Assessment

Research has demonstrated a strong association between certain psychosocial factors and posttransplant outcomes (Goetzmann et al. 2007). Thus, the pre-transplant psychosocial assessment plays an important role in evaluating the psychological preparedness of potential solid organ transplant recipients. Assessments of readiness for organ transplantation often include an exploration of difficulties in coping and of factors that may compromise adherence in the postoperative period (Phipps 1997). Reviews exploring the clinician's role in evaluating candidates for organ transplantation suggest that pretransplant assessments include an appraisal of the patient's psychosocial strengths and limitations and provide recommendations for interventions to optimize a patient's candidacy for transplantation (Klapheke 1999).

Most pediatric solid organ transplant centers in the United States review psychosocial vulnerabilities when assessing the suitability of potential transplant candidates. Despite the increasing numbers of children and adolescents undergoing transplantation, however, research into the psychological impact of transplantation has remained predominantly focused on adults, with comparatively little attention paid to children who receive transplants (Fung and Shaw 2008). To help identify areas of psychosocial vulnerability in the pediatric transplant population, the Pediatric Transplant Rating Instrument (P-TRI; Fung and Shaw 2008), a 17-item pretransplant rating instrument, has been introduced as an adaptation to adult scales (Olbrisch et al. 1989; Twillman et al. 1993). The P-TRI incorporates a developmental perspective and was designed primarily to identify psychosocial susceptibilities that may be associated with poor treatment adherence and outcomes in the pediatric transplant population. Clinicians need to keep in mind the additive effect for psychological risk factors, in that the more risk factors a patient has pretransplant, the more likely he or she is to have adherence difficulties posttransplant (Dew et al. 1996). Key areas to evaluate are discussed below.

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