Transplant psychologists have seen many changes over the past 5 to 10 years that have affected their work:
- Now that hepatitis C can be cured, treated patients no longer need a liver transplant. This has freed up organs for people previously not considered for transplant, specifically patients with acute alcohol-related hepatitis. This condition can develop so quickly that patients have little warning and are unable to detect early signs of illness; as a result, their physicians may not have cautioned them to reduce drinking. Assessing these patients and connecting them to treatment has become a greater focus of his practice, said Stephan Weinland, PhD, a transplant psychologist at Virginia Commonwealth University (VCU) Medical Center in Richmond.
- Advances in transplant medicine have led to improved survival rates and quality of life and have changed the nature of conversations with patients who are ambivalent about transplant, said Yelena Chernyak, PhD, the lead psychologist for the Advanced Heart and Lung Care Center at Indiana University Health. “Transplant is not always an obvious decision for the medical team, nor is it an obvious decision for the patient,” she said.
- As states have legalized marijuana use, more patients at transplant centers are using it, said Chernyak. Marijuana can reduce the effectiveness of antirejection medicines, “but more and more programs are experimenting with allowing those substances to be used, which is changing how we evaluate patients and prepare them for transplant,” she said.
- The increasing volume of transplants has meant that Weinland, currently the only transplant psychologist at VCU, spends less time on each assessment and more time working with social workers, addiction medicine specialists, and physicians to successfully engage patients in posttransplant care, he said. It has also led to a push to transplant faster and address mental health and behavioral concerns after transplant, said Kristin Kuntz, PhD, the director of transplant psychology at The Ohio State University Wexner Medical Center. But addressing issues before transplant can sometimes prevent or reduce significant psychological and behavioral issues after transplant, she said. “In addition, patients may be more motivated to seek help before transplant because there’s a bit of a carrot dangling in front of patients who have been asked to change their behavior to get on the waiting list,” Kuntz said.
- Transplant volume may increase further starting later this year because of a new government payment program incentivizing transplant centers to decline fewer kidneys and to expand their kidney transplant programs. The 6-year program is called the Increasing Organ Transplant Access (IOTA) Model and will enroll half of all eligible transplant centers starting July 1, 2025. Judy Jones, PhD, a clinical psychologist at the Transplant Institute of University Hospitals Cleveland Medical Center, expects IOTA to “absolutely” affect her work. More kidney transplants will mean more evaluations of potential candidates, some of whom may not have gas money to drive to the hospital, lack caregivers who can take time off from work to accompany them to medical appointments, or have psychological issues that could make a successful outcome more challenging. “It will be my job to help create pathways forward for these individuals,” said Jones. “Some of these patients will need increased attention during their hospital stay at the time of transplant and increased follow-up afterward.”
[Related: Psychologists pave the way for transplant success]
