*Purpose: To establish what, if any, currently available guidelines or assessment instruments can help transplant programs perform fair, and objective evaluations of patients with forensic psychiatric histories. Further, to establish a working set of principles to help clinicians risk stratify those candidates who do have forensic histories, using an evidence-based framework. Ethical considerations of the dilemmas arising in the evaluation of this subpopulation of transplant candidates is also reviewed. Lastly, we elaborate on our development of practice recommendations through the lens of our research and clinical experience with patients.

*Methods: Comprehensive search of the transplant and forensic psychiatric literature , with critical review of all existing transplant recipient assessment tools.

*Results: Currently there are no formal nor informal practice guidelines or recommendations regarding the assessment of transplant candidates who have forensic psychiatric histories. Forensic psychiatrists cannot be consulted at the ready to give an opinion on risks germane to a particular patient. A comprehensive review of the medical literature reveals a severe paucity of research regarding the special assessment needs of individuals with forensic psychiatric histories who need and are seeking organ transplantation. In addition,transplant programs’ policies and procedures may vary widely in how they address this delicate yet complex matter. There is a glaring deficit of dialogue about this sensitive and ethically challenging topic. In the absence of having guidelines or practice recommendations, programs are at risk for approaching candidates with forensic psychiatric histories with potential bias, or on the flip side, failing to adequately screen a candidate out of fear of being perceived as being biased.

*Conclusions: Practice recommendations are needed to assist transplant programs in fairly and objectively assessing transplant candidates with forensic psychiatric histories. This subpopulation of potential transplant recipients have unique assessment needs, and the many ethical challenges involved may engender discomfort, avoidance, or a tendency to summarily approve or dismiss recipients with such histories. Our practice recommendations appear to be the first effort to formally address this great need in the organ transplant arena.

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