is It Really Mine? -- MEDICA - World Forum for Medicine

Is It Really Mine?

Foto: Torso of a man without arms

Short before the world premiere:
As the first person ever, this man
received two new arms; © Klinik
rechts der Isar der TU München

He was the first to successfully receive a new hand but he did not want it for a long time. Clint Hallam from New Zealand had problems to accept the hand – psychological ones. He stopped taking the immunosuppressants, drugs that prevent the rejection of a foreign organ by the immune system. In 2001, two years after transplantation, medics had to remove the hand from Clint Hallam.

Theo Kelz from Austria is quite a different case. It was during a bomb blast in 1994 that the policeman lost his hands. The following years he wrote to more than 50 hospitals in order to find a doctor that would give him new ones. After he had found a doctor who ventured the operation Kelz accepted the hands immediately as his own ones: „It was my deepest wish to have new hands. For years I fought for them. Hence, after I finally got them, I did not think about where they came from“, Kelz says.

The psyche is an essential factor for the success of a transplantation. If liver, heart or hand - the organ is foreign and mostly from a dead person. „For many, the integration is a very difficult part“, says Wolfgang Albert, medical head of the medical care unit of the German Heart Centre Berlin. The psychologist takes care of patients undergoing heart transplantation. Especially when it comes down to the heart, people see a strong connection between beating organ and own personality. Many of his patients imagine that a piece of identity is transplanted together with the heart. This raises fear: „They ask themselves: what do I do if I get the heart of a ‘bad character’ or – considering men – that of a woman“, Albert explains.

Mood swings are a side effect of cortisone

About 2325 kidneys, 400 hearts, 1000 entire livers and 280 lungs were transplanted last year in Germany. 50 percent of Albert's heart patients suffer from depressions during the waiting period, although the operation itself is almost a routine nowadays. There is only one way that helps the patients: talking, talking, talking. That way, many fears can be eliminated by discussing them before the intervention. Thus, waiting for an organ also has its advantages: it offers time for discussion and dealing with problems. This raises the chances on coping better psychologically with the new organ compared to those patients having to be operated quickly due to acute organ failure.

„In the end, only three or four percent of patients experience the new heart as not belonging to themselves in the long term “, according to Albert. Also, the myth about a transplanted identity is quickly demystified through background information. „Many patients do change during the process of having received a foreign organ “, says Albert. However, this is not due to a transplanted identity but arises from the pivotal incidents that usually influence personality and individual values. Moreover, the immunosuppressants work on the brain causing mood swings or affecting the memory temporarily. „This is why, for example, men think they must have received the heart of a woman when they suddenly start crying while watching a love story“, explains Albert. „In reality, this is only a side effect of cortisone.“

„It is difficult to figure out who is mentally stable enough for a transplantation“, the psychologist Sibylle Storkebaum of the University Hospital of the Munich Technical University explains. In July, the first person ever received two full arm transplants in this hospital, in an operation that became famous worldwide. Storkebaum started accompanying this man a year before the operation in order to find out whether he really wanted the surgery and whether he would psychologically be strong enough for it - only mentally strong people with an intact social network can endure the strains well.

Sense of guilt and „honeymoon effect“

Many of transplant patients experience an emotional rollercoaster: First they are scared to die through their illness or, in the case of missing extremities, to stay completely dependent upon others resulting in a social death. On the other hand, they fear the operation. On top of that a vague sense of guilt often arises because of the impression that someone else would have to die for one’s own sake – especially when the longing for a donator's organ becomes very strong. Also, waiting, sometimes for years, wears down. After transplantation the so-called honeymoon effect occurs: the patients are euphoric, experience some kind of a second birthday. But the feeling fades away, the fear of losing the new organ spreads. Patients begin to wonder about the unknown donator, feelings of guilt and a piece of grief over this person’s death may start.

Before affected persons are put on the waiting lists „a huge ‚Yes, I want!‘ has to be noticeable“, according to Storkebaum. „The people must still have future plans for their lives and have to be ready to co-operate.“ Those not showing a strong will cannot be added to the waiting lists. The danger is too great that the patient would be worse off after than before the surgery resulting into not taking the immunosuppressants and endangering themselves – more damage than benefit would be caused.

Anyhow, the new heart, kidney or arm does not necessarily have to become completely one’s self. „In fact, it is not an own body part, it is a foreign one. The patient may just as well speak that out loudly “, Storkebaum argues. For example, sometimes it can be of help to personify the organ with a touch of humour. Some of Albert's patients give their heart a name. And one of Storkebaum’s patients recently said: „I think my donator fancies a beer right now.“

Anke Barth