The psychosocial evaluation of transplant candidates

Abstract

Despite the exponential growth in the need for organs, the method by which the medical community selects transplant recipients has seen little in terms of definitive change or the establishment of recipient selection standards. When evaluating a patient's candidacy as a potential transplant recipient, we must consider not only medical listing criteria but also the patient's psychosocial makeup. Many pre-transplant psychosocial problems continue after transplantation. Unfortunately, psychosocial listing criteria lack standardization, both regarding tools and techniques used. Studies have demonstrated a strong association between pre-transplant psychosocial vulnerability markers and a number of both medical and psychosocial negative outcomes, which has been linked to the ultimate transplant success or failure. Psychosocial consultants can enhance the candidate selection process by fine-tuning the assessment of patients considered for transplantation. The use of objective psychosocial assessment tools, such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), can assist transplant teams not only in eliminating the emotional factor from the assessment but also in presenting the facts of the case as they are. The role of psychosocial consultants should not be to make a determination regarding the patient's worthiness as a candidate, but to assist the transplant selection committee in making the best clinical decision based on current available data.