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Patients who refuse heart transplantation.
R L Frierson1, J B Tabler, S B Lippmann
1Department of Psychiatry, University of Louisville School of Medicine, Ky.
The Journal of Heart Transplantation
|July 1, 1990
Summary
Some terminally ill patients decline heart transplantation, often due to psychiatric conditions or prolonged heart disease. Factors influencing this decision include depression, survival ambivalence, and quality of life concerns.
Area of Science:
- Cardiology
- Psychiatry
- Transplantation Medicine
Background:
- Heart transplantation is a life-saving procedure for end-stage heart disease.
- Patient selection is crucial, but some candidates refuse the offered surgery.
Observation:
- Fifteen percent (6 of 40) of eligible patients refused heart transplant surgery.
- Refusal was associated with psychiatric diagnoses and longer duration of heart disease.
Findings:
- Key factors influencing refusal included depression, ambivalence about surgery/survival, prior negative surgical experiences, acceptance of death, and concerns about postoperative quality of life.
- Organic brain syndrome and denial of disease severity also played a role.
Implications:
- Understanding patient refusal is vital for transplant teams to address psychological and existential concerns.
- This insight can improve patient-centered care and decision-making processes in cardiac transplantation.