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O outro em si : fenomelogia do alotransplante de progenitores hematopoiéticos
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O alotransplante de progenitores hematopoiéticos é uma modalidade terapêutica indicada para tratar patologias hematológicas, oncológicas, imunológicas e metabólicas. Com a infusão dos precursores hematopoiéticos alogénicos, o sujeito transforma-se numa quimera biológica, num palco de conflito entre duas linhagens hematológicas distintas, cuja harmonização só é possível pela administração de um regime de condicionamento - prévio ao transplante - e de um regime imunossupressor. Enquadrado numa realidade em que o alotransplante se encontra banalizado e dissipado do seu caráter extraordinário, o presente estudo pretende conhecer as repercussões que a incorporação de um órgão-outro pode ter na identidade subjetiva do recetor. A compreensão desta problemática implica que se conheça a relação psicológica que o doente estabelece com o órgão-próprio lesado, com o órgão-outro e com o corpo-próprio subordinado à intrusão e à imunossupressão. A opção metodológica do estudo orienta-se para uma abordagem qualitativa, de desenho descritivo do tipo estudo de caso. Para a colheita de dados, realizada na consulta do STMO a uma amostra de 13 doentes alotransplantados com patologia hemato-oncológica, utilizou-se a entrevista semi-estruturada. Os resultados obtidos, após análise de conteúdo utilizando a técnica de Bardin (2008) e as orientações de Ghiglione & Matalon (2005), sugerem as seguintes conclusões: A representação do órgão hematopoiético é, essencialmente, biologicista, sobressaindo a sua função produtora e reguladora. Considerado como um órgão-objeto danificado, o desejo é o de substituição. Assim, o alotransplante aparece vinculado à possibilidade de cura ou à possibilidade de melhoria da qualidade de vida, e está associado à ideia de uma dádiva de vida e de renascimento. A adaptação psicológica ao órgão-outro passa pela sua desafetivação, facilitada por um conjunto de fatores como a semelhança do procedimento a uma transfusão, a banalização do procedimento da infusão, a relação com o dador aparentado e a focalização na cura. Alguns relatos rompem, contudo, com esta visão mecanicista da transplantação. O órgão-outro é sentido como uma presença estranha e, consequentemente, fraturante da identidade pessoal, criando no recetor o sentimento metamorfósico em quimera biológica, o sentimento de perda da identidade biológica, o receio da transformação ontológica, o sentimento de inquietante estranheza e o receio da transmissão de características do dador. Estes resultados tornam-se relevantes se pensarmos que a rejeição biológica pode ter reverberações na identidade subjetiva e na adaptação psicológica ao órgão-outro e, reciprocamente, a intolerância psicológica pode comprometer a adesão ao regime imunossupressor e aumentar a ameaça da doença enxerto contra hospedeiro (DECH).
Introduction: Allogeneic Hematopoietic Stem cell Transplantation (AHST) is a therapeutic modality indicated to treat hematologic oncologic, immunologic and metabolic diseases. By administrating allogeneic hematopoietic progenitor cells the receptor becomes a biological chimera with 2 separate hematologic lines. This situation of potential conflict is mitigated by a regime of conditioning and immunosuppressant therapy prior and during treatment. Currently the procedure of allogenic transplantation transformed from an extraordinary to a more standard procedure. The primary objective of the current investigation is to study the repercussions of the incorporation of a “nonself” organ on the psychologic identity of the receptor. To understand this problem, we need to understand the psychological relationship established between the patient the sick organ, the “nonself” organ and his/her body subjected to this treatment and immunosuppressant therapy. Methods: Qualitative descriptive case study. Thirteen patients, submitted to AHST for hematological oncological disease, followed on outpatient basis at the STMO, were submitted to a semi-structured interview. The results were submitted to analysis using methods described by Bardin (2008) and orientations by Ghiglione & Matalon (2005) leading to the following final results and conclusions: Results and conclusions: The presentation of the hematopoietic organ is essentially of biological nature, reflecting it producing and regulating function. Being considered as a damaged organ the patients desire is to replace the organ. Therefore, the allotransplant is linked to cure and or improvement of the quality of life and associated with a gift of life and rebirth. The psychological adaptation to a “nonself” organ is characterized by a lack of affect caused by various causes such as its administration with similarity to a blood transfusion, the banalization of the procedure, the relation with the related donor and the focus on cure. However, some results break from this mechanistic view of transplantation. The “nonself” organ is felt as strange presence and consequently fractures the personal identity resulting a sentiment of biological metamorphosis in the receiver, creating a feeling of loss of biological identity, a fear of ontological transformation, a feeling of unsettling strangeness and a fear of transmission of characteristics of the donor. These results become relevant when we consider that biological rejection can have reverberations on the subjective identity and on the psychological adaptation of the “nonself” organ and reciprocally, this psychological intolerance can compromise the adhesion to the immunosuppressant therapy, increasing the risk of graft versus host disease (GVHD).
Introduction: Allogeneic Hematopoietic Stem cell Transplantation (AHST) is a therapeutic modality indicated to treat hematologic oncologic, immunologic and metabolic diseases. By administrating allogeneic hematopoietic progenitor cells the receptor becomes a biological chimera with 2 separate hematologic lines. This situation of potential conflict is mitigated by a regime of conditioning and immunosuppressant therapy prior and during treatment. Currently the procedure of allogenic transplantation transformed from an extraordinary to a more standard procedure. The primary objective of the current investigation is to study the repercussions of the incorporation of a “nonself” organ on the psychologic identity of the receptor. To understand this problem, we need to understand the psychological relationship established between the patient the sick organ, the “nonself” organ and his/her body subjected to this treatment and immunosuppressant therapy. Methods: Qualitative descriptive case study. Thirteen patients, submitted to AHST for hematological oncological disease, followed on outpatient basis at the STMO, were submitted to a semi-structured interview. The results were submitted to analysis using methods described by Bardin (2008) and orientations by Ghiglione & Matalon (2005) leading to the following final results and conclusions: Results and conclusions: The presentation of the hematopoietic organ is essentially of biological nature, reflecting it producing and regulating function. Being considered as a damaged organ the patients desire is to replace the organ. Therefore, the allotransplant is linked to cure and or improvement of the quality of life and associated with a gift of life and rebirth. The psychological adaptation to a “nonself” organ is characterized by a lack of affect caused by various causes such as its administration with similarity to a blood transfusion, the banalization of the procedure, the relation with the related donor and the focus on cure. However, some results break from this mechanistic view of transplantation. The “nonself” organ is felt as strange presence and consequently fractures the personal identity resulting a sentiment of biological metamorphosis in the receiver, creating a feeling of loss of biological identity, a fear of ontological transformation, a feeling of unsettling strangeness and a fear of transmission of characteristics of the donor. These results become relevant when we consider that biological rejection can have reverberations on the subjective identity and on the psychological adaptation of the “nonself” organ and reciprocally, this psychological intolerance can compromise the adhesion to the immunosuppressant therapy, increasing the risk of graft versus host disease (GVHD).
Descrição
Tese de mestrado, Bioética, Universidade de Lisboa, Faculdade de Medicina, 2017
Palavras-chave
Alotransplante de progenitores hematopoiéticos Órgão-outro Quimera biológica Identidade pessoal Ética relacional Teses de mestrado - 2017