Psychiatric aspects of organ transplantation

Typical consult question “Evaluate the patient for possible organ transplantation.” Background Transplantation has become a standard procedure for end-stage organ disease. In 2008, 27,961 organ transplants were performed in the United States, with 6217 of those transplants coming from living donors. Organ transplantation has been demonstrated to extend survival and improve quality of life for the majority of recipients. Under ideal circumstances, a psychosocial evaluation would consist of a multi-disciplinary, multi-visit assessment that would provide the transplant team with an accurate picture of the patient's psychiatric and social history. More often, psychosocial evaluations involve single visits, particularly when patients present acutely ill and in need of transplantation. Depending on the severity of their condition, they may have a difficult time answering questions or providing adequate history (e.g., intubation, encephalopathy, pain); therefore ancillary sources of information (i.e., family members, healthcare providers) must be included. Although the request to see the patient may be related primarily to concerns about a specific psychiatric disorder, the consultant should attempt to evaluate all relevant aspects of the case. Ultimately, the goals of the psychosocial evaluation are to identify potential problems or risk factors that may interfere with successful post-transplant outcomes, and then to help the team actively address these issues.