Advertisement

Psychosocial Considerations of Heart Transplant: Keeping Apace with the Revolution in Cardiac Care

  • Elizabeth D. MorrisEmail author
Living reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

The cardiac transplant social worker assumes a complex role on a transplant team: assessor, fixer, ethical conscience of the team, resource expert, ambassador to other consultative teams, and is one of the central figures to the patient and family as they move through all phases of care. The function of the cardiac transplant social worker has evolved in similar parallel fashion as has cardiac transplantation itself. Once tasked with responsibilities that included supporting patients and their families while patients waited in hospital for organs to become available, social workers now work with patients and families who, for the most part, wait at home, often for years, on left ventricular assist devices (LVAD) as a prelude to transplant. The steps between listing and transplant have elongated as has the need for critical assessment tools and skills in an ever changing and revolutionary cardiac landscape. Social workers in cardiac transplant have been called upon to acquire different skill sets to incorporate the cataclysmic changes in cardiac care. Developing a psychosocial assessment tool is the foundation of performing a comprehensive, thorough, and detailed evaluation of the transplant candidate and LVAD candidate and should incorporate guidelines from UNOS, CMS, and JCAHO. Assessing health literacy is crucial to ascertaining a patient and family’s ability to understand, comply, and execute required care. Including the palliative care team at consistent intervals is imperative. Collective team agreement on absolute contraindications to listing and/or implanting is crucial to a shared vision of candidacy.

Keywords

Cardiac transplant social worker LVAD (left ventricular assist device) Psychosocial assessment Health literacy Substance abuse disorder SIPAT Contraindications Scoring tool Caregivers Palliative care Psychosocial presentation Retransplantation 

References

  1. Abel T (2015) Health literacy among young adults: a short survey tool for public health and health promotion research. Health Promot Int 30(3):725–735.  https://doi.org/10.1093/heapro/dat096. Last checked 5.9.2018CrossRefPubMedGoogle Scholar
  2. Bruce C (2017) Caregivers of patients with left ventricular assist devices possible impacts on patients’ mortality and interagency registry for mechanically assisted circulatory support–defined morbidity events. Circ Cardiovasc Qual Outcomes 10:e002879.  https://doi.org/10.1161/CIRCOUTCOMES.116.002879CrossRefPubMedGoogle Scholar
  3. Caplan A (2008) Organ transplantation. In: Crowley M (ed) From birth to death and bench to clinic: the Hastings Center bioethics briefing book for journalists, policymakers, and campaigns. The Hastings Center, Garrison, pp 129–132Google Scholar
  4. CMS Department of Health and Human Services Centers for Medicare & Medicaid Services March 30, 2007 Federal Register/Vol. 72, No. 61/Friday, March 30, 2007/Rules and RegulationsGoogle Scholar
  5. Dhital k (2017) Donation after circulatory death heart transplantation. Curr Opin Organ Transplant 22(3):189–197.  https://doi.org/10.1097/MOT.0000000000000419CrossRefPubMedGoogle Scholar
  6. Duong T (2017) A new comprehensive short-form health literacy survey tool for patients in general. Science Direct 11(1):30–35.  https://doi.org/10.1016/j.anr.2017.02.001CrossRefGoogle Scholar
  7. Gali K (2016) Smoking status at time of listing for a heart transplant predicts mortality on the waiting list. Prog Transplant 26(2):117–121.  https://doi.org/10.1177/1526924816640687CrossRefPubMedGoogle Scholar
  8. Hosseini K (2013) And the mountains echoed. Riverhead, New YorkGoogle Scholar
  9. Kalanithi P (2016) When breath becomes air. Random House, New YorkGoogle Scholar
  10. Kitko LA (2013) Caring for a spouse with end-stage heart failure through implantation of a left ventricular assist device as destination therapy. Heart Lung 42(3):195–201.  https://doi.org/10.1016/j.hrtlng.2012.10.004CrossRefPubMedPubMedCentralGoogle Scholar
  11. Maldonado M (2012) The Stanford integrated psychosocial assessment for transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics 53(2):123–132.  https://doi.org/10.1016/j.psym.2011.12.012CrossRefPubMedGoogle Scholar
  12. Morris R (2013) Patient’s desire for termination of VAD therapy should be challenged. J Cardiothorac Vasc Anesth 27:5 1048–5 1050.  https://doi.org/10.1053/j.jvca.2013.06.013CrossRefPubMedGoogle Scholar
  13. Neyer J (2016) Marijuana and listing for heart transplant: a survey of transplant providers. Circ Heart Fail e002851:9.  https://doi.org/10.1161/CIRCHEARTFAILURE.115.002851CrossRefGoogle Scholar
  14. NIH Publication No. 07-3769 National Institute on Alcohol and Alcoholism www.niaaa.nih.gov/guide
  15. Petty M, Bauman L (2015) Psychosocial issues in ventricular assist device implantation and management. Journal of Thoracic Disease 7(12):2181–2187.  https://doi.org/10.3978/j.issn.2072-1439.2015.09.10CrossRefPubMedPubMedCentralGoogle Scholar
  16. Shaw D, Gardiner D (2014) Moral distance and distributive justice: how the increase in organ donation is helping us make better ethical decisions. J Anaesthesia 70:1–17.  https://doi.org/10.1111/anae.12931CrossRefGoogle Scholar
  17. Stosell L (2012) Readability of patient education materials available at the point of care. J Gen Intern Med S27(9):1165–1170.  https://doi.org/10.1007/s11606-012-2046-0CrossRefGoogle Scholar
  18. Tsarova K (2016) SIPAT scale may be valuable in psychosocial assessment of LVAD candidates. J Card Fail 22:S79.  https://doi.org/10.1016/j.cardfail.2016.06.250CrossRefGoogle Scholar
  19. Twillman R (1993) The transplant evaluation rating scale: a revision of the psychosocial levels system for evaluating organ transplant candidates. Psychosomatics 34:144–153.  https://doi.org/10.1016/S0033-3182(93)71905-2CrossRefPubMedGoogle Scholar
  20. UNOS Newsroom January 2017Google Scholar
  21. Cohen C (2015) The role of palliative care in the ventricular assist device population. Case Western Reserve and University HospitalsGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Children’s Hospital of PhiladelphiaCenter for Fetal Diagnosis and Treatment and Special Delivery UnitPhiladelphiaUSA

Personalised recommendations