Preoperative psychological evaluation of transplant patients: Challenges and solutions

Psychological assessments are crucial for the evaluation and optimization of the suitability of transplant patients. The interdisciplinary evaluation in modern transplantation medicine focuses on important psychosocial issues, such as assessing patients’ characteristics that predict best postoperative outcome after solid organ transplantation. When assessing patients for reconstructive hand transplantation, the psychological evaluation should identify whether reconstructive hand transplantation is the best treatment option to regain functionality and sensation, to resolve body image concerns, and to improve health-related quality of life (HRQOL) for each patient. These psychosocial issues in transplantation medicine are receiving increased attention; however, standardized psychological evaluation and follow-up protocols are still being developed. Previously published reports in transplantation medicine have attempted to identify psychosocial factors important in the evaluation of transplant patients and that predict psychosocial outcomes. This review will provide an overview of recent investigations in solid organ and vascularized composite allotransplantation (VCA), including the domains of evaluation, pre- and posttransplant follow-up, psychiatric complications, evaluation of body image, and HRQOL. Recent work highlights the potential for a multicenter research approach utilizing standardized assessment strategies and emphasizing the need for a shared assessment approach to understand psychosocial outcomes. For example, the Chauvet Workgroup convened in 2014 in Paris with stakeholders in the assessment of psychosocial factors to discuss key areas and propose an ongoing shared effort across centers in addressing important questions related to psychosocial care of VCA. A successful transplantation requires a multistaged multidisciplinary psychosocial evaluation to identify those most suited to solid organ or reconstructive transplantation and minimize psychological morbidity. With this in place, current transplant psychosocial practices can be useful for solid organ transplantation and refined for VCA. This review will present potential challenges and solutions for guideline development in both solid organ and VCA.