In the last 10 years, the demand for psychological support for patients undergoing heart transplantation has increased, and the content has also changed with recent technical innovations. The psychological support provided, however, has not kept up with the changes in heart transplant technology. Support should be aimed at three major issues. The first is the mental and physical stress due to heart failure. The second is the pre-transplant psychosocial assessment of the recipient because the psychosocial background before transplant may affect the transplantation prognosis. The third is related to implantable ventricular assist devices (VAD). Due to the technological innovations of the VAD, the quality of life and activity of the patients have increased. In conjunction, responsibilities of self-care and economic self-reliance for the patients and their families have also increased, leading to various psychological issues.
Lung transplant recipients could become more fearful of death during the waiting period and tend to be unstable emotionally. Moreover, even if surgery is successful, anxiety about and fear of rejection will follow. Severe rehabilitation must be done immediately after surgery, and furthermore, medications (immunosuppressants), frequent hospital visits, medical examinations and health care are required over a lifetime. Along with changes in social roles, adaptation to a new life is also necessary.
Thus, in lung transplant recipients, psychiatric and psychosocial aspects are extremely important throughout the preoperative and postoperative periods.
In this article, the authors describe in detail psychiatrists’ assessment in the lung transplant recipient, based on the authors’ clinical experience.
Liver transplantation to alcoholic liver disease patients still holds problems such as conflict of psychiatrists who perform interviews with recipients, ethical issues and social dilemmas. Ironically, in spite of these unsolved problems, liver transplantation has been shown to be useful and medically established due to outcome of the treatment. Importance of the follow-up treatment of the organ recipients after transplantation is discussed more than validity of transplantation. We suggest that, for the liver transplantation recipients with alcoholic liver disease, much more attentive mental and physical care for the lifetime is necessary.
In Japan, elderly recipients and living donors who are involved in kidney transplantation have been increasing in number over this decade. Older age leads to high risk of cognitive impairment including dementia and delirium caused by any physical disorder. Psychosocial and psychiatric assessment and sufficient support for elderly kidney transplant recipients and donors are particularly important.
Although postoperative quality of life of living donors for organ transplantation has been reported to be better than that of the normal population, it is reported that they also experience various psychiatric and psychological problems. In this report, we review psychiatric and psychological problems and consider effective mental interventions for living donors. It is inferred that there is a specific psychological mechanism in the donor, such as obtrusion in donors, rebirth fantasy, rebound neglect, or ambivalent feelings about donor selection. In addition, donors sometimes exhibit physical, economic, and social anxiety and a depressive state arising from feelings of guilt towards the recipient. It is important for caregivers to recognize these mechanisms and understand the donor’s psychology. The death of the recipient, delay in returning to society, lack of family support, economic burden, and past history of mental illness are the risk factors for donors’ low psychological quality of life and require intensive support. Donors who are not fully aware of their own psychological ambivalence before donation also tend to experience decline in the psychological quality of life. In Japan, third parties evaluate the spontaneity of providing donor organs in an interview. In this interview, asking about donors’ ambivalence may contribute to donors’ mental well-being. Focusing on positive aspects of donation, such as post-traumatic growth and resilience, is also important.
The patient was a man in his sixties who received kidney transplantation from a deceased donor. Five months after the transplantation, his serum creatinine (sCre) increased up to 3.2 mg/dL from around 2.0 mg/dL. As we diagnosed as acute T cell-mediated rejection (TCMR) by renal biopsy, we performed steroid pulse for 3 days. Although sCre temporarily improved to around 2.5 mg/dL, sCre increased again immediately. Thus, we were forced to send the patient to another hospital for further examination and treatment. There, the steroid pulse was performed again, and sCre improved to around 2.5 mg/dL again. Due to the sudden increasing of sCre up to 5.2 mg/dL, the patient was hospitalized for treatment. After that, the gradual decline in platelet count resulted in bleeding from the sigmoid colon which required endoscopic clipping. As we considered the possibility of thrombotic microangiopathy (TMA), we decided to remove the transplanted kidney. Nevertheless, bleeding from the duodenum subsequently occurred. Although we performed the endoscopic clipping, and transcatheter arterial embolization (TAE) of the inferior pancreaticoduodenal artery and transfusion, the patient died after 38 days. After the autopsy, Epstein-Barr virus-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in the liver and spleen, bone marrow, and transplanted kidney was identified, although the bleeding from the digestive organs was the main cause of death. Consequently, EBV-PTLD surely brought death, and we learned the necessity of monitoring EBV-DNA by real-time PCR under the consideration of the possibility of the development of EBV-PTLD in the case of excessive immunosuppression like steroid pulse, even for EBV seropositive cases.