Psychosocial Criteria

Psychosocial Criteria

Patients must be emotionally stable enough to comply with extensive medical follow up required after the surgery. Patients must have a realistic attitude toward potential benefits and hazards of transplantation and immunosuppression. In other words, a history of attempted suicide may be a relative indicator that the patient is unsuitable for organ transplant. A recent suicide attempt is a definite contra indicator of being mentally fit for organ transplantation.

Patients must also have enough cognitive ability to understand and follow the regimen prescribed to transplant patients. A variety of intelligence tests are performed by a psychiatric social worker or doctor; for example the Test of Logical Abstractive Perception (TLAP) and the Non-Verbal Cognitive Performance Examination (NVCPE) are often used. Downs syndrome and other cognitive impairments are absolute contra indicators.You are the surgeon overseeing a medical transplant team. Your team has assembled to decide which of the persons on the recipient list will receive the heart. Under circumstances in which every needy patient would be able to receive a donated heart in a timely fashion (i.e. donated hearts are not scarce) there would be no dilemma. However, this is not the case. Since donated organs are rare, you, with assistance of our team, must make the best use of the donated heart. The recommending organization the United Network for Organ Sharing (UNOS) has published guidelines to help transplant centers make determinations. The OPTN (Organ Procurement and Transplantation Network) provides a list of those patients that are eligible and compatible with the donated heart. You must decide which patient would present the best risk for surviving the procedure.

You will use medical, financial, and psychological criteria in each potential recipient's file as the basis for your recommendation. You may also make assumptions about the patient based on the data provided. You need to make your decision quickly so the transplant team can notify the transplant patient. The patient has to get here immediately so their eligibility status can be verified, and they can be prepped for surgery.

Before you is the recommendation of the team. Do you follow the team's recommendation, or do you deviate from that recommendation?