Concluding Comments

Solid organ transplantation is a common and widely accepted surgical option for children and adolescents who formerly would not have survived their illness. Due to the steady and consistent improvements in outcomes for pediatric transplant recipients in childhood, many of these individuals may anticipate long-term survival into adulthood. These developments have been closely associated with a

' protocol topics and goals

Topics

Patient and family adjustment posttransplant

Development of adherence plan

Goals

Developmental issues that may impede adherence

Transition to home/school

Additional topics as needed (e.g., sibling-related issues, persisting psychiatric symptoms)

Review typical posttransplant course (e.g., possibility of readmission, medication changes)

Discuss typical emotional and behavioral responses (e.g., due to medication side effects)

Normalize patient's and family's reactions to transplant

Assess patient's and family's understanding of treatment expectations Child patients: Create adherence behavior plan (e.g., daily schedule, formal behavior modification plan)

Adolescent patients: Develop adherence contract, outlining responsibilities of patient and parents

Provide education about typical nonadherence rates Child patients: Provide psychoeducation regarding establishing/ maintaining routine, vulnerable child syndrome, and age-appropriate expectations

Adolescent patients: Show video about common issues faced by adolescents (e.g., not wanting to feel different) and consequences of nonadherence

Child patients: Create school reentry book to share with peers Adolescent patients: Discuss common issues that can impede adherence

- Teach problem-solving techniques

- Provide education about risk-taking behaviors

Address sibling-related issues

Assess and treat (or refer) patients or family members with persisting psychiatric symptoms

Note. The above information is based on an intervention being conducted with patients and families in the pediatric solid organ transplant programs at Lucile Packard Children's Hospital.

number of ethical and psychosocial issues for mental health consultants working in pediatric transplant programs. Still unresolved are many issues related to the screening of potential transplant recipients; one of the most important is the absence of data to guide transplant teams about candidate selection. However, a large database exists on the cognitive and emotional difficulties that face transplant recipients, and increased attention is being given to quality-of-life issues for both patients and family members. Future work should focus on efforts to demonstrate the health outcomes and financial benefits of mental health consultation with this patient population.

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