Departments of Psychiatry and Surgery (Transplant), Yale School of Medicine, New Haven, Connecticut, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
Liver Transpl. 2024 May 1;30(5):505-518. doi: 10.1097/LVT.0000000000000288. Epub 2023 Oct 23.
We surveyed living donor liver transplant programs in the United States to describe practices in the psychosocial evaluation of living donors focused on (1) composition of psychosocial team; (2) domains, workflow, and tools of the psychosocial assessment; (3) absolute and relative mental health-related contraindications to donation; and (4) postdonation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active living donor liver transplant programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely used, but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), nonadherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct postdonation psychosocial follow-up (57.6%) or screening (39.4%), but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donors is not uniform among programs though the domains assessed are consistent. Psychosocial contraindications to living liver donation vary among the transplant programs. Mental health follow-up of donor candidates is not standardized.
我们调查了美国的活体肝移植项目，以描述针对活体供者的社会心理评估实践，重点包括：（1）社会心理团队的构成；（2）社会心理评估的领域、工作流程和工具；（3）与心理健康相关的绝对和相对捐赠禁忌；以及（4）捐赠后的社会心理随访。我们收到了 52 条独特的回复，代表了 50 个活跃的活体肝移植项目中的 33 个（66%）。31 个（93.9%）提供者团队包括社会工作者，22 个（66.7%）精神科医生和 14 个（42.4%）心理学家。虽然很少使用验证工具，但评估的领域是一致的。受访者将活跃的酒精（93.8%）、可卡因（96.8%）和阿片类药物（96.8%）使用障碍评为绝对捐赠禁忌。活跃的自杀意念（97%）、自残行为（90.9%）、饮食失调（87.9%）、精神病（84.8%）、不遵医行为（71.9%）和无法与评估团队合作（78.1%）被视为绝对的捐赠禁忌。在肝脏捐赠的绝对社会心理禁忌方面，不同地理区域或大型和小型项目之间没有统计学上的显著差异。57.6%的项目进行了捐赠后的社会心理随访或筛查，但很少对被拒绝的捐赠者进行常规随访（15.8%）。供者候选人的社会心理评估是一个多学科的过程。尽管评估的领域是一致的，但各个项目的供者社会心理评估结构并不统一。活体肝移植项目之间的活体捐赠心理禁忌不同。供者候选人的心理健康随访没有标准化。
