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Are there well-accepted or standardized criteria for patient selection into a transplant program, particularly regarding psychosocial issues such as family support, substance use issues, etc.?
This is a broad-reaching question and I would refer the reader to the articles cited at the end of this response. However, the following may serve as an initial response. Although each transplant center develops its own set of psychosocial criteria, there appears to be general consensus about issues pertinent to patient selection. Factors such as patient compliance with medical care, acceptance of the need for transplantation, understanding risks and benefits of transplantation, past psychiatric history, substance use or abuse, and social stability/support are considered important. Questionnaires such as the Psychosocial Assessment of Candidates for Transplantation and Transplant Evaluation Rating Scale have been devised to help standardize the evaluation process, but are not used by all centers.
The aim of including psychosocial evaluations and selection criteria in transplant evaluations is to help predict which patients will be more at risk for poor outcomes. In theory, this knowledge beforehand gives the transplant program an opportunity to consider what resources may be necessary to increase the chance of patients experiencing successful posttransplant outcomes. This may involve assistance/advice about medical coverage, arranging transportation/nursing care, or assessing appropriate mental health services.
Differences in how psychosocial information is used in patient selection often vary according to the type of transplant program involved; cardiac transplantation programs tend to be the most stringent and renal transplantation programs tend to be the least stringent. Other factors such as organ availability, the need to fulfill a transplant quota (ie, minimum case volume to obtain Medicare center of excellence status), and prior outcomes with complicated psychosocial cases can also influence how psychosocial criteria are used in candidate selection.
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