The presence of end-stage liver disease carries a strong emotional impact for the patient, the family group, and close friends: loss of health and a life-threatening condition generate great stress, which may be accompanied by consternation, denial, anxiety, depression, etc. Indication for transplantation as a saving alternative triggers a counterpart in which fears, expectations, and vital hopes live together with the inevitable clinical deterioration that will eventually potentiate them.
Transplantation goes beyond the surgical act and has to be understood as a process that encompasses the period ranging from pretransplantation to posttransplantation and that affects all life areas, modifying their quality, habitual social and working environment functioning, and roles within the family group. Throughout this process, the patient and their family will have to face different vicissitudes regarding both the patient’s clinical evolution and emotional aspects. The attending team will care about the patient’s well-being and emotional balance; thus, they will contribute to the patient’s understanding of the treatment implications, of the importance of compliance with medical indications, and of the commitment to rehabilitation. Therefore, all these elements are considered of the utmost importance for a favorable evolution, and due to the importance and incidence of these aspects, most transplantation programs include psychologists, psychiatrists, social workers, and/or skilled nursing staff. Although the role of these professionals varies within the different centers and teams, they usually participate in the evaluation of recipients, of living donors and their families, and in the patient’s psychological support and help before and after transplantation.
Despite some differences between the different centers and programs, the psychosocial evaluation before transplantation aims to determine the patient’s aptitude, to identify risk factors, and to predict how he or she will manage the process so as to, if necessary, implement orientation and educational and psychotherapeutic interventions that help the patient and their family achieve a better performance. Studies state that the better the conditions are before transplantation, the better the evolution will be after transplantation.
Semistructured interviews are usually implemented for evaluation. Other tests and tools, together with some specific scales such as the Psychosocial Assessment of Candidates for Transplantation (PACT), the Transplant Evaluation Rating Scale (TERS), and the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) may also be used. Of note, many investigations have proved that poor family support is a factor associated with a poor evolution. Therefore, the family interview is a valuable tool that provides and complements family data by detecting difficulties and conflicts in family members’ interactions with the patient, as well as their strengths and potentialities for the patient’s support. Although the interview is not always carried out (since the family members do not always accompany the patient, the patient does not want them to be present in the interview, etc.), it is absolutely necessary to perform it in some cases. It is important to have an appropriate view of the situation to learn about the patient’s opinions and beliefs in urgent situations ...