Background: Poorly controlled mental health disorders pose contraindications to listing because they are associated with increased noncompliance and graft loss.[1] Once managed, these conditions do not change post- transplant outcomes.[2] Formal guidelines such as SIPAT can help programs make evidence-based listing decisions for these patients.[3] We conducted a survey of how US transplant programs weighed psychiatric characteristics in their listing decisions.

Methods: We distributed an online Qualtrics survey to 650 active adult and pediatric transplant programs in heart, kidney, liver, and lung. The full survey listed 38 psychosocial characteristics, and participants were asked 1) if each characteristic functioned as an absolute (AC), relative (RC), or irrelevant (RC) contraindication to listing, 2) whether their program retained formal, informal, or no guidelines regarding the characteristic, and 3) whether their program had encountered the characteristic. This study examines the subset of psychiatric characteristics .

Results: A majority of programs completed the survey (response rate = 52.8%). Programs reached consensus on all characteristics, but 6-40% of programs had zero guidelines for these. Up to 13% of programs considered stable schizophrenia as an absolute contraindication (AC). Kidney programs were the most lenient (lower %AC, higher %Irr) for dementia (p = 0.005) and multiple lifetime suicide attempts (p = 0.023). Liver programs were most lenient for all other characteristics. Pediatric programs were more lenient than adult programs overall (p << 0.001), but smaller percentages had encountered these characteristics (31-58%) compared to adult programs (83-94%) (p << 0.001).

Discussion: Transplant programs agree in how they consider psychiatric factors when making listing decisions. Even though a substantial percentage of programs have encountered these characteristics, too many currently lack guidelines for them. We recommend that programs draft evidence-based guidelines or adopt existing instruments to minimize variation in practice.

References:

[1] Corbett et al. Mental health disorders and solid-organ transplant recipients. Transplantation. 2013 Oct 15;96(7):593-600.

[2] Skotzko et al. Psychiatric disorders and outcome following cardiac transplantation. JHLT. 1999 Oct 31;18(10):952-6.

[3] Maldonado et al. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Psychosomatics. 2012 Apr 30;53(2):123-32.

CITATION INFORMATION: Lee G., Wall A., Magnus D., Maldonado J. Psychiatric Disorders and Disturbances in Transplant Listing Decisions Am J Transplant. 2017;17 (suppl 3).

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