During three and a half years of psychiatric liaison with a cardiac transplantation program, the authors evaluated and followed 101 transplantation candidates. Ten exhibited pronounced ambivalence toward cardiac transplantation. Ambivalence appears to be associated with three factors: difficulties facing the seriousness of the cardiac illness, fear of the actual operation, and quality of life-concerns. An essentially nonpathological response, ambivalence can produce significant psychiatric symptoms and management problems in transplant candidates. Its resolution can be facilitated by psychotherapy, appropriate medication, peer support, and patience. Some patients may need particular assistance in understanding that refusal of transplantation is an acceptable alternative.
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