Psychiatric Liaison to Liver Transplant Recipients

Abstract

Child psychiatric consultants perform psychiatric assessment and liaison among various clinical services. Execution of these familiar roles for pediatric liver transplantation recipients exposes unfamiliar and difficult bioethical problems. Administrative problems arise if the recipient's suitability is too narrowly evaluated. Assessment may be time-limited. The intensive care unit environment and the VIP characteristics of child transplantation patients may distort observations and constrain opportunities for preventive preoperative psychologic management. Unnecessary psychiatric complications may ensue, which imperil the transplantation surgery. The primary caretakers may have an extraordinary emotional investment, so liaison is pressured. Three cases are presented to illustrate these points. Medical ethical perspectives and the limitations of medical training to prepare physicians to perceive them are indicated. That these limitations also affect the psychiatrist is acknowledged, and a clinical research approach is suggested.

Transplanted children's experiences of daily living: Children's narratives about their lives following transplantation

“…It was also revealed that healthcare professionals should be responsive not only to the children's but also to their parents’ need for support. There are several reasons for offering the patient and his/her family co‐ordinated support following transplantation; the risk of organ rejection, the parents’ and children's lack of adequate coping strategies and young people's thoughts about death, as revealed by a study of liver‐transplanted children (35).…”

Pediatric Psychiatric Pretransplant Evaluation

“…Overall, there is a paucity of literature describing or empirically validating the pediatric psychiatric pretransplant evaluation. Articles have discussed the issues unique to pediatric evaluations (Gamburg, & Burge, 1994;Krener, 1987;Wolcott, Fawzy, & Wellisch, 1987), reviewed case studies (Atkins, & Patenaude, 1987;Pinard, & Minde, 1991), and even provided health educators with information regarding the effects of pediatric transplantation (Duitsman, 1996), yet no systematic studies of the utility, predictive validity, or reliability of pediatric pretransplant evaluations have been conducted.…”