Psychiatric aspects of heart transplantation.

Psychiatrists have been an integral part of the heart transplant team at the Royal Victoria Hospital in Montreal since the program was set up in September 1984. One hundred and twenty five candidates were evaluated for the operation; 12 were found to be unsuitable for surgery because of psychiatric illness. Heart transplant recipients who had previously suffered from a psychiatric disorder fared worse than those who had not. The psychiatrist's recommendations for or against surgery depended on the patient's ability to cope with a number of stressors, including compliance with the medical regimen, waiting for a donor, the surgical procedure itself, adaptation to life with a new organ, and the resolution of a distressing emotional state. Post-operative complications ranged from organic mental syndromes to depression. With the increase in heart transplantations, the competition for organ donors is intensifying and patient selection requires greater involvement of psychiatrists.