Title: Older Adult Kidney Transplant Recipients
Description: Study Purpose and Rationale The United States is witnessing growth in its aging population and an increase in the prevalence of end-stage renal disease, resulting in a substantial rise in kidney transplantation among adults age 65 and over. While older adult recipients fare better clinically than their counterparts on dialysis, far less is known about their psychosocial wellbeing following transplantation. A small body of qualitative work in organ transplantation suggests that there is an important period of adaptation following transplantation during which a recipient must incorporate the new organ into his or her sense of identity and bodily integrity. Difficulty navigating the adaptation process can have significant adverse effects on psychosocial and clinical outcomes, in extreme cases resulting in graft loss and even death. Employing a phenomenological approach, this study sought to better understand the lived experience of older adult kidney transplant recipients and the impact of kidney transplantation on their sense of identity and bodily integrity, with implications for the design of effective supports and interventions to optimize post-transplant mental health and wellbeing.

Methods Applying the hermeneutic phenomenology of philosopher Paul Ricoeur, this study explored the lived experience of 10 kidney transplant recipients age 65 and over. Participants completed one to two in-depth phenomenological interviews lasting approximately one hour each. Interview transcripts and field notes were analyzed using an inductive approach, beginning with an epoché (bracketing) phase and followed by the processes of phenomenological reduction (textured description), imaginative variation (structured description) and synthesis to arrive at an understanding or approximation of the universal essence of the phenomenon of adapting to a kidney transplant. Findings Participants reported experiencing the “strangeness” of incorporating the organ of another person into their own body and concern over specific corporeal changes associated with dialysis and transplantation, expressing a disruption of their ‘idem’ sense of identity that ranged from mildly unsettling to deeply distressing.

However, participants also articulated powerful narratives of resilience and coping, describing their ability to overcome adversity as an anchor of their ‘ipse’ sense of identity that allowed them to navigate idem corporeal changes over time. The continuity and strength of participants’ ipse sense of self over the life course enabled them to adjust to profound corporeal change, and for some participants kidney transplantation represented a form of liberation from ‘machine life’ (dialysis) and restoration of their idem sense of self. Conclusions/Implications Findings from this study have significant implications for ensuring the provision of optimal support to older adult kidney transplant recipients. A more nuanced understanding of the post-transplant experience of adapting to a new organ will enhance the informed consent process, providing the opportunity for transplant teams, potential recipients and their caregivers to engage in meaningful dialogue about the risks and benefits of the procedure and helping to establish expectations for post-transplant recovery.

By shedding light on older adult recipients’ perspectives, findings also will help to inform the design of future research studies addressing candidacy for transplantation and post-transplant quality of life. Furthermore, study results will assist transplant teams in determining how to optimize post-transplant care and support for older adult recipients, thereby improving outcomes and contributing to the overall wellbeing of this population. Finally, the findings have implications for ongoing policy discussions in the field, including how to ensure equitable patient selection by establishing appropriate age-related criteria for kidney transplant recipients.