Palliative Care in Solid Organ Transplantation

Betty R. Ferrell, PhD, RN

Disclosures

December 08, 2015

Discussion: Palliative Care for Patients Awaiting Transplant

The field of solid organ transplantation is growing and represents another area of patient care with potential for integration with palliative care. Diseases of the liver, kidneys, heart, and lungs create devastating and life-threatening effects on patients, and many of these patients will be candidates for organ transplant.

In 2012, a total of 28,924 patients received organ transplants in the United States.[1] Approximately 2000 lung transplants are performed each year in North America; of these, 81% will survive for 1 year, and 63% survive to at least year 3. On average, 1 in 6 patients awaiting lung transplant will die.[2] During the waiting period for transplant as well as the posttransplant phase, whether successful or not, patients will experience numerous symptoms, side effects of treatment, and significant psychological burden of living with uncertainty and with life-threatening illness. The added financial and social burdens of solid organ disease and transplant make these patients ideal for palliative care consultation.[3,4]

Many challenges can be encountered when integrating palliative care into organ transplantation care. These patients, as in Clare's case, are often singularly focused on survival and do not want to discuss palliative care, believing that this represents end-of-life care and abandoning hope for transplant. Patients waiting for transplants also have uncertain courses with periods of stability alternating with unexpected crises. The process of transplantation usually involves extensive psychosocial evaluation, yet as in Clare's case, there are many psychological, social, and spiritual factors that will greatly influence care.

Early involvement by palliative care in organ transplant can assist with symptom management and avoidance of hospital readmissions. The early involvement of palliative care is also valuable in establishing relationships so that when the patient faces a crisis, acute symptoms after transplant, or progression to end-of-life care, the patient is familiar with the palliative care team and its benefits.

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