A delicate balance: negotiating renal transplantation, immunosuppression and adherence to medical regimen

Abstract

Despite the volume of biomedical and psychosocial discourse surrounding both renal transplantation and the immune system, there is a limit to current understandings of immunosuppression in the context of kidney transplantation. For example, we do not know how the immunosuppressed renal transplant recipient experiences and understands their immune system and body. In addition, we do not know if the patient is as fi xated on 'graft survival' as their healthcare team or whether other concerns are more relevant. What is missing is the discourse of those who actually 'live' the medically altered immune system in the context of renal transplantation. We propose that this gap in knowledge is bound to an acknowledged problem among renal transplant recipients and their healthcare teams – a lack of compliance with recommended medical regimens. Our argument here is that an exploration of patient intimacy with transplant-related immunosuppression might illuminate a different understanding of this experience that could enhance health professionals' understanding and their subsequent approach to treatment. We contend that the embodied and contextual experience of the patient needs to be equally valued in order to enhance patient outcomes.