Transplantation Psychiatry: an Overview.

ABSTRACT

Psychiatric consultation and evaluation is an important part of candidate selection for organ transplantation. Psychiatric assessment of patients undergoing transplantation procedure is done in pre- and post-transplantation periods, each one having its specifics. In the pre-transplantation period it is crucial to assess the patient's therapeutic adherence and the ability of understanding the treatment. The main prediction factor for short and long-term success is medical compliance for which thorough clarification of psychosocial support is needed. Symptoms of psychological exhaustion due to physical illness should be distinguished from psychiatric disorders. If a patient has a history of psychiatric illness, the risks of exacerbation or recurrence of a disease need to be evaluated. Pharmacokinetic and pharmacodynamics of psychotropic drugs resulting from to organ failure should be considered when deciding on treatment. Psychiatric assessment of the organ donor aims to clarify the psychological suitability and motivation. There are specific aspects of liver, kidney, heart and lung transplantation to keep in mind. Understanding psychosexual development is particularly important to children, before transplantation, as is the assessment of every family member. The consultation concludes with an overall evaluation of the patient's psychosocial strengths and limitations and recommended interventions to optimize the candidacy for transplantation. In the post-transplantation period potential psychological problems or psychiatric disorders must be identified and treated accordingly, in addition to psychiatric side effects of immunosuppressive therapy. The use of psychotropic drugs in the post-transplantation period requires knowledge of medication interactions. Overall, psychiatrists perform multiple roles in the transplantation team. The psychiatrists' goals are to meet the psychological needs of both patients and potential donors, evaluate candidates and to help other medical experts on the team with understanding underlying psychological mechanisms triggered by serious medical conditions and procedures. Finally, the most important purpose is optimal organ recruitment and recovery.