Over the past several decades, organ transplant procedures have advanced from experimental grounds into medical mainstream as a well-established set of clinical procedures. While there have been tremendous advancements in science and techniques, with the number of transplants approaching a figure of 1 million,1 several factors still impose significant constraints on the transplant process. One is embodied by the fact that, despite the closing gap, the need for organs (almost 110,000 in 2019)2 still by far exceeds the number of organs available for transplant (almost 40,000 transplants in 2019),2 and the other is subsumed in the sometimes onerous regimen of medications and follow-ups needed to maintain the precarious balance between the host and the graft. A vast majority of organs transplanted in the United States includes kidneys, followed by liver and heart transplants.
Because organs for transplants are a precious resource, transplant programs understandably seek to optimize the benefit of a transplanted organ by evaluating all candidates through the lens of a multidisciplinary team. That team, as a rule, includes a psychosocial component in the form of a social worker, psychologist, psychiatrist, or another specialized mental health practitioner. When approached in this manner, the psychosocial component is utilized to nurture and strengthen the candidate’s coping skills, promote emotional resilience, and build social support systems that the candidate will need in the posttransplant period. This is a considerable evolution from the initial role psychiatrists and psychologists had in the early programs, which was to determine psychological suitability and stability of a transplant candidate.
That task of evaluating psychological suitability still exists today, but now as part of a more comprehensive process. The objective of psychosocial evaluation and preparation in the multidisciplinary team differs slightly from the objective of medical evaluation. In the biological process of transplantation, the guiding principle rests on finding the “optimal match” between the recipient and the organ (donor). The process of psychosocial evaluation and selection in this process allows for more latitude in determining the quality of the match—aiming for a “good enough fit.”
Transplantation is often described as a process, one that begins with a failing organ and a discussion about transplantation as an option. It continues with a number of tests and placement on a candidate list, all the while managing the principal illness, until a final decision has been made and a transplant organ becomes available.3
A comprehensive program seeks to incorporate psychosocial wrap-around into the entire process, rather than have a psychosocial/psychiatric evaluation done as a single test, a “snapshot” of sorts that either “passes” or “fails” the candidate. Even those candidates who appear fit on a psychiatric evaluation can considerably benefit from receiving help in getting prepared for the transplant. On the other hand, candidates who appear to be struggling to meet all the requirements can receive help building resources and strengths that can “push them over ...