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Case Vignettes in Transplant Psychiatry Ethics

Published online by Cambridge University Press:  28 July 2022

H. Paul Chin
H. Paul Chin*
Affiliation:
Departments of Psychiatry and Transplant, California Pacific Medical Center, San Francisco, California 94114, USA
*
Corresponding author. Email: [email protected]
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Abstract

The demand for liver transplants continues to far exceed the number of available viable donor organs; hence, it is of utmost importance to determine those individuals who are best able to care for these valuable, limited resources as potential recipients. At the same time, psychiatric comorbidity is common in the course of end-stage liver disease and can be mutually complicating. This article focuses on liver transplant candidacy from a psychiatric perspective, using illustrative cases to underscore the foundational facets of medical ethics that serve as the guide to these complex medical and ethical decisions.

Keywords

organ transplantationliver transplantorgan donorsorgan recipientstransplant psychiatryconsultation-liaison psychiatrytransplant ethics
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 31 , Issue 3 , July 2022 , pp. 386 - 394
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Notes

1. Donate Life America; available at https://www.donatelife.net/statistics/ (last accessed 15 Dec 2021).

2. Singh, N, Gayowski, T, Wagener, MM, Marino, IR. Depression in patients with cirrhosis: Impact on outcome. Digestive Disease and Sciences 1997;42:1421–7CrossRefGoogle ScholarPubMed.

3. Pelgur, H, Atak, N, Kose, K. Anxiety and depression levels of patients undergoing liver transplantation and their need for training. Transplant Proceedings 2009;41:1743–8CrossRefGoogle ScholarPubMed.

4. United Network of Organ Sharing website; available at https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/ (last accessed 16 Dec 2021).

5. Dew, MA, Rosenberger, EM, Myaskovsky, L, DiMartini, AF, DeVito Dabbs, AJ, Posluszny, DM, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: A systematic review and meta-analysis. Transplantation 2015;100(5):988–1003. doi:10.1097/TP.0000000000000901 CrossRefGoogle ScholarPubMed.

6. Kedia, SK, Ali, B, Jiang, Y, Arshad, H, Satapathy, SK, Gonzalez, HC. Post-liver transplant outcomes in patients with major psychiatric diagnosis in the United States. Annals of Hepatology 2021;22:100311. doi:10.1016/j.aohep.2021.100311 CrossRefGoogle ScholarPubMed.

7. Zanarini, MC, Frankenburg, FR, Reich, DB, Fitzmaurice, G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: A 16-year prospective follow-up study. American Journal of Psychiatry 2012;169(5):476–83. doi:10.1176/appi.ajp.2011.11101550 CrossRefGoogle ScholarPubMed.

8. Perkonigg, A, Pfister, H, Stein, MB, Höfler, M, Lieb, R, Maercker, A, et al. Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. American Journal of Psychiatry 2005;162(7):1320–7. doi:10.1176/appi.ajp.162.7.1320 CrossRefGoogle Scholar.

9. Scales specifically designed for organ transplant have been developed, including the PACT (Olbrisch ME, Levenson JL, Hamer R: The PACT: a rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation 1989; 3:164-169), TERS (Twillman RK, Manetto C, Wellisch DK, Wolcott DL. The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates. Psychosomatics. 1993 Mar-Apr;34(2):144-53. PMID: 8456157), and most recently the SIPAT (Maldonado JR, Dubois HC, David EE, Sher Y, Lolak S, Dyal J, Witten D. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics. 2012 Mar-Apr;53(2):123-32. doi: 10.1016/j.psym.2011.12.012. PMID: 22424160), which can incorporate the results of commonly used diagnostic scales into an overall psychosocial rating for transplant candidate suitability.

10. Pagura, J, Stein, MB, Bolton, JM, Cox, BJ, Grant, B, Sareen, J. Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research 2010;44(16):1190–8. doi:10.1016/j.jpsychires.2010.04.016 CrossRefGoogle ScholarPubMed.

11. Ridola, L, Cardinale, V, Riggio, O. The burden of minimal hepatic encephalopathy: From diagnosis to therapeutic strategies. Annals of Gastroenterology 2018;31:151–64Google ScholarPubMed.

12. California Welfare and Institutions Code Part 1. The Lanterman-Petris-Short Act [5000–5556]; available at https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtmllawCode=WIC&division=5.&title=&part=1.&chapter=1.&article= (last accessed 16 Dec 2021).

13. Gignac, A, McGirr, A, Lam, RW, Yatham, LN. Recovery and recurrence following a first episode of mania: A systematic review and meta-analysis of prospectively characterized cohorts. Journal of Clinical Psychiatry 2015;76(9):1241–8. doi:10.4088/JCP.14r09245 CrossRefGoogle Scholar.

14. Stephenson, LA, Gergel, T, Gieselmann, A, Scholten, M, Keene, AR, Rifkin, L, et al. Advance decision making in bipolar: A systematic review. Front Psychiatry 2020;11:538107. doi:10.3389/fpsyt.2020.538107 CrossRefGoogle ScholarPubMed. eCollection 2020.

15. Tondo, L, Vázquez, G, Baldessarini, RJ. Mania associated with antidepressant treatment: Comprehensive meta-analytic review. Acta Psychiatrica Scandinavica 2010;121(6):404–14. doi:10.1111/j.1600-0447.2009.01514.x CrossRefGoogle ScholarPubMed.

16. Pfitzmann, R, Benscheidt, B, Langrehr, JM, Schumacher, G, Neuhaus, R, Neuhaus, P. Trends and experiences in liver retransplantation over 15 years. Liver Transplantation 2007;13(2):248–57. doi:10.1002/lt.20904 CrossRefGoogle ScholarPubMed.

17. Kashyap, R, Jain, A, Reyes, J, Demetris, AJ, Elmagd, KA, Dodson, SF, et al. Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow-up. Transplantation Proceedings 2001;33(1–2):1486–7CrossRefGoogle ScholarPubMed.

18. Chen, GH, Fu, BS, Cai, CJ, Lu, MQ, Yang, Y, Yi, SH, et al. A single-center experience of retransplantation for liver transplant recipients with a failing graft. Transplantation Proceedings 2008;40(5):1485–7. doi:10.1016/j.transproceed.2008.01.076 CrossRefGoogle ScholarPubMed.

19. Smith, LA, Cornelius, V, Warnock, A, Bell, A, Young, AH. Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: A systematic review of randomized controlled trials. Bipolar Disorders 2007;9(4):394–412. doi:10.1111/j.1399-5618.2007.00490.x CrossRefGoogle ScholarPubMed.

20. Barton, BB, Segger, F, Fischer, K, Obermeier, M, Musil, R. Update on weight-gain caused by antipsychotics: A systematic review and meta-analysis. Expert Opinion on Drug Safety 2020;19(3):295–314. doi:10.1080/14740338.2020.1713091 CrossRefGoogle ScholarPubMed.

21. Carbon, M, Hsieh, CH, Kane, JM, Correll, CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: A meta-analysis. Journal of Clinical Psychiatry 2017;78(3):e264–78. doi:10.4088/JCP.16r10832 CrossRefGoogle ScholarPubMed.

22. Obrisch, ME. Ethical issues in psychological evaluation of patients for organ transplant surgery. Rehabilitation Psychology 1996;41(1):53–71 CrossRefGoogle Scholar.

23. Belli, LS, Perricone, G, Adam, R, Cortesi, PA, Strazzabosco, M, Facchetti, R, et al. Impact of DAAs on liver transplantation: Major effects on the evolution of indications and results. An ELITA study based on the ELTR registry. Journal of Hepatology 2018;69(4):810–7. doi:10.1016/j.jhep.2018.06.010 CrossRefGoogle ScholarPubMed.

24. Mehta, N, Bhangui, P, Yao, FY, Mazzaferro, V, Toso, C, Akamatsu, N, et al. Liver transplantation for hepatocellular carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference. Transplantation 2020;104(6):1136–42. doi:10.1097/TP.0000000000003174 CrossRefGoogle Scholar.

25. Siskind, D, McCartney, L, Goldschlager, R, Kisely, S. Clozapine v. first- and second-generation antipsychotics in treatment-refractory schizophrenia: Systematic review and meta-analysis. British Journal of Psychiatry 2016;209(5):385–92. doi:10.1192/bjp.bp.115.177261 CrossRefGoogle ScholarPubMed.

26. Buchanan, RW, Kreyenbuhl, J, Kelly, DL, Noel, JM, Boggs, DL, Fischer, BA, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia Bulletin 2010;36(1):71–93. doi:10.1093/schbul/sbp116 CrossRefGoogle ScholarPubMed.

27. Strauss, GP, Harrow, M, Grossman, LS, Rosen, C. Periods of recovery in deficit syndrome schizophrenia: A 20-year multi-follow-up longitudinal study. Schizophrenia Bulletin 2010;36(4):788–99. doi:10.1093/schbul/sbn167 CrossRefGoogle ScholarPubMed.

28. Modestin, J, Huber, A, Satirli, E, Malti, T, Hell, D. Long-term course of schizophrenic illness: Bleuler’s study reconsidered. American Journal of Psychiatry 2003;160(12):2202–8. doi:10.1176/appi.ajp.160.12.2202 CrossRefGoogle ScholarPubMed.

29. Cherkassky, L. A fair trial? Assessment of liver transplant candidates with psychiatric illnesses. Journal of Medical Ethics 2011;37(12):739–42. doi:10.1136/jme.2011.042556 CrossRefGoogle ScholarPubMed.

30. Osorio, RW, Ascher, NL, Avery, M, Bacchetti, P, Roberts, JP, Lake, JR. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease. Hepatology 1994;20(1 Pt 1):105–10. doi:10.1016/0270-9139(94)90141-4 Google ScholarPubMed.

31. Mathurin, P, Moreno, C, Samuel, D, Dumortier, J, Salleron, J, Durand, F, et al. Early liver transplantation for severe alcoholic hepatitis. New England Journal of Medicine 2011;365(19):1790–800. doi:10.1056/NEJMoa1105703 CrossRefGoogle ScholarPubMed.

32. Lee, BP, Mehta, N, Platt, L, Gurakar, A, Rice, JP, Lucey, MR, et al. Outcomes of early liver transplantation for patients with severe alcoholic hepatitis. Gastroenterology 2018;155(2):422–30.e1. doi:10.1053/j.gastro.2018.04.009 CrossRefGoogle ScholarPubMed.

33. Norris, KC, Agodoa, LY. Unraveling the racial disparities associated with kidney disease. Kidney International 2005;68(3):914–24. doi:10.1111/j.1523-1755.2005.00485.x CrossRefGoogle ScholarPubMed.

34. Zhang, X, Melanson, TA, Plantinga, LC, Basu, M, Pastan, SO, Mohan, S, et al. Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system. American Journal of Transplantation 2018;18(8):1936–46. doi:10.1111/ajt.14748 CrossRefGoogle ScholarPubMed.

35. Goyes, D, Nsubuga, JP, Medina-Morales, E, Patwardhan, V, Bonder, A. New OPTN simultaneous liver–kidney transplant (SLKT) policy improves racial and ethnic disparities. Journal of Clinical Medicine 2020;9(12):3901. doi:10.3390/jcm9123901 CrossRefGoogle ScholarPubMed.

36. Achieving Racial Equity in Transplantation; available at https://unos.org/news/racial-equity-in-transplantation/ (last accessed 16 Dec 2021).