H - 40 The Role of Neuropsychology in Solid Organ Transplantation Candidacy in a Patient with a Diverse Linguistic and Sociocultural Background.

Abstract

Candidates for transplantation with end stage organ failure (ESOF) undergo extensive pre-surgical medical and psychosocial evaluations, however neuropsychology is rarely required. This is concerning, as patients with ESOF often have cognitive deficits that may impact their ability to safely manage post-transplant care and are at increased risk for morbidity/mortality. This case highlights the novel perspective a comprehensive neuropsychological evaluation provides, especially in patients of diverse sociocultural backgrounds. The patient is a 37-year-old monolingual Spanish-speaking woman referred for evaluation in the context of liver transplant candidacy due to apparent inability to follow medical guidance, medication adherence, and continued alcohol consumption. Medical history includes autoimmune hepatitis, multifocal hepatocellular carcinoma, and diabetes. The patient reported problems with remembering information from providers even with compensatory strategies. Her family assists heavily with scheduling and transportation. When asked about alcohol use, she reported recent use of a few beers due to very hot weather, limited access to clean water, and the death of a family member despite providers urging her to remain abstinent. She was not aware of the hazard that even minimal alcohol use presented to her candidacy. She did not meet criteria for a neurocognitive disorder. The etiology of her noncompliance was secondary to poor social support, limited coping skills, and feeling overwhelmed by team instructions. Conducting a culturally informed evaluation in the patient's native language provided clear evidence of intact cognition and a nuanced understanding of her limitations that would not be appreciated in a more limited evaluation.