Preconference Skills Course
Paula Zimbrean, MD, FAPA, FACLP
Interim Chief, Yale Psychological Medicine Service, Associate Professor in Department of Psychiatry and Surgery (Transplant)
Director Transplant Psychiatry Section, Yale New Haven Hospital
New Haven, Connecticut
Transplant psychiatrists evaluate and treat some of the most complex patients in medicine. They address psychosocial, psychological, neuropsychiatric, and psychopharmacological needs while patients deal with medical comorbidities and existential questions. Transplant psychiatrists perform psychosocial evaluations of recipients and donors, help transplant teams optimize candidacy of higher risk patients, and assist patients on the waiting list, immediately post-transplant, and many years post-transplantation. In this pre-conference course, we will focus on more nuanced and challenging psychosocial topics in the ever evolving and advancing field of transplantation.
As the number of patients qualified for transplantation increases, so does the gap between those who can benefit from transplantation and the availability of deceased donors. Dr. Jose Maldonado will discuss psychosocial evaluation and psychological and medical outcomes of live donors, healthy individuals who are willing to undergo serious surgery for the benefit of others.
Liver transplantation for alcoholic liver disease (ALD) has traditionally been considered in patients who have achieved at least 6 months of abstinence. However, patients with severe acute alcoholic hepatitis (AAH) unresponsive to medical therapy may not have 6 months to live. Preliminary data from recent studies demonstrates that early liver transplantation in carefully selected AAH patients is associated with 1- and 3- year post transplant survival similar to other ALD patients undergoing usual evaluation and at least 6-month abstinence prior to transplant. Dr. Filza Hussain will review current data and outcomes of early transplantation in this population.
The recent increase in cannabis use, in the context of decriminalization and expansion of medical marijuana programs, raises new challenges regarding evaluation and treatment. Dr. Paula Zimbrean will discuss the impact of marijuana use in context of transplantation.
Dr. Marian Fireman will discuss transplantation of patients with opioid use disorders, including those on maintenance therapies (ie, methadone and buprenorphine) in the era of opioid epidemic. She will discuss evaluation of such patients, pharmacological considerations, post-operative pain management, and longer-term outcomes.
Patients from remote regions and those with limited means struggle to follow-up with transplant psychiatry. Compounding the problem, their local mental health professionals are often unfamiliar with organ transplantation and wary treating transplant patients. Dr. G. Scott Winder will discuss novel and alternative treatment modalities including embedding into medical clinics, telemedicine, and coordination with local providers.
As patients face mortality, psychiatrists are called upon to deal with existential challenges. Dr. Yelizaveta Sher will discuss such issues as they arise during the evaluative stage, during the prolonged recovery phase, and as patients yet again decompensate after transplantation. Dr. Sher will discuss role of transplant/CL psychiatrists in this context as well as collaboration with the palliative care.
This presentation will incorporate discussion of cases to illustrate presented topics and to encourage audience participation.