The Role of Pediatric Psychologists in the Pre-Transplant Evaluation: A Practice Survey

The psychology pre-transplant evaluation is an integral component of the pediatric transplant process and serves to identify both risk and resilience factors that may contribute to peri- and posttransplant outcomes. Despite guidelines with general considerations, the pediatric pre-transplant psychological evaluation is not standardized. This study presents results from a practice survey of pediatric transplant psychologists to inform the standard of care.

A workgroup of members of the Society for Pediatric Psychology Solid Organ Transplant Special Interest Group designed a survey assessing pre-transplant psychological evaluation practices. A total of 88 psychologists were identified and asked to complete the survey. Descriptive statistics were used to summarize survey results.

Forty-seven psychologists representing 38 medical centers provided complete responses. Respondents represented multiple solid organ groups: 70% kidney, 68% heart, 47% liver, 19% lung and multi-visceral respectively, 13% intestinal, and 9% pancreas. Psychology is routinely involved in evaluations, though psychology evaluation practices are impacted by various barriers (e.g., time, insurance) and patient characteristics (e.g., medical acuity, age). The most commonly assessed domains were developmental history, allocation of treatment responsibility, social history, patient psychiatric history, motivation for transplant, understanding of transplant, treatment adherence, and medical coping. Although domains assessed were largely consistent among respondents and represented important risk and resilience domains, there was reported variability in the role of psychology on selection committees and listing decision-making.

Despite a lack of standardization of the pre-transplant psychological evaluation, areas of consistency exist. However, variability in practice among pediatric solid organ transplant centers remains, necessitating the development of a common foundation for the pre-transplant psychological evaluation. Results also emphasize the importance of psychology's role within pediatric transplant teams.