Palliative care in transplant patients

Abstract

Lack of integration between transplant medicine and palliative care has been a product of the aggressive measures that transplant medicine has undertaken to prolong life and the erroneous assumption that palliative care is exclusively end-of-life care. Instead, due to the high symptom burden and mortality rates for patients pre-and posttransplant, these fields are necessarily linked. In reviewing the unique needs of patients requiring heart, lung, kidney, liver, bowel, and bone marrow transplant, early involvement of palliative care improves quality of life, reduces symptom burden, and increases advanced care planning. In cases where pretransplant symptom burden was high and/or duration of illness prior to transplant long, patients welcomed and benefitted from earlier discussions around advance care planning and end-of-life care. When the goals of care change, palliative care can assist in the transition from active to comfort care while maximizing quality of life. No studies reviewed have found any disadvantage or harm with the involvement of palliative care in the transplant process. The integration of palliative care throughout the transplant process has been implemented at many transplant centers and has shown to benefit patients, families, and the transplant team while providing well-rounded and comprehensive care.