2 - Organ transplantation

In 1954, there was the first …

•  1st successful (living donor) kidney transplant between two twins.

  • The reason they were able to do this so long ago was because they were identical twins.

In 1967, there was the first…

•  1st heart and 1st liver transplant

  • But they were not living a long time

In 1983, …

Anti-rejection medication: Cyclosporine FDA-approved, 1st successful lung transplant (TGH) done in Toronto.

In 1998, there was the first …

1st adult-to-adult living liver transplant

In 2010, there was the first…

1st FULL face transplant

 

• High-level investment from health care, patient, families

• A LOT required, and a lot of people.

If you think it is important, why have you not registered?

• Aversive/unpleasant to think about our death

• Knowledge

• Time, logistics and not a priority

• Religious beliefs

• Family objections

Why the Donor Shortage?

• Attitudes/beliefs

  • "if I want to be a donor, they wont try and save me"

  • General distrust in medical system

• Emotional factors

  • Fear of disfigurement

  • Don’t want to think of own death

• Social factors

  • Family objections (despite donor consent)

• Lack of knowledge/education

  • How to donate, who can donate, what will it cost

 

 

• Few deaths are “eligible” for organ donation

• Organ quality

• Organ preservation

Almost ____ of BC residents support organ donation, yet only _____ have registered their decision on BC's Organ Donor Registry

85%
28%

Presumed consent "opt out"

• Organs automatically available unless registered objections

• Family can still object

• 20-30% increase in donors

 

• Quite a few countries who have this

• NOVA SCOTIA is the only one is Canada that uses this system

Xenotransplantation

Transplantation of living cells, tissues or organs from one species to another 

What are the 3 parts of the process psychology is involved in?

• Pre-transplant psychosocial assessment

• The Waiting Game

• Post-transplantation

In the pre-transplant psychosocial assessment, the psychologist can

• Screen people for a variety of surgeries

• Interested in spinal cord stimulation, bariatric surgery, etc.

• Medical urgency, blood type matching, size of the individual, time on list

  • But other factors…

Goals of Pre-transplant Psychosocial Assessment?

Is patient suitable from psychosocial perspective?

 

• Any psychosocial factors that would be absolute contraindication? (i.e., no-go!)

• Any psychosocial factors that would be relative contraindication? (i.e., can be waitlisted but factors that must be addressed before/during/after transplant to reduce risk and optimize outcomes)

There are standardized assessment tools used to be consistent across patients and transplant centres.

This includes the ______

Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT)

Is BMI a contraindication?

In a study of 430 patients transplanted during a 10 year period, BMI was NOT an independent predictor of mortality and “no level of BMI led to significantly worse survival”

 

• research out that weight should not disqualify a candidate

• Underweight may be more at risk

Is psychiatric disorder a contraindication?

• Findings have been mixed for depression as risk factor for post-transplant mortality

 

• “there is NO psychiatric disorder that is an absolute contraindication to transplantation and even the most psychiatrically complex patient, can have successful long—term outcomes.

Is medical nonadherence a contraindication?

IS an absolute contraindication for heart and lung transplant

• “psychiatric conditions associated with the inability to cooperate with the medical/allied health care team and/or adhere with complex medical therapy”

Is lack of social support a contraindication?

• Depends on organ

  • YES (absolute) --> heart and lung

  • NO (relative contraindication)-->  kidney and liver

 

• Liver --> “patients should have adequate social/caregiver support to provide the necessary assistance both while waitlisted and until independently functioning in the postoperative period.

Is alchohol use a contraindication?

Main point --> “There is no conclusive evidence to support the abstinence rule”

• Typically therapy/rehab to address alcohol use (not outright rejection)

 

Study --> Meta-analysis of substance use post-tx

• Relapse predicted by: poor social support, family history of alcohol abuse/dependence duration of pre-tx abstinence.

• BUT: relapse does not appear to predict survival

 

• Research has suggested we should not be using this rule (should be compassionate) --> discrimination associated with stigma of alcohol and cannabis use disorders.

  • Stigma increases health-related inequities.