Current psychiatric and ethical issues in solid organ transplantation

All countries lack insufficient organs to meet medical needs. Laws are necessary for distribution of these scarce resources. Transplantation policies and procedures vary internationally. Differences occur in the selection of transplant recipients, and in the utilization of cadaveric or living organ donor tissue. Three ethical models for transplant candidate selection are an individual rights model, a utilitarian model and a medical model. Generally the medical model prevails. It requires that treatment be available to those who can benefit. A patient's capacity to benefit from solid organ transplantation depends on medical and psychosocial factors. Psychosocial factors affect adherence to essential medical routines and follow-up care. Education, belief and life style also have a great impact on patient compliance. Transplantation programs must therefore provide effective teaching and perioperative support. Primary and secondary prevention of psychopathological states is also essential. This paper reviews current ethical and psychological factors in organ procurement, candidate selection, and perioperative care of the organ transplant recipient.