Addiction, Pain, Transplant
Organ transplantation, once a cutting edge lifesaving treatment for patients with end-stage organ failure, is now a well-established treatment option for patients that offers the chance of renewed hope, extended survival, and restored functionality. However, in order to reach this potential, individuals must first go through multiple steps including the initial evaluation, acceptance for listing, surviving the wait for a donor organ, undergoing transplant surgery, post-operative recovery and rehabilitation, then adjustment to post-transplant care, chronic immunosuppression, and the inevitable setbacks and complications that follow transplantation. At each step along this transplant continuum, psychiatric issues often arise and lead to the request for consultation. While there are C-L psychiatrists who specialize in transplant psychiatry, the fact that there are over 250 transplant centers in the U.S. alone and over 35,000 transplant annually, the greater likelihood is that a general C-L psychiatrist will be asked for their assistance in the care of this patient population.
In order to assist the non-transplant C-L psychiatrist, this presentation aims to provide a condensed, but comprehensive, and clinically-oriented overview of psychiatric issues relevant to the assessment and care of patients along the transplant continuum. Guidance about the process of evaluating patients for transplant listing, considerations about high-risk groups, communication with transplant teams. and the care of patients awaiting transplantation will be reviewed. This will be followed by discussion of post-transplant issues starting with the initial post-operative period where management of neuropsychiatric complications (e.g. delirium, seizures), early complications of immunosuppression, demoralization, and delayed recovery occur. We will then progress to post-transplant life where treatment adherence, continued disability, negotiation of new social or family responsibilities, substance relapse, long-term medical complications, and palliative care issues become the focus of clinical care.
Throughout the presentation, longitudinal case material from the presenters' own experiences will be interwoven in order to provide the audience with additional insight into the patient experience, including the psychological hurdles, unique concerns, and stressors facing transplant candidates and recipients. Thus, we will enable the non-transplant C-L psychiatrist to feel empowered to provide more informed and compassionate care to the transplant patients he or she is asked to see.
Pre-Transplant Clinical Issues
Psychosocial Assessment - Purpose/Content/Execution (10 minutes)
Psychosocial Instruments and Measures - Evidence Based Approaches (10 minutes)
Complex/ High Risk Considerations (15 minutes)
The Waiting Period - Preparing for Life and Death (10 minutes)
Post-Transplant Clinical Issues
Post-surgical Care (15 min)
-immunosuppressant side effects
Adaptation to Post-Transplant Life (15 min)
-psychiatric complications -PTSD/mood disorders
Long-term Post-Transplant Concerns (10 min)
-long-term complications/ second transplant
-palliative care issues
-Questions (5 minutes)