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Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (훽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (훽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (훽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility. [ABSTRACT FROM AUTHOR]

Objetive: The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians. Method: The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions. Results: A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified. Conclusions: (1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

Objetive: The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians. Method: The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions. Results: A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified. Conclusions: (1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families. [ABSTRACT FROM AUTHOR]

One of the criteria used by many transplant centers in assessing psychosocial eligibility for solid organ transplantation is social support. Yet, social support is a highly controversial requirement that has generated ongoing debate between ethicists and clinicians who favor its consideration (i.e., utility maximizers) and those who object to its use on equity grounds (i.e., equity maximizers). The assumption underlying both of these approaches is that social support is not a commodity that can be purchased in the marketplace. This essay argues for the reconceptualization of social support as a product that can—and should—be purchased for transplant candidates to render them eligible for transplant. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to examine the clinical and sociodemographic characteristics of children and adolescents whom juvenile courts have given health measures.Methods:The data of 351 cases that were followed up and treated in the Child and Adolescent Mental Health and Diseases Outpatient Clinic of Mersin City Training and Research Hospital between March 2017 and June 2022 were retrospectively analyzed.Results:The mean age of the cases was 12.71±3.61, and the majority (66.1%) were girls. The family’s inadequacy in care was the most common reason for health measure decisions (35.3%). 54.7% of children and adolescents belonged to broken families. While the rate of having at least one psychiatric diagnosis was 63.2%, the most common diagnosis was anxiety disorder, with 23.9%. Nearly half of the cases (46.7%) were not followed up regularly within the scope of health measures.Conclusion:The frequency of health measure decisions for children and adolescents is increasing. This study exhibited the high rates of psychopathology and family problems in children with health measure decisions. A holistic approach that includes the family and social environment should be developed in these cases’ follow-up and treatment processes.

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Children with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as antegrade continence enema (ACE) procedures are considered. Many children benefit from these procedures; however, some children continue to have incontinence, experience complications, or discontinue the use of the ACE stoma. There is some evidence in the literature to indicate that psychosocial factors can have an impact on ACE outcomes; however, standardized biopsychosocial guidelines related to ACE candidacy and surgery do not currently exist. Purpose: The purpose of this review is to summarize the research to date on psychosocial factors related to ACE treatment outcomes and complications. Identifying what is known and what limitations remain can support future research to inform development of guidelines for pre‐procedure evaluations. Psychosocial pre‐procedure evaluations could help to inform eligibility for the procedure as well as interventions to enhance outcomes for children at increased risk for poor outcomes or complications from ACE. Age, psychiatric symptoms, and adherence to the ACE flush regimen were some of the factors identified in the literature as impacting ACE outcomes; however, there is limited research in this area. [ABSTRACT FROM AUTHOR]

Copyright of Medicus (1330-013X) is the property of Pliva Hrvatska d.o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article discusses the first cardiac xenotransplant performed on a consciously consenting human. Xenotransplantation, the transplantation of organs from animals to humans, is seen as a potential solution to the shortage of human organs available for transplantation. However, there are various risks and considerations associated with xenotransplantation, including zoonotic disease transmission, lifelong monitoring, animal welfare issues, and psychosocial impacts on recipients. The article highlights the need for comprehensive psychiatric evaluation and support for patients undergoing xenotransplantation, both before and after the procedure. It also emphasizes the importance of preparing patients for potential media exposure and the disclosure of private health information. The case discussed in the article reveals the challenges and shortcomings in the current approach to psychiatric assessment and support in xenotransplantation cases. The authors suggest the development of standardized guidelines and a multidisciplinary approach to address the unique challenges of xenotransplantation. [Extracted from the article]

With increasing evidence highlighting the link between psychological factors such as self-esteem, self-efficacy and optimism on employability outcomes, this paper reports an evaluation of a unique student experience initiative called 'Life Design' developed to support the professional and personal development of undergraduate students. First year undergraduates engaged in a two-hour workshop involving interactive exercises designed to foster self-reflection, self-efficacy, and career optimism. The impact of this workshop on validated self-report measures of self-esteem, self-efficacy, and optimism, alongside career-related outcomes was explored using a prospective longitudinal design. Analyses revealed a significant immediate and sustained increase in self-esteem following Life Design, but no impact on self-efficacy or career optimism. Certainty of career developing steps increased at a later follow up, but no changes to career prospect confidence or career choice certainty were reported. This paper highlights the benefits and wider challenges of delivering and engaging students in initiatives designed to enhance employability. [ABSTRACT FROM AUTHOR]

• VAD program coordinators report adoption of the 2018 ISHLT PS recommendations into clinical practice. • Capacity to operate MCS was recognized as one of the most important elements of the psychosocial evaluation. • Barriers remain to full adoption and implementation of the 2018 ISHLT psychosocial recommendations in clinical practice. Recommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation. Assess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support. Cross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email. Total of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 – 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41). The 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Psychosocial evaluations to assess candidacy for advanced heart failure therapies are not standardized across institutions, potentially contributing to disparities in approval for advanced therapies. Remediation rates of psychosocial stressors among patients with advanced HF and reconsideration for advanced therapies have not been well-described., Methods and Results: We performed a retrospective, single-center study of 647 adults evaluated for heart transplant and ventricular assist device implantation between 2014 and 2020, of whom 89 (14%) were denied for psychosocial stressors, including caregiver, substance use, housing, financial, or mental health concerns. Later reevaluation occurred in 32 patients (36%), of whom 23 were then approved. Patients initially declined were mostly male (76%), White (74%), and urban (79%). Reevaluation occurred in more women than men (43% vs 34%), Black patients than White (43% vs 37%), and urban patients than rural (39% vs 28%). Patients had fewer psychosocial stressors at reevaluation (median 0.5) than at initial denial (median 2.0). Caregiver and substance use concerns were the most prevalent stressors in patients never returning for or subsequently denied at reevaluation., Conclusions: Caregiver and substance use concerns were common in patients denied for psychosocial reasons. Future efforts should focus on early screening for these stressors and the implementation of a systematic reevaluation process., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The average life expectancy for cystic fibrosis (CF) has increased over the past four decades resulting in a higher rate of adult CF patients. Adults seeking lung transplant to address CF-related advanced lung disease (ALD) represent a small, yet growing, subset of lung transplant recipients. Psychosocial factors such as adherence to medical recommendations, self-management of medical care, and caregiver support have been identified as positive prognostic factors in lung transplant outcomes. These factors are also implicated in the pediatric chronic illness literature and are crucial as patients begin to transition to a more autonomous and independent role in their own health management. Adults with CF facing ALD must navigate through another transitional phase as lung transplant requires additional supports and new expectations. A case series is used to highlight specific psychosocial considerations in this population and to explore the seemingly dichotomous relationship between independent self-management and caregiver support. [ABSTRACT FROM AUTHOR]

Background: Data regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre- and post-LT outcomes of adult LT candidates with a self‐reported history of MJ use. Methods: Baseline clinical characteristics, waitlist, and post‐LT outcomes of adult LT candidates from January 2010 to March 2017 were compared. Results: Among 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12 months, respectively. Although the proportion of MJ users increased over time(β =.76, p =.03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01–1.52), MELD score (OR 1.08, 95% CI 1.01–1.15), HCC (OR 1.83, 95% CI 1.39–2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50–0.91, p =.01). The median time to listing was longer among MJ users compared to non‐users (115 vs. 87 days, p <.0005). Post-LT survival was similar in 83 MJ users and 306 non‐users. Conclusion: The proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post‐LT survival was not impacted by self‐reported MJ use history. [ABSTRACT FROM AUTHOR]

A psychosocial evaluation is an important component of the preoperative assessment process for people seeking metabolic and bariatric surgery (MBS), and is required for accreditation of MBS programs. Recently, independent companies without affiliations with MBS programs have been marketing remotely administered, unaffiliated psychosocial evaluations for MBS (RUS), and American Society for Metabolic and Bariatric Surgery (ASMBS) members have raised concerns about these evaluations. To explore ASMBS members' beliefs about RUS. Online survey. We developed a survey to evaluate ASMBS members' opinions, experiences, and/or concerns about in-person and RUS psychosocial evaluations for MBS. In total, 635 ASMBS members responded to the online survey and 156 responded to an open-ended question on RUS. Responses were coded based on a manual developed for this study, yielding themes of concerns about the quality of RUS, lack of ongoing relationships in RUS, and conditions under which/reasons why RUS evaluations could be acceptable. Respondents expressed both interest in and concerns about RUS in pre-MBS psychosocial evaluations. Use of RUS has the potential to improve access to MBS by providing a convenient and efficient means of completing the psychosocial evaluation. Conversely, respondents expressed concerns about the background and training of RUS providers, the quality of the reports, and the limited relationships between the RUS provider and both the MBS patient and the MBS team. We discuss the clinical and research implications of response themes, particularly for patients in rural areas or those who have other barriers to care. • Patients seeking bariatric surgery must complete a psychosocial evaluation • Unaffiliated companies are increasingly hired to complete these evaluations remotely • A benefit of unaffiliated evaluations is lessening barriers to care • Concerns include limited provider training and lower evaluation quality [ABSTRACT FROM AUTHOR]

Summary: Presurgical psychosocial evaluations are an important component of bariatric care; yet, bariatric programs vary widely in their assessment and interpretation of psychosocial risk. There is a need for validated clinical tools that help to standardize and streamline the assessment of variables relevant to surgical outcomes. The present study contributes to the validation of the Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASS), a novel presurgical psychosocial evaluation tool, by: (a) examining the psychometric properties and optimal cutoff score, and; (b) examining the ability of the BIPASS tool to predict outcomes 1 and 2 years postsurgery, including weight regain, quality of life, psychiatric symptoms and adherence to postsurgical follow‐up appointments. The BIPASS was applied retrospectively to the charts of 179 consecutively referred patients to a metropolitan bariatric surgery programme. Internal consistency for the BIPASS was acceptable, and interrater reliability was excellent. Higher BIPASS scores predicted higher binge eating symptomatology and lower mental health‐related quality of life at 1 year postsurgery, and weight regain at 2 years (all P <.01). The BIPASS did not predict adherence to postsurgical follow‐up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of disordered eating, poor quality of life and weight regain early in the postsurgical course, thereby facilitating patient education and appropriate interventions. [ABSTRACT FROM AUTHOR]

Introduction: Patients with liver cirrhosis who are candidates for liver transplantation must be evaluated both clinically and socially in order to obtain the optimal outcomes and avoid futile therapeutic measures. For the evaluation of the social aspects in these patients, no validated scale in Spanish is available. The SIPAT (Stanford Integrated Psychosocial Assessment for Transplantation) scale is an instrument that measures the social, family and psychological aspects in candidates for solid organ transplantation. The objective of this study is to adapt and validate an abbreviated version of the SIPAT scale in Spanish for patients with liver cirrhosis., Material and Methods: Prospective observational study carried out in the Hepatology Unit of the La Fe Unversity Hospital in Valencia, by questionnaire validation methodology. To analyze the reliability of the questionnaire, the internal consistency of all variables was calculated, for variability an exploratory factor analysis, and for stability the test-retest test was carried out., Results: 96 patients who were admitted for decompensated cirrhosis to the Hepatology Unit of the La Fe Hospital in Valencia between November 1, 2017 and January 31, 2017 were selected. 84% were men, the mean age was 60.01 (SD 10.12) years. In 73.2% of those admitted, the etiology of cirrhosis was alcoholic. 14.4% had a Child's stage A, 57.7% B and 27.8% C. The internal consistency of all variables reached a Cronbach's Alpha of 0.766. In the exploratory factor analysis, 6 dimensions of the questionnaire were identified that explain 84.27% of the total variability. To see the stability of the instrument, the measurement was repeated at 2 and 6 months of follow-up, obtaining in the test-retest a kappa agreement of 0.612 and 0.565 respectively., Conclusion: The SIPAT-11 questionnaire has good psychometric characteristics in cirrhotic patients who are candidates for liver transplantation. It is easy to complete and can be administered by professionals who are not specialists in the area of Mental Health., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

ObjectiveIt is well known that the occurrence of mental disorders is more common in lung transplant candidates compared to the general population. After transplantation mental disorders may negatively affect quality of life, adherence to immunosuppressive medication, as well as overall survival. Therefore, the identification of patients at risk is of utmost importance and in Germany pre-transplant psychosocial evaluation of the patients is required. To ensure high quality and comparability of these assessments, the use of psychometrically sound instruments is recommended. We applied the Transplant Evaluation Rating Scale (TERS), a broadly used expert interview. Two research groups have detected a two-factor structure of the TERS in different transplant samples; however, with slightly different results. The present study investigated which of the models would fit best in our sample of lung transplant patients. Additionally, we assessed convergent and predictive validity of the best fitting model to evaluate its clinical usefulness.MethodsBetween 2016 and 2019, 390 lung transplant candidates were evaluated and included in the study. The median age was 53 years and 54% were male. TERS interviews were conducted by trained medical doctors and psychologists. The participants completed questionnaires assessing quality of life and levels of depression and anxiety. Transplant- and disease-specific variables (lung disease, listing date, oxygen use) were taken from the patient charts. Confirmatory factor analysis was used to test the two proposed TERS-models in the present sample.ResultsThe two-factor structure of the TERS reported by Hoodin and Kalbfleisch fit our sample best, showing good psychometric properties. The factor “emotional sensitivity” was highly correlated with quality of life and measures of psychosocial health while the factor “defiance” correlated with obstructive lung disease and older age but not with quality of life. The two factors showed differential predictive validity with regard to time until listing and pulmonary-specific quality of life 1 year after transplantation.ConclusionsThe two factors showed good psychometric properties, and differential convergent and predictive validity. However, further studies concentrating on the predictive value of the TERS and its factors regarding somatic outcomes (mortality, graft functioning) are required.

Ming-Kung Wu,1 Li-Wen Hsu,2 Kuang-Tzu Huang,3 Chih-Che Lin,2 Chih-Chi Wang,2 Ting-Lung Lin,2 Wei-Feng Li,2 Shigeru Goto,2 Chao-Long Chen,2 Chien-Chih Chen1 1Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Background: Living donor liver transplantation (LDLT) has been developed as one of gold standard treatments for end-stage liver disease. Mental health is a required selection criterion for adult living liver donors and may influence the quality of life after operation. Patients and methods: A total of 1,210 potential living donor candidates for liver transplantation (LT) underwent psychosocial evaluation that included a semi-structured interview, multi-choice self-reported inventory (Beck Depression Inventory-2nd edition [BDI-II], Beck Anxiety Inventory [BAI]), and the family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) index. The test results were compared by family relationships, and subgroups were classified based on the donation type: 1) parents to children, 2) grown children to parents, 3) siblings to siblings, 4) spouses to spouses, and 5) other relatives to other relatives. Results: The BDI-II (P < 0.001) and BAI differed considerably according to the donation type in potential donor candidates. Compared with other subgroups, parents donating to their children suffered the most severe psychological stress before LDLT and exhibited more depressive (P < 0.001) and anxiety symptoms. However, the stress associated with grown children donating to their parents, siblings, and spouses was not significantly higher than it was for other relatives. Furthermore, a significant negative correlation existed between family APGAR scores and the severity of depression and anxiety (P < 0.001) among potential donor candidates. Conclusion: These results indicate the importance of understanding potential donor candidates’ psychological characteristics before LT. Greater anxiety and depression may be exhibited by parent donors due to the distress from fears of death or illness of the recipients, or their guilty feeling for their child. Additionally, family dysfunction also revealed more depression and anxiety. Such donor candidates should be given more extensive pre-donation counseling for minimizing pre-LDLT psychological stress. Keywords: living donor candidates, psychosocial evaluation, depression, anxiety, family function, family relationship

Adoption is a way of enabling children and adolescents deprived of family life to have a family. Adoption candidates must undergo a process of evaluation and preparation, guided by the technical teams of the Child and Youth Courts. Professionals should evaluate complex questions about adoption and parenting, but the lack of a guiding criterion can lead to difficulties in this process. Thus, the present study aimed to describe the criteria used by judicial technicians of the state of Rio Grande do Sul in the qualification processes for adoption. Interviews were conducted with psychologists and social workers from 7 cities in the state. The content analysis identified that issues related to life history, personal characteristics, family and social relationships, and motivation for parenting should be evaluated. It is argued that the qualification process can be thought of as a space for reflection on the adoption project and the parenting of the adopters besides only an evaluation. [ABSTRACT FROM AUTHOR]

Objective: It is well known that the occurrence of mental disorders is more common in lung transplant candidates compared to the general population. After transplantation mental disorders may negatively affect quality of life, adherence to immunosuppressive medication, as well as overall survival. Therefore, the identification of patients at risk is of utmost importance and in Germany pre-transplant psychosocial evaluation of the patients is required. To ensure high quality and comparability of these assessments, the use of psychometrically sound instruments is recommended. We applied the Transplant Evaluation Rating Scale (TERS), a broadly used expert interview. Two research groups have detected a two-factor structure of the TERS in different transplant samples; however, with slightly different results. The present study investigated which of the models would fit best in our sample of lung transplant patients. Additionally, we assessed convergent and predictive validity of the best fitting model to evaluate its clinical usefulness. Methods: Between 2016 and 2019, 390 lung transplant candidates were evaluated and included in the study. The median age was 53 years and 54% were male. TERS interviews were conducted by trained medical doctors and psychologists. The participants completed questionnaires assessing quality of life and levels of depression and anxiety. Transplant- and disease-specific variables (lung disease, listing date, oxygen use) were taken from the patient charts. Confirmatory factor analysis was used to test the two proposed TERS-models in the present sample. Results: The two-factor structure of the TERS reported by Hoodin and Kalbfleisch fit our sample best, showing good psychometric properties. The factor "emotional sensitivity" was highly correlated with quality of life and measures of psychosocial health while the factor "defiance" correlated with obstructive lung disease and older age but not with quality of life. The two factors showed differential predictive validity with regard to time until listing and pulmonary-specific quality of life 1 year after transplantation. Conclusions: The two factors showed good psychometric properties, and differential convergent and predictive validity. However, further studies concentrating on the predictive value of the TERS and its factors regarding somatic outcomes (mortality, graft functioning) are required. [ABSTRACT FROM AUTHOR]

Abstract Background The scarcity of human organs requires the transplant community to make difficult allocation decisions. This process begins at individual medical centers, where transplant teams decide which patients to place on the transplant waiting list. Each transplant center utilizes its own listing criteria to determine if a patient is eligible for transplantation. These criteria have historically considered preexisting affective and psychotic disorders to be relative or absolute contraindications to transplantation. While attitudes within the field appear to be moving away from this practice, there is no data to confirm that eligibility criteria have changed. Main body There are no nationwide guidelines detailing the manner in which affective and psychotic disorders should impact transplant eligibility. Individual transplant centers thus form their own transplant eligibility criteria, resulting in significant inter-institution variability. Data from the 1990s indicates that the majority of transplant programs considered certain psychiatric illnesses, such as active schizophrenia, to be absolute contraindications to transplantation. A review of literature reveals that no comprehensive data has been collected on the topic since that time. Furthermore, the limited data available about current practices suggests that psychiatric illness continues to be viewed as a contraindication to transplantation at some transplant centers. In light of this finding, we review psychiatric literature that examines the impact of affective and psychotic disorders on transplant outcomes and conclude that the presence of these disorders is not an accurate predictor of transplant success. We then discuss the requirements of justice as they relate to the creation of a just organ allocation system. Conclusion We conclude that transplant eligibility criteria that exclude patients with affective and psychotic disorders on the basis of their psychiatric diagnosis alone are unjust. Just listing criteria must incorporate only those factors that have a causative effect on posttransplant morbidity and mortality. Justice also demands that we eliminate current inter-institution practice variations in favor of national transplant eligibility criteria. Given the limited data available about current practices, we call for an updated study investigating the manner in which affect and psychotic disorders impact transplant eligibility determinations.

Purpose of Review: We update evidence underlying the recommendations of a 2018 multi-society consensus report regarding the psychosocial evaluation of individuals for cardiothoracic transplantation and mechanical circulatory support (MCS). In the present review, we focus on heart transplantation and MCS. Recent Findings: Expert opinion and new evidence support the inclusion of ten core content areas in the psychosocial evaluation. Prospective data indicate that psychosocial factors can predict post-transplantation/post-implantation outcomes. Such factors include treatment adherence history, mental health and substance use history, cognitive impairment, knowledge about treatment options, and social factors such as socioeconomic status. For other factors (e.g., coping, social support), new evidence is weaker because it derives largely from cross-sectional studies. Concerning evaluation process issues, expert opinion remains consistent with consensus recommendations, but there is a dearth of empirical evidence. Summary: The psychosocial evaluation can identify factors relevant for candidacy for heart transplantation and MCS implantation. It enables the provision of interventions to improve patients' viability as candidates, and facilitates care planning. [ABSTRACT FROM AUTHOR]

Psychosocial factors greatly impact the course of patients throughout the liver transplantation process. A retrospective chart review was performed of patients who underwent liver transplantation at Hadassah-Hebrew University Medical Center between 2002 and 2012. A composite psychosocial score was computed based on the patient’s pre-transplant evaluation. Patients were divided into two groups based on compliance, support and insight: Optimal psychosocial score and Non-optimal psychosocial score. Post-liver transplantation survival and complication rates were evaluated. Out of 100 patients who underwent liver transplantation at the Hadassah-Hebrew University Medical Center between 2002 and 2012, 93% had a complete pre-liver transplant psychosocial evaluation in the medical record performed by professional psychologists and social workers. Post-liver transplantation survival was significantly higher in the Optimal group (85%) as compared to the Non-optimal group (56%, p = .002). Post-liver transplantation rate of renal failure was significantly lower in the Optimal group. No significant differences were observed between the groups in other post-transplant complications. A patient’s psychosocial status may impact outcomes following transplantation as inferior psychosocial grades were associated with lower overall survival and increased rates of complications. Pre-liver transplant psychosocial evaluations are an important tool to help predict survival following transplantation. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand how the evaluation of applicants for adoption in the Brazilian context has been approached, described and problematized in the scientific literature, by means of an integrative review. Based on pre-established criteria, 30 studies were retrieved in the SciELO, PePSIC, LILACS and PsycINFO databases (2006-2016) and analyzed by the PRISMA strategy. Empirical studies of qualitative character predominate, with varied instruments and samples, and which, in general, discuss a culture of adoption in which the child is recognized as the protagonist, as well as different family configurations gain visibility and seek legitimacy. Only eight studies allow the visualization of instruments/techniques, challenges, recommendations and criticisms present in the evaluation process. However, the evaluation of applicants does not appear as a focus of problematization in the studies, limiting comprehension about professional practice and suggesting that it is a subjective analysis by the aspects it encompasses. Further studies on the actors involved in the adoption process are suggested. [ABSTRACT FROM AUTHOR]

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients’ receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs’ unique needs and goals. [ABSTRACT FROM AUTHOR]