Informed consent: what the patient heard

Transplant Psychiatrist: "Why is it important to take (routine) medications after transplantation?" Transplant candidate: "To protect the liver." Doctor: "How?"

"I don't know." Doctor: "Think about it for a moment."

"To prevent rejection and infection." Doctor: "Which one: rejection or infection?"

"Both." This article reports significant conceptual limitations in patient medical knowledge. In the course of customary comprehensive psychiatric evaluation, patients with end-stage renal and/or hepatic disease were asked about knowledge of benefits and side effects of required post-transplant medication. Liver transplant candidates were asked about their understanding of primary organ function and instructed in reference to components of Model for End-stage Liver Disease status on the deceased donor transplant list. Candidates for renal transplantation were selectively asked about risks regarding medical dietary compliance, including dangers of hyperkalemia. PATIENTs had less than expected understanding of required immunosuppression. Liver transplant candidates, with infrequent exception, described the organ as a filter. Those with medical compliance problems related to end-stage renal disease had limited understanding of the kidney's role in homeostasis and impact of hyperkalemia on neurologic function. Additional teaching centered on narrative and analogy specific to individual life experience and skills. Historical reference to Sir Peter Medawar's Nobel Prize-winning work on skin allograft failure for treatment of World War II burn victims effectively illustrated the primacy of immunosuppression for successful organ transplantation. PATIENTs were receptive to this teaching approach. Many expressed gratitude for improved understanding. Clinical awareness of patient skills and life experience can enrich understanding of transplantation objectives and importance of medical compliance.