Lung Transplantation

Lung transplantation, a treatment option for progressive respiratory failure, is the only therapeutic option that is likely to improve survival and HRQOL for patients with advanced lung disease and declining lung function (Spahr et al. 2007). However, the supply of donor lungs for transplant is limited, and lung transplantation is associated with significant morbidity. Data from the Cystic Fibrosis Foundation's patient registry showed that more people with cystic fibrosis received a lung transplant in 2006 than in previous years (Cystic Fibrosis Foundation 2008).

Psychological evaluations are a key part of the extensive workup in preparation for lung transplantation. Among the absolute contraindications for lung transplant are psychiatric illness that precludes adherence to required medical regimen, inability to adhere to complex medical treatment plans, lack of an adequate social support system, and substance addiction within the previous 6 months (Orens et al. 2006). In considering pediatric lung transplantation, treatment teams need to take into account psychosocial issues, not only for the child, but also for parents (Sweet 2003). One study found that 20% of children on the transplant waiting list had a psychiatric disorder, and 60% of the parents scored within the psychiatric disorder range; 20% of these families scored within the range of chaotic functioning (Serrano-Ikkos and Lask 2003).

After transplantation, patients have to cope with the rigors of posttransplant immunosuppression regimens, frequent surveillance, worry about graft rejection, and adjustment to a new lifestyle. Despite these complex demands, most patents with cystic fibrosis who undergo lung transplantation report significant improvements in HRQOL (Durst et al. 2001; Vermeulen et al. 2004). Psychiatric or psychological interventions may enhance the suitability of a potential recipient and may be important to good transplant outcomes.

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