Psychosocial challenges before and after organ transplantation

Figures & data

Table 1 Generic course of a chronic disease before and after transplantation, patients’ coping demands, and psychological interventions

Disease course	Patients’ psychological reactions and coping demands	Psychological interventions
First symptoms Diagnosis Living with a chronic illness Persistent symptoms Frequent doctor visits and hospital stays Medical treatment	Adaptation to crisis Attribution of meaning (subjective illness theory) Attempting to maintain personal autonomy Accepting changes in occupational and family roles Developing new life goals Acquiring new coping strategies and activating resources (eg, social support)	Crisis intervention Supportive therapy to facilitate illness acceptance and illness coping Facilitate adherence and knowledge/understanding of illness (illness education) Facilitate formation of new role perceptions and life goals Family counseling Mediate contact to patient support groups and targeted treatment measures (eg, detoxification therapy)
Preoperative stage Transplant evaluation Waiting list Medical crises Hospitalization	Decisional conflicts Uncertainty Helplessness, hopelessness Preoperative fear Fear of death Acute stress reaction (shock)	Psychosocial evaluation Facilitate decision-making and adherence Facilitate coping with uncertainty and stress reduction Facilitate processing of fear, grief, depressiveness, and aggression Family counseling Crisis intervention
Perioperative stage Complications Acute rejection	Postoperative delirium (acute organic brain syndrome) Organ integration Traumatic experiences Fear of rejection Coping with complications	Facilitate processing of delirium/psychotic symptoms Facilitate organ integration and processing of “donor fantasies” Facilitate processing of traumatic reactions, fear, and pain Support/encouragement in case of somatic crises
Postoperative stage Convalescence New medical treatments Immunosuppressive medication Side effects, associated comorbidities Rehospitalization Chronic rejection Retransplantation	Fear of organ failure/loss Fear of infections and other comorbidities (eg, cancer) Coping with medical problems Readjustment and adherence problems In case of graft failure: Hopelessness, depressiveness Feelings of guilt Increased fear of retransplantation and organ failure	Facilitate fear processing and emotional stabilization Facilitate adherence and readjustment Crisis intervention Supportive therapy Cognitive and behavioral interventions Family counseling Mediate contact to patient support groups

Table 2 Psychosocial evaluation criteria and critical results

Evaluation criteria	Critical results
Disease acceptance	Denial/lack of acceptance of illness or necessity for transplantation
Knowledge regarding disease and transplantation	Lack of knowledge
Transplant motivation	Lack of motivation to receive a transplant
Expectations regarding transplant outcome	Unrealistic expectations
Past and present coping behavior	Inadequate coping behavior
Past and present adherence	Inadequate adherence
Health behavior	Inadequate health behavior
Substance use (alcohol, tobacco, illicit drugs)	Substance abuse
Past and present addictive behavior	Substance dependence
Past and present psychiatric disorders	Active psychiatric disorder
Symptoms of anxiety, depression	Severe symptoms of anxiety/depression
Cognitive status, capacity to give consent and adhere to the medical regimen	Cognitive deficits, inability to give consent/adhere
Social anamnesis (living arrangements, relationships, social support)	Unstable/problematic relationships, lack of social support
Occupational situation and post-transplant expectations/goals, economic situation	Occupational and/or financial problems, unrealistic goals (under- or overstated)
Other psychosocial stressors	High psychosocial burden