PSYCHIC COMORBIDITY AND PSYCHOSOCIAL FEAT URES OF PATIENTS BEFORE HEART, LIVER, OR LUNG TRANSPLANTATION

Organ transplant operations are regularly carried out in Switzerland a t 6 transplantation centres. Between January 1995 and October 1996, 11 9 patients at Zurich University Hospital completed a semistructured ps ychiatric interview and the Transplant Evaluation Rating Scale (TERS). Inclusion criteria comprised all indications for organ transplant. Di agnostic evaluation was according to ICD-IO. Of the 44 women and 75 me n (mean age 40.2 years), 48 required a heart transplantation (HTPL), 3 7 a liver transplantation (LETPL), and 34 lung transplantation (LUTPL) . 39 patients (32.8%) had one, and 15 (12.6%) 2 current psychiatric di sorders. 65 of the 119 patients (54.6%) were without a current psychia tric disorder. The candidates for lung transplantation were the most p sychologically healthy (68% had no psychiatric disorder). Approximatel y half of the heart and liver patients had at least one psychiatric di sorder. The LETPL group had the highest prevalence of psychiatric como rbidity, with organic brain disorders present in a third of the patien ts. A quarter of all patients had stress disorders, panic disorder or a somatoform disorder. Full criteria for an affective disorder were no t met by any patient. 61% enjoyed good to excellent family and social support, 29% had an unresolved conflict, and 11% had strong conflicts. Earlier coping behaviour appeared to be good to excellent in 57%, suf ficient in 37%, and poor in 6%. Estimated compliance rate was found to be complete in 87%, partial or involving problems in 12% and unsatisf actory in 1%. We conclude that in transplant candidates psychiatric di sorders and psychosocial problems are frequent and must be considered regularly during evaluation and the transplantation process. The resul ts of this analysis and 3 case examples and the results of the study s how the clinical importance of a detailed psychiatric and psychosocial examination as part of the evaluation of patients about to undergo li fe-saving organ transplant operations.