Pre-Transplant Psychosocial Assessment and Preparing Families for Pediatric Organ Transplantation

Background and Purpose:

Being listed for a transplant involves undergoing evaluation by a transplant team, being added to the waiting list for a suitable organ based on medical need and compatibility, and awaiting notification for surgery once a matching organ becomes available. Assessments like the Pediatric Psychosocial Assessment Tool (PPAT) guide medical decisions and referrals to psychosocial services, managed by transplant social workers. While adult pre-transplant assessments are available, pediatric-specific tools are limited, mainly due to the complexities associated with patient developmental considerations and a focus on family-centered care. The PPAT, developed by the Society for Transplant Social Workers and their pediatric care membership, provides a standardized and evidence-based assessment. The current study sought to analyze the PPAT assessments for pediatric heart transplantation candidates and related transplant social worker recommendations to improve understanding of medical social work with a vulnerable pediatric population.

Methods:

The PPAT evaluates diverse psychosocial factors pertinent to transplantation candidacy, providing valuable insights into the transplant process. A total of 189 completed PPAT assessments from a large pediatric heart transplant center in the southern United States were assessed. Non-parametric tests were used to examine differences in PPAT scores between patients listed and not listed for heart transplantation. All patients were seen and evaluated at the transplant center between October 2016 and December 2021. Written recommendations from providers were examined through content analysis to delineate common themes and patterns for transplantation selection.

Results:

Results revealed a statistically significant disparity in PPAT scores (z= 2.58; p = .005) between transplant-listed (M=13.45, SD = 3.84, n = 148) and non-listed patients (M=18.33, SD = 6.47, n = 12). Hedge’s g indicated a large effect size (g=1.19). Subsequent analysis explored whether PPAT scores correlated with actual transplantation status, finding no statistically significant difference in mean scores. Recommendations from an assessment of 189 cases revealed key themes and patterns critical for transplant selection. These recommendations encompassed ongoing education, financial planning, psychological and emotional support, family and social support, and treatment adherence. Observed patterns included tailored educational approaches, risk management strategies, integrated care, and addressing specific challenges encountered by transplant families.

Conclusion:

This intersection of transplantation and social work reveals a notable disparity in PPAT scores between adolescent patients listed and those not listed for transplantation, with the latter group showing higher average scores. It also suggests that social work interventions could effectively alleviate barriers to transplantation access, as indicated by the absence of significant differences in PPAT scores regardless of transplantation status. Furthermore, the provider recommendations display themes contributing to transplant selection and imply the need for processes to involve transplant social workers and multidisciplinary teams in preparing patients and families for transplant procedures and challenges. This information could inform pre-transplant decision-making and optimize the patient selection processes with collaborative efforts in addressing the needs of adolescent patients and equitable healthcare.