Psychosocial Evaluation of Candidates for Solid Organ Transplantation

Abstract

Transplant candidates should undergo an assessment of their mental health, social support, lifestyle and behaviours. The primary aims of this 'psychosocial evaluation' are to ensure transplantation is of benefit to life expectancy and quality of life, and to allow optimisation of the candidate and transplant outcomes. The content of psychosocial evaluations is informed by evidence regarding pre-transplant psychosocial predictors of transplant outcomes. This review summarises the current literature on pre-transplant psychosocial predictors of transplant outcomes across differing solid-organ transplants, and discusses the limitations of existing research. Pre-transplant depression, substance misuse, and non-adherence are associated with poorer post-transplant outcomes. Depression, smoking and high levels of prescription opioid use are associated with reduced post-transplant survival. Pre-transplant non-adherence is associated with post-transplant rejection, and non-adherence may mediate the effects of other psychosocial variables such as substance misuse. There is evidence to suggest social support is associated with likelihood of substance misuse relapse after transplantation but there is a lack of consistent evidence for an association between social support and post-transplant adherence, rejection or survival across all organ transplant types.Psychosocial evaluations should be undertaken by a trained individual and should comprise multiple consultations with the transplant candidate, family members, and healthcare professionals. Tools exist which can be useful for guiding and standardising assessment, but research is needed to determine how well scores predict post-transplant outcomes. Few studies have evaluated interventions designed to improve psychosocial functioning specifically pre-transplant. We highlight the challenges of carrying out such research and make recommendations regarding future work.

Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018

“…Effective interventions to address these inequities will require expanding national data collection to include social determinants of health that are currently not available, both pretransplant (eg, at the level of referring nephrologists or dialysis clinicians) and at the transplant center level . The recent report from the National Academy of Sciences, Engineering, and Medicine sharpened the focus of these efforts, identifying the need to measure factors known to influence transplant evaluation, such as social risk assessments . In parallel, the United Network for Organ Sharing Kidney Paired Donation recently began a project to link third-party data to Organ Procurement & Transplantation Network in an effort to increase the depth and breadth of social determinants of health data available on transplant recipients.…”

The role of preoperative psychosocial counselling on the improvement of the recipient compliance and speed of recovery after liver transplantation – A systematic review of the literature and expert panel recommendations

“…Bailey et al. in their literature review of pretransplant psychosocial predictors of transplant outcomes suggest that treating depression using currently recommended pharmacological or nonpharmacological therapies pretransplant translates into improved post‐transplant outcomes 4 . The authors also note that depression that develops as a new problem post‐transplant has a stronger link to poor outcomes, indicating a need for ongoing surveillance for potential psychological problems.…”

“…The aim of psychosocial evaluation is to ensure that the transplant will benefit the candidate, to understand the expectations both from the transplant candidate as well as the transplant program, and to identify targets for interventions with the aim of the best chance for a successful LT. Indeed, patients with psychosocial problems such as poor social support, psychiatric diagnoses, pre‐existing treatment concordance issues, and active alcohol/substance abuse have worse post‐transplant outcomes 4 . Yet, there is not a consensus on how to carry out psychosocial assessments, with some transplant programs using validated tools and others using well documented interviews that consist of appropriate screening measures.…”

“…Indeed, patients with psychosocial problems such as poor social support, psychiatric diagnoses, pre-existing treatment concordance issues, and active alcohol/substance abuse have worse posttransplant outcomes. 4 Yet, there is not a consensus on how to carry out psychosocial assessments, with some transplant programs using validated tools and others using well documented interviews that consist of appropriate screening measures. Furthermore, the type of inter-…”

Solid organ transplant.

“…The literature indicates that pretransplant nonadherence is associated with posttransplant nonadherence and organ rejection; thus, understanding pretransplant adherence behaviors is essential to help mitigate the risk of poor outcomes (Dobbels et al, 2009;Neuberger et al, 2017;Telles-Correia et al, 2012). Numerous patient-level factors have been associated with posttransplant nonadherence, including age, gender, ethnicity, self-efficacy, self-care agency, substance abuse, socioeconomic status (SES), education, employment status, social support, and health literacy (Bailey et al, 2021;Neuberger et al, 2017). Examining the variables related to nonadherence will help develop interventions that address the individual and systems-level factors at play (Dew et al, 2007;Neuberger et al, 2017).…”