The Role of Psychiatrist in Organ Transplantation: From Gate-keeper to Patient's Advocate

Purpose: To offer a uniform framework for the participation of psychiatrists and mental health professionals involved in the multidisciplinary evaluation leading to decision about listing patients for organ transplantation. Method: Literature review of evidence regarding the impact of psychiatric disease upon post- transplantation outcomes; literature review and opinion review regarding psychological implications of decision to list or decline from organ transplantation for patients, family and medical staff. Results: The authors propose three areas of knowledge which can help the mental health professionals who participate in the decision to list or decline patients from listing for organ transplantation. The first area consists of the body of knowledge regarding the impact of psychiatric illness upon medical outcomes post transplantation. A second domain consists in structural and administrative factors related to the transplant program. Third area of interest is represented by the psychodynamic implications of the decision about listing upon patients, family and medical staff. These areas are discussed based on the existing literature and author’s experience. Conclusion: In addition to the psychiatric evaluation of the transplant candidate, psychiatrists can help the transplant teams with the difficult process of declining from listing.