Abstract
In Japan brain death organ transplantation was just started recently and many patients requiring transplant are still under strong mental stresses because of long waiting period, low possibility of transplant, long distance from their home to transplantation hospital. In order to investigate mental states of cadaver heart or lung transplant candidates, psychiatric diagnosis, psychological or behavioral problems and need for treatment were evaluated around the time of registration to waiting list and followed up. The subjects consisted of 71 heart transplant candidates (male 54, female 17, average age 35, SD = 18) in Osaka University Hospital and National Cardiovascular Center from December 1997 to May 2001 and 11 lung transplant candidates (male 4, female 7, average age 38, SD = 11) in Osaka University Hospital from April 2000 to May 2001. In about a half of the candidates their dwelling places were out of Kansai area. Forty eight (68%) of 71 heart transplant candidates were equipped with ventricular assist device during the follow-up period. This ratio is much higher than foreign candidates because of severe deficiency of brain death donors in Japan. Among total 82 candidates 41 had more than one DSM-IV diagnosis. Twenty-four candidates were diagnosed as Adjustment Disorder which was most frequent diagnosis. Three candidates had Depressive Disorder, two had Psychotic Disorder and three had Personality Disorder. Excluding the candidates who had only Cognitive Disorders, intelligence problems or Mental Disorders due to a General Medical Condition, 30 candidates (37%) were diagnosed as disorders with mainly psychological elements. Need for intervention in mental problems were divided into four levels such as (1) need for crisis intervention including psychotic state, suicidal idea, extreme agitation and violence, etc : 7 candidates (9%), (2) need for therapy or intensive observation : 23 candidates (28%), (3) need for some attention : 38 candidates (46%), (4) no need of specific concern : only 14 candidates (17%). Unstable emotions such as anxiety, depression and irritation were most frequent problems. Organic mental diseases such as delirium, cognitive dysfunction and personality change due to cerebrovascular disease were important, too. Behavioral problems such as poor compliance, violence, neglect of rules, withdrawal and regression were difficult to treat because personality problems were often behind them. Such high rate of necessity for mental treatment or attention indicates that consultation-liaison activity is important in heart or lung transplantation. Especially candidates having severe mental problems may become contraindication for transplant. Urgent and sufficient mental treatment and support must be provided for them. In the future more efficient liaison structure should be made and consultation-liaison activity should be expanded into many hospitals that are not transplant hospital but have to manage transplant candidates. It would also be important to support family of candidates who experience strong and long-lasting mental stresses.
