Psychiatric evaluation and outcomes in candidates for heart transplantation
Phipps, L.
Clinical and Investigative Medicine 20(6): 388-395
1997
ISSN/ISBN: 0147-958X PMID: 9413636 Document Number: 481324
Objective: To describe the results of psychiatric evaluations and to describe psychiatric outcomes in patients in a heart transplantation program. Design: Descriptive study. Setting: Heart transplant unit at the Royal Victoria Hospital in Montreal from September 1984 to December 1995. Patients: A total of 706 candidates for heart transplantation, of whom 226 received a graft. Interventions: All candidates underwent a psychiatric evaluation consisting of a semi-structured interview with mental status examination and diagnosis of mental disorders. Outcome measures: Results of psychiatric evaluation and postoperative recovery and complications. Results: Twenty-eight candidates were found to be unsuitable for surgery because of psychiatric illness. The 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, the wait for a donor, the surgical procedure itself, adaptation to life with a new organ and the resolution of a distressing emotional state. Postoperative psychiatric complications ranged from organic mental syndromes to depression. Conclusions: With the increase in the number of heart transplantations, the competition for organ donors is intensifying, and patient selection requires greater involvement of psychiatrists.