0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

CLINICAL SYNTHESIS   |    
Psychiatric Aspects of Organ Transplantation
Andrea F. DiMartini, M.D.; Catherine Crone, M.D.; Emily M. Rosenberger, B.A.; Mary Amanda Dew, Ph.D.
FOCUS 2013;11:460-470. doi:10.1176/appi.focus.11.4.460
View Author and Article Information

Author Information and CME Disclosure

Andrea F. DiMartini, M.D., Departments of Psychiatry and Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA

Catherine Crone, M.D., Department of Psychiatry, George Washington University, Washington, DC, Department of Psychiatry at Inova Fairfax Hospital and Clinical Professor of Psychiatry Virginia Commonwealth University

Emily M. Rosenberger, B.A., Department of Clinical and Translational Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA

Mary Amanda Dew, Ph.D., Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, School of Medicine, University of Pittsburgh, Pittsburgh, PA

All authors report no competing interests.

Address correspondence to Andrea DiMartini, M.D., Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: dimartiniaf@upmc.edu

Abstract

Psychiatrists working with transplant populations need to understand the organ transplant process, transplant-specific psychosocial issues, and the medical complexity of organ transplant candidates and recipients in order to provide appropriate psychiatric care. Strategies for psychiatric assessment and treatment have been developed with these transplant-related issues in mind. Patients with complex psychiatric histories present particular challenges to the transplant team and specific considerations in these cases are discussed. For living organ donors the psychiatrist’s role focuses on the protection of the psychological health and well-being of the donors and the pre-donation assessment must consider risks for poor post-donation psychosocial outcomes. Following transplantation, nonadherence to transplant directives is a significant problem in transplant recipients, and psychiatrists may be asked to assist in developing/providing strategies to improve patient adherence.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1. Discrete Time Periods With Attendant Issues for Transplant Patients
Anchor for Jump
Table 1.Psychotropic Drug-Immunosuppressant Drug Interactionsa
Table Footer Note

a From Ferrando et al. (22), p 490. Used with permission.

Table Footer Note

b Case report of 50% reduction in cyclosporine levels.

Table Footer Note

c Reports of calcineurin level reduction leading to organ rejection.

Table Footer Note

d Implicated in several case reports of causing calcineurin inhibitor toxicity leading to acute renal failure, elevated liver enzymes and delirium in transplant patients.

Anchor for Jump
Table 2.Strategies for Identifying Nonadherence
+

References

DiMartini  A;  Dew  MA;  Crone  C:  Organ transplantation, in  Kaplan and Sadock’s Comprehensive textbook of psychiatry , 9th ed, vol. 2. Edited by Sadock  BJ;  Sadock  VA;  Ruiz  P.  Philadelphia,  Lippincott Williams & Wilkins, 2009, pp 2441–2456
 
Rosenberger  EM;  Dew  MA;  Crone  C;  DiMartini  AF:  Psychiatric disorders as risk factors for adverse medical outcomes after solid organ transplantation.  Curr Opin Organ Transplant 2012; 17:188–192
[CrossRef] | [PubMed]
 
Rogal  S;  Dew  MA;  Fontes  P;  DiMartini  A:  Early treatment of depressive symptoms and long-term survival after liver transplantation.  Am J Transplant 2013; 13:928–935
[CrossRef] | [PubMed]
 
Rosenberger  EM;  Dew  MA;  DiMartini  AF;  DeVito Dabbs  AJ;  Yusen  RD:  Psychosocial issues facing lung transplant candidates, recipients and family caregivers.  Thorac Surg Clin 2012; 22:517–529
[CrossRef] | [PubMed]
 
Frisch  M:  Quality of life therapy and assessment in health care.  Clin Psychol 1998; 5:19–40
 
Rodrigue  JR;  Baz  MA;  Widows  MR;  Ehlers  SL:  A randomized evaluation of quality-of-life therapy with patients awaiting lung transplantation.  Am J Transplant 2005; 5:2425–2432
[CrossRef] | [PubMed]
 
Rodrigue  JR;  Mandelbrot  DA;  Pavlakis  M:  A psychological intervention to improve quality of life and reduce psychological distress in adults awaiting kidney transplantation.  Nephrol Dial Transplant 2011; 26:709–715
[CrossRef] | [PubMed]
 
Rodrigue  JR;  Widows  MR;  Baz  MA:  Caregivers of lung transplant candidates: do they benefit when the patient is receiving psychological services? Prog Transplant 2006; 16:336–342
[PubMed]
 
Hirth  AM;  Stewart  MJ:  Hope and social support as coping resources for adults waiting for cardiac transplantation.  Can J Nurs Res 1994; 26:31–48
[PubMed]
 
Napolitano  MA;  Babyak  MA;  Palmer  S;  Tapson  V;  Davis  RD;  Blumenthal  JA; Investigational Study of Psychological Intervention in Recipients of Lung Transplant (INSPIRE) Investigators:  Effects of a telephone-based psychosocial intervention for patients awaiting lung transplantation.  Chest 2002; 122:1176–1184
[CrossRef] | [PubMed]
 
Blumenthal  JA;  Babyak  MA;  Keefe  FJ;  Davis  RD;  Lacaille  RA;  Carney  RM;  Freedland  KE;  Trulock  E;  Palmer  SM:  Telephone-based coping skills training for patients awaiting lung transplantation.  J Consult Clin Psychol 2006; 74:535–544
[CrossRef] | [PubMed]
 
Dew  MA;  Goycoolea  JM;  Harris  RC;  Lee  A;  Zomak  R;  Dunbar-Jacob  J;  Rotondi  A;  Griffith  BP;  Kormos  RL:  An internet-based intervention to improve psychosocial outcomes in heart transplant recipients and family caregivers: development and evaluation.  J Heart Lung Transplant 2004; 23:745–758
[CrossRef] | [PubMed]
 
Kugler  C;  Geyer  S;  Gottlieb  J;  Simon  A;  Haverich  A;  Dracup  K:  Symptom experience after solid organ transplantation.  J Psychosom Res 2009; 66:101–110
[CrossRef] | [PubMed]
 
Gross  CR;  Kreitzer  MJ;  Thomas  W;  Reilly-Spong  M;  Cramer-Bornemann  M;  Nyman  JA;  Frazier  P;  Ibrahim  HN:  Mindfulness-based stress reduction for solid organ transplant recipients: a randomized controlled trial.  Altern Ther Health Med 2010; 16:30–38
[PubMed]
 
Kreitzer  MJ;  Gross  CR;  Ye  X;  Russas  V;  Treesak  C:  Longitudinal impact of mindfulness meditation on illness burden in solid-organ transplant recipients.  Prog Transplant 2005; 15:166–172
[PubMed]
 
Macdonald  JH;  Kirkman  D;  Jibani  M:  Kidney transplantation: a systematic review of interventional and observational studies of physical activity on intermediate outcomes.  Adv Chronic Kidney Dis 2009; 16:482–500
[CrossRef] | [PubMed]
 
Ihle  F;  Neurohr  C;  Huppmann  P;  Zimmermann  G;  Leuchte  H;  Baumgartner  R;  Kenn  K;  Sczepanski  B;  Hatz  R;  Czerner  S;  Frey  L;  Ueberfuhr  P;  Bittmann  I;  Behr  J; Munich Lung Transplant Group:  Effect of inpatient rehabilitation on quality of life and exercise capacity in long-term lung transplant survivors: a prospective, randomized study.  J Heart Lung Transplant 2011; 30:912–919
[PubMed]
 
Langer  D;  Burtin  C;  Schepers  L;  Ivanova  A;  Verleden  G;  Decramer  M;  Troosters  T;  Gosselink  R:  Exercise training after lung transplantation improves participation in daily activity: a randomized controlled trial.  Am J Transplant 2012; 12:1584–1592
[CrossRef] | [PubMed]
 
Cupples  S;  Dew  MA;  Grady  KL;  De Geest  S;  Dobbels  F;  Lanuza  D;  Paris  W; Psychosocial Outcomes Workgroup of the Nursing and Social Sciences Council of the International Society for Heart and Lung Transplantation:  Report of the Psychosocial Outcomes Workgroup of the Nursing and Social Sciences Council of the International Society for Heart and Lung Transplantation: present status of research on psychosocial outcomes in cardiothoracic transplantation: review and recommendations for the field.  J Heart Lung Transplant 2006; 25:716–725
[CrossRef] | [PubMed]
 
Corruble  E;  Barry  C;  Varescon  I;  Castaing  D;  Samuel  D;  Falissard  B:  The Transplanted Organ Questionnaire: a validation study.  J Psychosom Res 2012; 73:319–324
[CrossRef] | [PubMed]
 
Fukunishi  I;  Sugawara  Y;  Takayama  T;  Makuuchi  M;  Kawarasaki  H;  Surman  OS:  Association between pretransplant psychological assessments and posttransplant psychiatric disorders in living-related transplantation.  Psychosomatics 2002; 43:49–54
[CrossRef] | [PubMed]
 
Ferrando SJ, Levenson JL, Owen JA (eds): Clinical Manual of Psychopharmacology in the Medically Ill. Washington, DC, American Psychiatric Press, 2010.
 
Dew  MA;  DiMartini  AF;  Steel  J;  De Vito Dabbs  A;  Myaskovsky  L;  Unruh  M;  Greenhouse  J:  Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs.  Liver Transpl 2008; 14:159–172
[CrossRef] | [PubMed]
 
Dew  MA;  DiMartini  AF;  De Vito Dabbs  A;  Myaskovsky  L;  Steel  J;  Unruh  M;  Switzer  GE;  Zomak  R;  Kormos  RL;  Greenhouse  JB:  Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation.  Transplantation 2007; 83:858–873
[CrossRef] | [PubMed]
 
Coffman  KL;  Crone  C:  Rational guidelines for transplantation in patients with psychotic disorders.  Curr Opin Organ Transplant 2007; 7:385–388
[CrossRef]
 
Le Melle  SM;  Entelis  C:  Heart transplant in a young man with schizophrenia.  Am J Psychiatry 2005; 162:453–457
[CrossRef] | [PubMed]
 
Taborda  JG;  Bordignon  S;  Bertolote  JM;  Taborda  ML:  Heart transplantation and schizophrenia.  Psychosomatics 2003; 44:264–265
[CrossRef] | [PubMed]
 
DiMartini  A;  Twillman  R:  Organ transplantation and paranoid schizophrenia.  Psychosomatics 1994; 35:159–161
[CrossRef] | [PubMed]
 
Mahadeva  S;  Lynch  S;  Davies  MH:  Liver transplantation in an undiagnosed schizophrenic.  J R Soc Med 1997; 90:563
[PubMed]
 
Okayasu  H;  Ozeki  Y;  Chida  M;  Miyoshi  S;  Shimoda  K:  Lung transplantation in a Japanese patient with schizophrenia from brain-dead donor.  Gen Hosp Psychiatry 2013; 35:e11–e13
[CrossRef] | [PubMed]
 
De Geest  S;  Dobbels  F;  Fluri  C;  Paris  W;  Troosters  T:  Adherence to the therapeutic regimen in heart, lung, and heart-lung transplant recipients.  J Cardiovasc Nurs 2005; 20(Suppl):S88–S98
[CrossRef] | [PubMed]
 
Shemesh  E;  Fine  RN:  Is calculating the standard deviation of tacrolimus blood levels the new gold standard for evaluating non-adherence to medications in transplant recipients? Pediatr Transplant 2010; 14:940–943
[CrossRef] | [PubMed]
 
Berben  L;  Dobbels  F;  Kugler  C;  Russell  CL;  De Geest  S:  Interventions used by health care professionals to enhance medication adherence in transplant patients: a survey of current clinical practice.  Prog Transplant 2011; 21:322–331
[PubMed]
 
De Bleser  L;  Matteson  M;  Dobbels  F;  Russell  C;  De Geest  S:  Interventions to improve medication-adherence after transplantation: a systematic review.  Transpl Int 2009; 22:780–797
[CrossRef] | [PubMed]
 
DeVito Dabbs  A;  Dew  MA;  Myers  B;  Begey  A;  Hawkins  R;  Ren  D;  Dunbar-Jacob  J;  Oconnell  E;  McCurry  KR:  Evaluation of a hand-held, computer-based intervention to promote early self-care behaviors after lung transplant.  Clin Transplant 2009; 23:537–545
[CrossRef] | [PubMed]
 
Sengpiel  J;  Fuehner  T;  Kugler  C;  Avsar  M;  Bodmann  I;  Boemke  A;  Simon  A;  Welte  T;  Gottlieb  J:  Use of telehealth technology for home spirometry after lung transplantation: a randomized controlled trial.  Prog Transplant 2010; 20:310–317
[PubMed]
 
Miloh  T;  Annunziato  R;  Arnon  R;  Warshaw  J;  Parkar  S;  Suchy  FJ;  Iyer  K;  Kerkar  N:  Improved adherence and outcomes for pediatric liver transplant recipients by using text messaging.  Pediatrics 2009; 124:e844–e850
[CrossRef] | [PubMed]
 
Klein  A;  Otto  G;  Krämer  I:  Impact of a pharmaceutical care program on liver transplant patients’ compliance with immunosuppressive medication: a prospective, randomized, controlled trial using electronic monitoring.  Transplantation 2009; 87:839–847
[CrossRef] | [PubMed]
 
Chisholm-Burns  MA;  Spivey  CA;  Graff Zivin  J;  Lee  JK;  Sredzinski  E;  Tolley  EA:  Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial.  Am J Transplant  (Epub ahead of print: Jul 2, 2013)
 
Lisson  GL;  Rodrigue  JR;  Reed  AI;  Nelson  DR:  A brief psychological intervention to improve adherence following transplantation.  Ann Transplant 2005; 10:52–57
[PubMed]
 
Dew  MA;  Jacobs  CL;  Jowsey  SG;  Hanto  R;  Miller  C;  Delmonico  FL; United Network for Organ Sharing (UNOS); American Society of Transplant Surgeons; American Society of Transplantation:  Guidelines for the psychosocial evaluation of living unrelated kidney donors in the United States.  Am J Transplant 2007; 7:1047–1054
[CrossRef] | [PubMed]
 
DiMartini  AF;  Sotelo  JL;  Dew  MA:  Organ transplantation, in  The American Psychiatric Publishing textbook of psychosomatic medicine: Psychiatric care of the medically ill , 2nd ed. Edited by Levenson  JL.  Washington, DC,  American Psychiatric Publishing, Inc., 2010, pp 725–758
 
Jowsey  SG;  Schneekloth  TD:  Psychosocial factors in living organ donation: clinical and ethical challenges.  Transplant Rev (Orlando) 2008; 22:192–195
[CrossRef] | [PubMed]
 
Olbrisch  ME;  Benedict  SM;  Haller  DL;  Levenson  JL:  Psychosocial assessment of living organ donors: clinical and ethical considerations.  Prog Transplant 2001; 11:40–49
[PubMed]
 
Fisher  MS  Sr:  Psychosocial evaluation interview protocol for living related and living unrelated kidney donors.  Soc Work Health Care 2003; 38:39–61
[CrossRef] | [PubMed]
 
Leo  RJ;  Smith  BA;  Mori  DL:  Guidelines for conducting a psychiatric evaluation of the unrelated kidney donor.  Psychosomatics 2003; 44:452–460
[CrossRef] | [PubMed]
 
Schroder  NM;  McDonald  LA;  Etringer  G;  Snyders  M:  Consideration of psychosocial factors in the evaluation of living donors.  Prog Transplant 2008; 18:41–48, quiz 49
[PubMed]
 
Organ Procurement and Transplantation Network, Policy 12, Living donation. http://Optn.transplant.hrsa.gov/policiesandbylaws2/policies/pdfs/policy_172.pdf. Last accessed April 21, 2013.
 
Organ Procurement and Transplantation Network. Living kidney donor psychosocial evaluation checklist. http://optn.transplant.hrsa.gov/news/newsDetail.asp?id=1590. Last accessed April 21, 2013.
 
Clemens  K;  Boudville  N;  Dew  MA;  Geddes  C;  Gill  JS;  Jassal  V;  Klarenbach  S;  Knoll  G;  Muirhead  N;  Prasad  GV;  Storsley  L;  Treleaven  D;  Garg  AX; Donor Nephrectomy Outcomes Research (DONOR) Network:  The long-term quality of life of living kidney donors: a multicenter cohort study.  Am J Transplant 2011; 11:463–469
[CrossRef] | [PubMed]
 
Dew  MA;  Zuckoff  A;  DiMartini  AF;  DeVito Dabbs  AJ;  McNulty  ML;  Fox  KR;  Switzer  GE;  Humar  A;  Tan  HP:  Prevention of poor psychosocial outcomes in living organ donors: from description to theory-driven intervention development and initial feasibility testing.  Prog Transplant 2012; 22:280–292, quiz 293
[CrossRef] | [PubMed]
 
Dew  MA;  Dimartini  AF;  Devito Dabbs  AJ;  Zuckoff  A;  Tan  HP;  McNulty  ML;  Switzer  GE;  Fox  KR;  Greenhouse  JB;  Humar  A:  Preventive intervention for living donor psychosocial outcomes: Feasibility and efficacy in a randomized controlled trial.  Am J Transplant  (in press)
 
Lamba  S;  Murphy  P;  McVicker  S;  Harris Smith  J;  Mosenthal  AC:  Changing end-of-life care practice for liver transplant service patients: structured palliative care intervention in the surgical intensive care unit.  J Pain Symptom Manage 2012; 44:508–519
[CrossRef] | [PubMed]
 
Colman  RE;  Curtis  JR;  Nelson  JE;  Efferen  L;  Hadjiliadis  D;  Levine  DJ;  Meyer  KC;  Padilla  M;  Strek  M;  Varkey  B;  Singer  LG:  Barriers to optimal palliative care of lung transplant candidates.  Chest 2013; 143:736–743
[CrossRef] | [PubMed]
 
Schwarz  ER;  Baraghoush  A;  Morrissey  RP;  Shah  AB;  Shinde  AM;  Phan  A;  Bharadwaj  P:  Pilot study of palliative care consultation in patients with advanced heart failure referred for cardiac transplantation.  J Palliat Med 2012; 15:12–15
[CrossRef] | [PubMed]
 
Shemesh  E:  Assessment and management of psychosocial challenges in pediatric liver transplantation.  Liver Transpl 2008; 14:1229–1236
[CrossRef] | [PubMed]
 
Stuber  ML:  Psychiatric issues in pediatric organ transplantation.  Child Adolesc Psychiatr Clin N Am 2010; 19:285–300, viii–ix
[CrossRef] | [PubMed]
 
Annunziato  RA;  Jerson  B;  Seidel  J;  Glenwick  DS:  The psychosocial challenges of solid organ transplant recipients during childhood.  Pediatr Transplant 2012; 16:803–811
[CrossRef] | [PubMed]
 
LaRosa  C;  Glah  C;  Baluarte  HJ;  Meyers  KE:  Solid-organ transplantation in childhood: transitioning to adult health care.  Pediatrics 2011; 127:742–753
[CrossRef] | [PubMed]
 
LaRosa  C;  Baluarte  HJ;  Meyers  KE:  Outcomes in pediatric solid-organ transplantation.  Pediatr Transplant 2011; 15:128–141
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Who coined the term “psychosomatic medicine?”

See Friedman and Muskin; Clinical Context, History, p 441
2.
Research demonstrates that concordance rates with consultation recommendations primarily depend upon which of the following factors?

See Friedman and Muskin; Treatment Strategies and Evidence, p 443
3.
In treating an agitated delirious patient with a pre-existing dementia in the ICU, which of the following factors influences the choice of an antipsychotic medication?

See Friedman and Muskin; Agitated Patient, p 445
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
DSM-5™ Clinical Cases > Chapter 5.  >
DSM-5™ Clinical Cases > Chapter 5.  >
Textbook of Psychotherapeutic Treatments > Chapter 5.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 9.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 34.  >
Topic Collections
Psychiatric News
PubMed Articles
Immunosuppression-state-of-the-art: anything new in the pipeline? Curr Opin Organ Transplant Published online Aug 23, 2014.;
Bone disease after transplantation: osteoporosis and fractures risk. Arq Bras Endocrinol Metabol 2014;58(5):484-92.