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Use of a Behavior Contract as a Means to Support the Evaluation, Education, Consent and Preparation of Lung Transplant Candidates

nancy blumenthal

University of Pennsylvania Medical Center
Philadelphia, Pennsylvania, USA

Ask a transplant clinician what the most frustrating part of patient care is and you will likely hear about complications associated with non-adherence. Research has shown that patients who fail to follow recommended treatment plans have inferior outcomes post-transplant.1 We expect our patients to make lifestyle modifications, to follow a complicated and expensive medication regimen and to attend myriad follow up visits for the rest of their lives. Early identification of the subtle presentation of complications requires that patients perform self-monitoring and communicate changes with the transplant team. To make a safe transition to home and to be successful in managing self-care post-transplant, we look to care givers to engage with the patient and the medical team. A stable relationship between patient and primary caregiver has been recognized as an essential element of adaptation of these changes into the patient's lifestyle.2 Despite a multi-pronged approach to patient and caregiver education about the expectations associated with transplantation, there are still those who arrive at the post-transplant phase of care unprepared or unwilling to meet the self-care expectations. This lecture describes the use of a behavior contract with patients and caregivers to support the screening and preparation of transplant candidates to help meet the ethical imperatives of consent, resource utilization and justice. The author invites collaboration on assessing the effectiveness of this intervention.



  1. Devito Dabbs, A., Terhorst, L., Song, M., Shellmer, D. A., Aubrecht, J., Connolly, M., & Dew, M. A. (2012). Quality of recipient-caregiver relationship and psychological distress are correlates of self-care agency after lung transplantation. Clinical Transplantation, (In press) Retrieved from
  2. Dew, M. A. (2007). Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation, 83(7), 858-873.

Disclosure Statement: The author has no conflicts of interest to disclose.