Academic journal article The Journal of Rehabilitation

Employment and the Transplant Patient

Academic journal article The Journal of Rehabilitation

Employment and the Transplant Patient

Article excerpt

Survival rates after heart, liver, or kidney transplantation are steadily increasing, and the morbidity associated with long term immunosuppressive therapy is slowly being reduced (Cooper & Paris, 1993). As a result, there is increased attention focused on improving the transplant (TX) recipient's quality of life by health care professionals (Jones et al., 1990).

One consistent measure of post-TX quality of life used by patients and staff is whether the patient has returned to competitive employment (Levy et al., 1995; Russell, Beecroft, Ludwin & Churchill, 1992). Not all patients, however, return to the full activity one would expect. Less than 50% of those assessed as medically able to work actually return to successful employment (Adams, Ghent, Grant & Wall, 1995; Jones et al., 1993; Paris et al., 1992).

In the TX literature "successful" is defined as employment which is:

(i) full-time, including homemakers and students but only when they return to their previous pre-TX role, (ii) part-time, or (iii) self-employed. The aim of TX should be to enable each recipient to return to an active lifestyle, and this should include employment in those of an age where this is usual in the population as a whole (Cooper & Paris, 1993). Unfortunately, this goal has not yet been achieved.

There have been only a limited number of studies that have been implemented to enhance post-TX employment. Hence, there is little background information applicable to predicting which patients are more likely to have a successful vocational outcome or the challenges specific to their rehabilitation.

Review of Literature

Economic Issues

Today, there is more discussion than ever before about the need for TX patients to return to competitive employment. The reasons for this are many but include the following: (i) improved medical results with fewer limitations, (ii) greater financial pressures to ration healthcare, and (iii) increased legal options/rights of disabled patients due to the passage of the Americans with Disabilities Act (Paris et al., 1993; Satcher & Hendren, 1992). In addition, both the public and private sectors are questioning whether the benefits warrant the expenditures. In a 1987 UNOS (United Network for Organ Sharing) public opinion survey on heart transplantation, 72% of respondents agreed that a patient's ability to return to work or other regular activity was second in importance only to patient survival (with which 83% of respondents agreed) (Evans & Manninen, 1987). Ultimately, lives have been saved, although the economic price we pay continues to increase (Evans, 1986).

The term "cost/benefit analysis" is becoming a familiar issue in this debate. As early as 1987, Oregon drew national attention when their state Medicaid program stopped funding for solid organ transplants. The legislature believed that the funds spent on TX would save many more lives per dollar spent, if the money was invested in pre-natal maternal care (Golenski, 1990). Although this decision was reversed a few years later, it reflects how economic forces can impact the availability of potential medical funding.

Placing a dollar figure on the costs associated with TX is much easier than placing a dollar figure on the benefits resulting from patients being employed. In fact, at the present time no such data is available. We do know that patients with end stage kidney disease account for 0.35% of the Medicare population but 3.7% of expenditures, and many believe this is indicative of how certain procedures use an excessive "proportion" of health care dollars (Evans, 1990). Previously published return-to-work rates of 45% for heart, 57% for liver, and 41% for kidney TX perhaps gives some credence to the "economic" concern that the cost of TX outweigh the benefits (Adams et al., 1993; Paris et al., 1992; Russell et al., 1992).

Social Issues

Historically (prior to 1990), research studies considered post-TX employment was feasible only for those who could return to a pre-TX job. …

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