Occupational therapy services to enable liver patients to thrive following transplantation

ABSTRACT Transplantation is the only viable treatment for end-stage liver failure. With advances in biomedicine and surgical technique, survival rates have improved and current research is beginning to focus on patient-related outcomes such as of quality of life (QOL) and life satisfaction. However, attention to the rehabilitation needs of those patients whose lives are saved, is lagging. Pretransplantation, there are serious strains to role function and limitations to mental and physical capacity. Following transplantation, the ability to perform once easy familiar tasks is difficult for a prolonged recovery period. Within a year many people do well, others do not. Little has been done for this latter group. The purpose of this article is to systematically describe the contributions occupational therapy can make to the people struggling with the challenges faced during the transplantation process. The first part presents a framework for understanding the impact of end-stage liver disease, then the transplant, and the subsequent recovery through the combination of two frameworks: the International Classification of Functioning Disability and Health (ICF) and the Model of Human Occupation. The second part of this article will present the implications for occupational therapists throughout seven stages: (1) decline in health, (2) organ failure, (3) referral for transplantation, (4) the waiting period, (5) the transplant surgery, (6) recovery, and (7) return of health. Attention to the needs of transplant recipients who lack the adaptive skills to resume productive lifestyles has the capacity to improve participation outcomes for this population.