Donor-recipient interaction: the Heidelberg model of evaluation and consultation

Abstract

Background. In order to avoid psychological complications in living-donor transplantation, careful evaluation and consultation of the donor-recipient system is necessary. This article describes the Heidelberg consultation procedure before and after transplantation. This approach emphasizes close collaboration between physician and psychologist in joint interviews. Methods. Consultations focus on family genogram, the history of the donation idea; stability and balance of relationship; expectations; hesitations and doubts; discussion of complications; previous hospital experiences; the offer to provide crisis intervention when needed.Results. In 20% of all cases, unresolved problems appear. These include: unilaterally dependant relationships; unrealistic hopes for change; anxious avoidance to reflect complications; lack of medical information; risky health behaviour; negative experiences with hospitals. When properly consulted, half of these couples resign from transplantation. Conclusions. Close physician-psychologist collaboration adds significant value to a 'psychologist-only' consultation. Discussing hesitations and concerns strengthens confidence in the professional transplantation system. Access to post-transplant consultation needs further improvement.