Evaluation for organ transplantation involves more than just ruling out contraindications. The psychosocial support system is extremely important and can involve counseling for events leading up to transplantation and the considerable care involved afterwards. Although the psychiatric transplantation evaluation is important, it is only a small part of the entire decision to proceed with transplantation as successful transplantation has occurred in a wide range of psychiatric disorders. The social support system is highly important.
The pre-transplantation psychosocial evaluation can be valuable in predicting posttransplant adjustment. A major goal is to identify psychosocial issues that can be addressed prior to the transplantation.
Ideally, the pre-transplantation evaluation should be multi-disciplinary and include psychiatrists, psychologists, addiction specialists, social workers, and of course transplant surgeons.
Unlike a typical psychiatric evaluation, the psychiatrist is primarily serving the needs of the transplantation team, rather than the patient. There are several goals of psychosocial screening listed here.
Interestingly, the selection of patients for transplantation appears to depend in part on the organ being transplanted. For example, psychosocial issues appear to be more important in heart transplant programs than in liver.
Kidney transplant issues
The kidney transplant differs from other orthotopic transplants in that the kidney comes form a living donor. This means that both the donor and recipient are evaluated. With the recipient, one looks largely at the issues described above, as with other organs. That is. the focus is on identifying any issues that can be corrected or improved or any issues that may significantly lower the chances of a successful transplant.
When evaluating the donor of a kidney, it is important to determine that the donor has capacity to make the decision and is not being unduly coerced or ambivalent about the procedure. In addition the donor should understand the risks that he or she incurs by donating a kidney. Though the donation procedure itself is relatively low risk, should the donor later contract renal disease, he or she will be at increased risks for complications given that there is only one kidney remaining.