The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support

Abstract

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.

Lung transplant referral for individuals with cystic fibrosis: Cystic Fibrosis Foundation consensus guidelines

“…In addition, providers should be aware that the introduction of uncertainty about patients' eligibility for LTx may serve to increase ambivalence and ultimately avoidance of transplant-related knowledge or health decisions [39,40]. Moreover, depression and anxiety are common among individuals with CF [38] and, if persistent and inadequately treated, may adversely impact LTx outcomes [41,42].…”

Exploring the Developmental Impact of Cystic Fibrosis on Lung Transplant Candidacy: Considerations for Adulthood

“…The pretransplant evaluation additionally assesses for various psychosocial or psychiatric conditions which may impair or prevent the patient's ability to fully engage in the necessary recovery and management (Morrell et al, 2019;Smith et al, 2016). A clinician with expertise in the behavioral, emotional, and social aspects of transplant, such as a health psychologist, a psychiatrist or a medical social worker, interviews the patient and their caregiver(s) to collect data regarding multiple psychosocial domains, including adherence, mental health, substance use, cognitive capacity, understanding of treatment and treatment options, ability to cope with illness, social support, and social history (Dew et al, 2018). These psychosocial domains have been previously defined and recommended in a joint collaboration between the International Society for Heart and Lung Transplantation (ISHLT), Academy of Psychosomatic Medicine (APM), American Society of Transplantation (AST), International Consortium of Circulatory Assist Clinicians (ICCAC), and Society for Transplant Social Workers (SWSW) (Dew et al, 2018).…”

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“…We believe that initial cardiac xenografting candidates should fulfill current heart transplant candidacy "listing" criteria, which exclude patients with recent malignancy or chronic infections. [16][17][18] The function of extracardiac organs should predict tolerability of the proposed procedure and postoperative treatment regimen. Frailty is well-recognized as a risk factor driving surgical outcomes, and technical feasibility based on anatomy and surgical history should be taken into account.…”