A fair trial? Assessment of liver transplant candidates with psychiatric illnesses

Cherkassky, Lisa

doi:10.1136/jme.2011.042556

Cited by 9 publications

(5 citation statements)

References 4 publications

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“…Even pediatric patients may be viewed as less worthy of a transplant when they are perceived as likely having caused their liver to fail by their own actions. The limited literature on liver transplant in adults after a suicide attempt recommends nonjudgmental beneficence and avoidance of bias based on both social standing and a patient’s behavior (Cherkassky, 2011; Rhodes et al, 2011; Willey & Tolchin, 2014). Willey and Tolchin (2014) explicitly state that rejecting a patient for transplant because of tendencies to self-harm or the patient’s contribution to his or her hepatic injury is “contradictory to the principle of beneficence, the historical best practices of the medical community generally, and the ideals of the transplantation community in particular” (p. 683).…”

Section: Ethical Issuesmentioning

confidence: 99%

Adolescents with suspected intentional overdose: Ethical considerations in determining liver transplant candidacy.

Triplett

Mayersohn

Pelley

et al. 2019

Clinical Practice in Pediatric Psychology

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As the suicide rate for early adolescents has doubled in the past decade, pediatric liver transplant centers may more frequently encounter patients who present with acute liver failure secondary to an intentional ingestion of substances. The purpose of this article is to explore the ethical issues surrounding the determination of liver transplant candidacy for pediatric patients with suspected intentional ingestion of substances. Two case examples of pediatric patients who were evaluated for liver transplant after a suspected intentional ingestion of substances are explored. Evaluations to determine transplant candidacy in cases where an overdose is suspected, but unable to be confirmed, are typically complicated by time constraints due to medical urgency and potential biases by members of multidisciplinary transplant team members. More rigorous examination of long-term outcomes in pediatric patients who are post–liver transplant secondary to ingestion of substances is warranted. Until more robust pediatric outcome data are available, clinicians should continue to carefully weigh the risks and benefits of transplant while being guided by ethical principles. Pediatric psychologists working with potential liver transplant patients play a key role in ensuring that ethical principles are considered as a guide to inform transplant listing decisions.

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Section: Ethical Issuesmentioning

confidence: 99%

Adolescents with suspected intentional overdose: Ethical considerations in determining liver transplant candidacy.

Triplett

Mayersohn

Pelley

et al. 2019

Clinical Practice in Pediatric Psychology

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“…8,66 Grafts of a visible organ impact the patients' self-image, ideas regarding the allograft, and the patients' psychological reactions to the allograft. 96 If the patients do not succeed in psychologically accepting the allograft, the consequences can be serious such as a poorly integrated sense of self and incorporation. 97…”

Section: Multicenter Research and Standardizationmentioning

confidence: 99%

Preoperative psychological evaluation of transplant patients: challenges and solutions

Kumnig¹,

Jowsey‐Gregoire²

2015

TRRM

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Psychological assessments are crucial for the evaluation and optimization of the suitability of transplant patients. The interdisciplinary evaluation in modern transplantation medicine focuses on important psychosocial issues, such as assessing patients' characteristics that predict best postoperative outcome after solid organ transplantation. When assessing patients for reconstructive hand transplantation, the psychological evaluation should identify whether reconstructive hand transplantation is the best treatment option to regain functionality and sensation, to resolve body image concerns, and to improve health-related quality of life (HRQOL) for each patient. These psychosocial issues in transplantation medicine are receiving increased attention; however, standardized psychological evaluation and follow-up protocols are still being developed. Previously published reports in transplantation medicine have attempted to identify psychosocial factors important in the evaluation of transplant patients and that predict psychosocial outcomes. This review will provide an overview of recent investigations in solid organ and vascularized composite allotransplantation (VCA), including the domains of evaluation, pre-and posttransplant follow-up, psychiatric complications, evaluation of body image, and HRQOL. Recent work highlights the potential for a multicenter research approach utilizing standardized assessment strategies and emphasizing the need for a shared assessment approach to understand psychosocial outcomes. For example, the Chauvet Workgroup convened in 2014 in Paris with stakeholders in the assessment of psychosocial factors to discuss key areas and propose an ongoing shared effort across centers in addressing important questions related to psychosocial care of VCA. A successful transplantation requires a multistaged multidisciplinary psychosocial evaluation to identify those most suited to solid organ or reconstructive transplantation and minimize psychological morbidity. With this in place, current transplant psychosocial practices can be useful for solid organ transplantation and refined for VCA. This review will present potential challenges and solutions for guideline development in both solid organ and VCA.

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“…This in turn may prematurely exclude them from transplantation (60). Reliance on questionnaires to detect mental health disorders is limited because those with psychiatric disease may not be able to communicate with the transplant assessment team as effectively as those unaffected by psychiatric disease.…”

Section: Ethical Challenges Of Transplantation In People With Mental mentioning

confidence: 99%

Mental Health Disorders and Solid-Organ Transplant Recipients

et al. 2013

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Depression affects up to 60% of solid-organ recipients and is independently associated with both mortality (hazard ratio for death of ~2) and de novo malignancy after transplantation, although the mechanism is not clear. Both pretransplantation psychosis and depression occurring more than 2 years after transplantation are associated with increased noncompliance and graft loss. It remains to be shown that effective treatment of depression is associated with improved outcomes and quality of life. Immunosuppressive drugs (especially corticosteroids and calcineurin inhibitors) and physiologic challenges can precipitate deterioration in mental health. All potential transplant candidates should be assessed for mental health problems and preexisting medical conditions that can mimic mental health problems, such as uremic, hepatic, or hypoxic encephalopathy, should be identified and treated appropriately. Expert mental health review of those with identified risk factors (such as previous suicide attempts, history of mental illness or noncompliance with medications) is advisable early in the transplant assessment process to mitigate risk and support the patient. Patients with mental health disorders, when adequately controlled and socially supported, have outcomes similar to the general transplant population. Therefore, exclusion from transplantation based on the diagnosis alone is neither ethically nor medically justified. However, it is ethically and clinically justifiable to deny access to transplantation to those who, despite full support, would have a quality of life that is unacceptable to the candidate or are likely to be noncompliant with treatment or follow-up, which would lead to graft loss.

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A fair trial? Assessment of liver transplant candidates with psychiatric illnesses

Abstract: Allocating scarce organs to transplant candidates is only one stage in the long process of organ transplantation.

Cited by 9 publications

References 4 publications

Adolescents with suspected intentional overdose: Ethical considerations in determining liver transplant candidacy.

Adolescents with suspected intentional overdose: Ethical considerations in determining liver transplant candidacy.

Preoperative psychological evaluation of transplant patients: challenges and solutions

Mental Health Disorders and Solid-Organ Transplant Recipients

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