Psychiatric Liaison to Liver Transplant Recipients

Abstract

Child psychiatric consultants perform psychiatric assessment and liaison among various clinical services. Execution of these familiar roles for pediatric liver transplantation recipients exposes unfamiliar and difficult bioethical problems. Administrative problems arise if the recipient's suitability is too narrowly evaluated. Assessment may be time-limited. The intensive care unit environment and the VIP characteristics of child transplantation patients may distort observations and constrain opportunities for preventive preoperative psychologic management. Unnecessary psychiatric complications may ensue, which imperil the transplantation surgery. The primary caretakers may have an extraordinary emotional investment, so liaison is pressured. Three cases are presented to illustrate these points. Medical ethical perspectives and the limitations of medical training to prepare physicians to perceive them are indicated. That these limitations also affect the psychiatrist is acknowledged, and a clinical research approach is suggested.

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References

Buchanan DC Group Therapy for Kidney Transplant Patients. Int J Psychiatry in Medicine 1975;6:523-32.

Caplan AL Organ transplants: the cost of success. Institute of Society, Ethics, and the Life Sciences. The Hastings Center Report. 1983;13(6):23-32.

Starzl TE , Shunzaburo I. , Van Thief DH , et al. Evolution of liver transplantation. Hepatology 1982;2:614-36.

Ahlqvist J. Hormonal influences on immunologic and related phenomena. In Ader R (ed). Psychoneuroimmunology . New York: Academic Press, 1981, pp 355-404.

Famularo RA , Kimball CP Liaison psychiatry considerations in renal hemodialysis patients with acute organic cerebral disorders. In Levy, NB (ed). Psychonephrology 2, New York : Plenum 1983, pp 71-8.

Klein SD , Simmons RG The psychosocial impact of chronic kidney disease on children. In Simmons RG , Klein SD , Simmons RL (eds). Gift of Life. New York: Wiley 1977, pp 89-118.

Bernstein DM Psychiatric assessment of the adjustment of transplanted children . In Simmons RG , Klein SD , Simmons RL (eds). Gift of Life: New York: Wiley 1977, pp 119-48.

Eisendrath RM The role of grief and fear in the death of kidney transplant patients. Am J Psychiatry 1969;126: 381-7.

Greenberg RP , Davis G. , Massey R. The psychological evaluation of patients for a kidney transplant and hemodialysis program. Am J Psychiatry 1973;130:3.

10.

Engel GL , Schmale AH Jr. Psychoanalytic theory of somatic disorder: conversion, specificity and the disease onset situation. J Am Psychoanalytic Assoc 1967;15:344-65.

11.

Freyberger H. The renal transplant patient: three-stage model and psychotherapeutic strategies . In Levy NB (ed). Psychonephrology 2, New York: Plenum 1983, pp 259-66.

12.

Armstrong S. Children and adolescents on hemodialysis and transplantation programs . In Levy NB (ed). Psychonephrology 2. New York: Plenum 1983, pp 213-22.

13.

Penn D. , Bunch D. , Olenk D. , et al. Psychiatric experiences with patients receiving renal and hepatic transplants. In Castelnuovo-Tedesco (ed). Psychiatric Aspects of Organ Transplantation. New York: Grune and Stratton, 1971 .

14.

Koocher GP , O'Malley JE The Damocles syndrome. Psychosocial issues in treatment of childhood cancer . New York: McGraw-Hill, 1981, pp 1-30.

15.

Viederman M. The search for meaning in renal transplantation . Psychiatry 1974;37:283-90.