Palliative care for solid organ transplant candidates and recipients: A scoping review

Solid organ transplant patients experience high morbidity and mortality before and after transplantation. International guidelines recommend integrating palliative care into the management of patients with advanced organ failure, including transplant candidates and recipients, as it supports advance care planning, enhances communication and improves symptom management. However, it remains unknown how and to what extent palliative care is actually provided to these patients. The present scoping review aimed to systematically summarize and compare existing evidence regarding the integration of palliative care for solid organ transplant patients.

We searched PubMed, Web of Science, Embase, Cochrane and ClinicalTrials.gov for original articles published regarding the provision of palliative care to adult candidates or recipients of heart, lung, kidney, or liver transplant and/or their caregivers. This scoping review is reported in accordance with the PRISMA-ScR guidance.

Thirty-two articles were included. Most studies were conducted in the United States, included lung or liver patients, and relied on small samples. Overall, between 2 % and 53 % of patients had at least one palliative care consultation, and between 0 % and 35 % had end-of-life care conversations. Symptom management, especially pain and dyspnea, was the most important reason for referral. Some studies demonstrated that early palliative care interventions improved symptom management and care planning.

This scoping review shows that palliative care for organ transplant has received little attention heretofore. Further research is essential, especially for kidney and heart transplant patients, to determine optimal timing throughout the transplant journal, referral indications, and the effectiveness of palliative care interventions.