Psychiatric aspects of organ transplantation and donation

Faeder, Sarah; Moschenross, Darcy; Rosenberger, Emily M.; Dew, Mary Amanda; DiMartini, Andrea F.

doi:10.1097/yco.0000000000000185

Cited by 42 publications

(18 citation statements)

References 48 publications

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“…Early posttransplant depression subsequently served as the strongest predictor of long-term patient survival. A recent review article further supports the association between pretransplant depression and increased risk of posttransplant mortality in various solid organ transplants [ 18 ].…”

Section: Main Textmentioning

confidence: 86%

Transplant eligibility for patients with affective and psychotic disorders: a review of practices and a call for justice

Cahn-Fuller

Parent

2017

BMC Med Ethics

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BackgroundThe scarcity of human organs requires the transplant community to make difficult allocation decisions. This process begins at individual medical centers, where transplant teams decide which patients to place on the transplant waiting list. Each transplant center utilizes its own listing criteria to determine if a patient is eligible for transplantation. These criteria have historically considered preexisting affective and psychotic disorders to be relative or absolute contraindications to transplantation. While attitudes within the field appear to be moving away from this practice, there is no data to confirm that eligibility criteria have changed.Main bodyThere are no nationwide guidelines detailing the manner in which affective and psychotic disorders should impact transplant eligibility. Individual transplant centers thus form their own transplant eligibility criteria, resulting in significant inter-institution variability. Data from the 1990s indicates that the majority of transplant programs considered certain psychiatric illnesses, such as active schizophrenia, to be absolute contraindications to transplantation. A review of literature reveals that no comprehensive data has been collected on the topic since that time. Furthermore, the limited data available about current practices suggests that psychiatric illness continues to be viewed as a contraindication to transplantation at some transplant centers. In light of this finding, we review psychiatric literature that examines the impact of affective and psychotic disorders on transplant outcomes and conclude that the presence of these disorders is not an accurate predictor of transplant success. We then discuss the requirements of justice as they relate to the creation of a just organ allocation system.ConclusionWe conclude that transplant eligibility criteria that exclude patients with affective and psychotic disorders on the basis of their psychiatric diagnosis alone are unjust. Just listing criteria must incorporate only those factors that have a causative effect on posttransplant morbidity and mortality. Justice also demands that we eliminate current inter-institution practice variations in favor of national transplant eligibility criteria. Given the limited data available about current practices, we call for an updated study investigating the manner in which affect and psychotic disorders impact transplant eligibility determinations.

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Section: Main Textmentioning

confidence: 86%

Transplant eligibility for patients with affective and psychotic disorders: a review of practices and a call for justice

Cahn-Fuller

Parent

2017

BMC Med Ethics

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“…In solid organ transplantation, an intentionally self-inflicted MOI is generally not sufficient to deny an individual a liver transplant, 81,82,83,84,85,86,87,88,89,90,91,92,93 nor does it serve as a criterion in liver allocation priority. 94,95,96,97,98 These conclusions are derived from data suggesting that long-term outcomes for those with intentional self-inflicted injury are comparable to those with non-self-inflicted injury, which supports ethical arguments that the circumstances creating the need for liver transplantation should not influence whether transplant will be offered as a treatment option.…”

Section: Recipient Considerationsmentioning

confidence: 99%

Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation

McQuinn¹,

Kimberly²,

Parent³

et al. 2019

Camb Q Healthc Ethics

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Abstract:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation.

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“…Many psychosocial problems, including depression, anxiety, adjustment disorder, somatic distress, posttraumatic stress disorder (PTSD), and substance abuse disorders, are more common among transplant candidates or recipients than in the general population . If preexisting, psychosocial issues may affect the disease for which the patient needs a transplant or they may arise due to long wait times, uncertainty, adaptation difficulties, medications, interpersonal changes, or other factors …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] If preexisting, psychosocial issues may affect the disease for which the patient needs a transplant or they may arise due to long wait times, uncertainty, adaptation difficulties, medications, interpersonal changes, or other factors. 6 Psychosocial problems in transplant candidates and recipients are associated with a number of poor outcomes. Depression, PTSD, and personality disorders have been linked to decreased posttransplant medical compliance and higher resource utilization, and overall mental distress is associated with decreased health-related quality of life posttransplant.…”

Section: Introductionmentioning

confidence: 99%

Mental health and chemical dependency services at US transplant centers

Niazi

Spaulding

Vargas

et al. 2020

American Journal of Transplantation

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The purpose of this study was to assess the availability of mental health (MH) and chemical dependency (CD) services at US transplant centers, because appropriate psychosocial assessment and care is associated with better transplant outcomes. We used the 2017‐2018 American Hospital Association survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to quantify availability of services and examined associations of hospital‐ and health services area‐level characteristics with odds of offering services with generalized linear mixed models. We found that 15% of transplant centers did not offer MH services and 62% did not offer CD services. Hospitals were more likely to offer MH services if they were larger (OR [95% CI]: 1.03 [1.01, 1.06]) and had a lower rate of uninsured patients in the health services area (OR [95% CI]: 0.89 [0.80, 0.99]) and were more likely to offer CD services if they were larger (OR [95% CI]: 1.02 [1.01, 1.03]) or were members of a system (OR [95% CI]: 2.31 [1.26, 4.24]). Additional research is needed to understand whether lack of MH or CD services at transplant centers affects patients’ ability to access comprehensive psychosocial care and whether this affects patient outcomes.

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Psychiatric aspects of organ transplantation and donation

Cited by 42 publications

References 48 publications

Transplant eligibility for patients with affective and psychotic disorders: a review of practices and a call for justice

Transplant eligibility for patients with affective and psychotic disorders: a review of practices and a call for justice

Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation

Mental health and chemical dependency services at US transplant centers

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