Heart to Heart: Transplant Medicine

Psychologists foster organ donations, aid recipients What the Research Shows What motivates someone to donate a kidney while alive? What helps family members donate a newly dead loved one's heart? What helps a transplant patient achieve a better quality of life? Psychologists play an increasing role in the cycle of transplantation, helping to increase organ donations and ensure that recipients have a better quality of life. When psychologists began researching this area in the 1980s, their first concern was to raise the number of donations. According to the U.S. Department of Health and Human Services (HHS), although about 74 people receive transplants daily, about one of every five potential recipients does not receive a life-saving organ. As transplant medicine improved, psychologists joined the multi-disciplinary teams seeking to help fill the need for vital organs. Basic research highlighted a lack of awareness, which led to public awareness campaigns to raise rates at which individuals signed organ-donor cards. For example, researchers found that although in surveys, people said they would donate, far fewer actually signed organ-donation cards. Studies of behavior change also, for example, found that when sent a letter of thanks, frequent blood donors were more likely than less frequent donors to join a bone-marrow registry, highlighting an opportunity to reach those already known to be altruistic. It's also been found that beyond signing an organ-donation card, prospective donors should let family members know one's wishes and encourage their cooperation. By law, most families must be given the opportunity to donate, and researchers have discovered that donors say that helping others help them feel some good has come from their tragedy. Transplant experts share these insights to try to maximize “yes” responses once the question is raised. Behavioral research has also fostered a more sensitive communication with grieving families. Transplant professionals are trained to avoid terms such as “harvesting” and “cadavers” and refer instead to the “opportunity” to donate critically needed organs from “the deceased.” On the receiving side, psychologists help to evaluate candidates for transplant. Comprehensive, multidisciplinary screening helps patients and families understand the transplant process and improves compliance with post-transplant medical regimens, raising the odds of success. Psychologists also evaluate whether the patient has adequate social support, a key factor in post-transplant outcomes. And they help patients master the adaptive challenges at every stage of the illness and treatment, from organ failure and chronic illness, to pre-transplant evaluation, waiting for a donor, surgery, recovery, rehabilitation and permanent maintenance. Critically, psychologists foster adaptive health behaviors such as taking medicine; following diet and exercise programs; and refraining from the use of alcohol, nicotine and illicit drugs. For example, researchers at the University of Pittsburgh found what makes a heart recipient more likely to resume smoking after the transplant: a short period of abstinence before transplantation, problems with depression or anxiety within months of the transplant, and being cared for by someone who smokes. This knowledge helps experts develop targeted interventions for high-risk patients. A 2004 study determined that transplantation also takes a physical and mental toll on caregivers, with many of them showing poorer health and higher depression and anxiety, including post-traumatic stress disorder related to the transplant. The research team analyzed specific risk factors; for example, younger caregivers with a low sense of mastery and high use of avoidance as a coping strategy were more likely to develop anxiety disorders. Thus psychologists can turn their attention to helping families adjust to the transplant process over the long term. Their tools include the Internet. The University of Pittsburgh tested a multifaceted Web site for heart recipients and their families living long distances from the transplant program. The program included workshops on managing stress and the medical regimen, monitored discussion groups, Email access to the transplant team, and information on transplant-related health issues. Patients who used the site showed significant drops in depression and anxiety; caregivers' anxiety and hostility also went down. More frequent users of the site showed greater mental-health and quality-of-life benefits, and the sub-group using the medical regimen workshop showed significantly better compliance at follow up than all other patients, in going to clinic appointments, completing blood work and following diet. What the Research Means Enabling organ donation and successful transplantation can, every year, help tens of thousands of chronically ill people get a new chance at life. Although according to HHS, the number of people requiring a life-saving transplant is still rising faster than the number of available donors (about 300 new candidates join the waiting list every month), behavioral science has helped to raise donation rates from previous lows. In addition, psychologists continue to find innovative ways to bolster transplant success by helping recipients both comply with doctor's orders and be more physically and emotionally resilient. How We Use the Research Transplant recipients have been helped to go on to happier, healthier and longer lives. Studies have shown that for patients and their loved ones, problem solving, optimism and religious coping aid short- and long-term adjustment. Psychologists can develop some of these skills and encourage the kinds of social involvement that will improve patient health and lower health-care costs. They also run support groups for patients and family members, which have been found to raise compliance with medical regimens, provide validation, offer social support, facilitate the educational process, and heighten a sense of control. Sources & Further Reading Cacioppo, J. T., & Gardner, W. L. (1993). What underlies medical donor attitudes and behavior? Health Psychology, 12, 269-271. Christensen, A. J., Raichle, K., Ehlers, S. L., & Bertolatus, J. A. (2002). Effect of family environment and donor source on patient quality of life following renal transplantation. Health Psychology, 21, 468-476. Dew, M. A., Goycoolea, J. M., Stukas, A. A., Switzer, G. E., Simmons, R. G., Roth, L. H., & DiMartini, A. (1998). Temporal profiles of physical health in family members of heart transplant recipients: predictors of health change during caregiving. Health Psychology, 17(2), 138-151. Dew, M. A., Goycoolea, J. M., Harris, R. C., Lee, A., Zomak, R., Dunbar-Jacob, J., Rotondi, A., Griffith, B. P., & Kormos, R. L. (2004). An Internet-based intervention to improve psychosocial outcomes in heart transplant recipients and family caregivers: Development and evaluation. Journal of Heart and Lung Transplantation, 23, 745-758. Dew, M. A., Myaskovsky, L., DiMartini, A. F., Switzer, G. E., Schulberg, H. C., & Kormos, R. L. (2004). Onset, timing and risk for depression and anxiety on family caregivers to heart transplant recipients. Psychological Medicine, 34 , 1065-1082. Dew, M. A., Myaskovsky, L., Switzer, G. E., DiMartini, A. F., Schulberg, H. C., & Kormos, R. L. (2005). Profiles and predictors of the course of psychological distress across four years after heart transplantation. Psychological Medicine, 35, 1215-1227. Myaskovsky, L., Dew, M. A., Switzer, G. E., McNulty, M. L., DiMartini, A. F., & McCurry K. R. (2005). Quality of life and coping strategies among lung transplant candidates and their family caregivers. Social Science and Medicine, 60, 2321-2332 . Olbrisch, M. E., Benedict, S. M., Ashe, K. & Levenson, J. L. (2002). Psychological assessment and care of organ transplant patients. Journal of Consulting and Clinical Psychology, 70, 771-783. Perkins, K. A. (1987). The shortage of cadaver donor organs for transplantation: Can psychology help? American Psychologist, 43, 921-930. Radecki, C. M., & Jaccard, J. (1997). Psychological aspects of organ donation: A critical review and synthesis of individual and next-of-kin donation decisions. Health Psychology, 16, 183-195. Sarason, I. G., Sarason, B. R., Slichter, S. J., Beatty, P. G., Meyer, D. M., & Bolgiano, D. C. (1993). Increasing participation of blood donors in a bone-marrow registry. Health Psychology, 12, 272-276. Shanteau, J., & Harris, R. J. (Eds.). (1990). Organ Donation and Transplantation: Psychology and Behavioral Factors. Washington, DC: American Psychological Association. Stilley, C. S., Dew, M. A., Kormos, R. L., DiMartini, A. F., Switzer, G. E., Goycoolea, J. M., & Griffith, B. P. (2005). Smoking after heart transplantation (abstract). Journal of Heart and Lung Transplantation, 2005, 21, 81. United Network for Organ Sharing. Available: http://www.unos.org American Psychological Association, July 7, 2006 Click for more on HEALTH.

Glossary of Psychological Terms