Psychosocial Contraindications to Heart Transplant Listing in an Urban Academic Medical Center

Abstract

Purpose Psychosocial assessment is a key component of heart transplantation (HT) evaluation. Criteria such as patient compliance to medical therapy, level of social support, and history of substance abuse are important considerations when assessing appropriateness for listing. The aim of this study was to characterize the patients who do not satisfy listing criteria due to psychosocial criteria and assess the reasons for which they are rejected. Methods We conducted a retrospective review of patients in a large urban medical center who were evaluated for HT between 4/14-5/18. Psychosocial evaluations were completed using the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Reasons for HT denial were collected from documentation of patient cases presented at weekly transplant listing meetings. Results Out of 277 patients evaluated, 113 were not listed: 68 (60%) due to only medical reasons, 26 (23%) due to only psychosocial reasons, and 19 (17%) due to both. The most common psychosocial contraindications were inadequate social support (42%), substance abuse (29%), and noncompliance (22%). Patients denied HT had worse overall SIPAT scores than patients listed for HT (16.7 ± 10.4 vs 12.8 ± 7.5, p = 0.026), and specifically scored poorer on patient readiness (5.6 ± 3.9 vs 3.9 ± 2.7, p = 0.002) and social support (4.4 ± 4.5 vs 2.4 ± 2.8, p < 0.001). The SIPAT domains of psychopathology and lifestyle/substance abuse were not significantly different between the two groups (figure). Conclusion Psychosocial barriers are a common cause of rejection for HT listing. Patient readiness and social support are the two factors that are most strongly associated with rejection for HT listing for psychosocial reasons. Psychosocial assessment is a key component of heart transplantation (HT) evaluation. Criteria such as patient compliance to medical therapy, level of social support, and history of substance abuse are important considerations when assessing appropriateness for listing. The aim of this study was to characterize the patients who do not satisfy listing criteria due to psychosocial criteria and assess the reasons for which they are rejected. We conducted a retrospective review of patients in a large urban medical center who were evaluated for HT between 4/14-5/18. Psychosocial evaluations were completed using the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Reasons for HT denial were collected from documentation of patient cases presented at weekly transplant listing meetings. Out of 277 patients evaluated, 113 were not listed: 68 (60%) due to only medical reasons, 26 (23%) due to only psychosocial reasons, and 19 (17%) due to both. The most common psychosocial contraindications were inadequate social support (42%), substance abuse (29%), and noncompliance (22%). Patients denied HT had worse overall SIPAT scores than patients listed for HT (16.7 ± 10.4 vs 12.8 ± 7.5, p = 0.026), and specifically scored poorer on patient readiness (5.6 ± 3.9 vs 3.9 ± 2.7, p = 0.002) and social support (4.4 ± 4.5 vs 2.4 ± 2.8, p < 0.001). The SIPAT domains of psychopathology and lifestyle/substance abuse were not significantly different between the two groups (figure). Psychosocial barriers are a common cause of rejection for HT listing. Patient readiness and social support are the two factors that are most strongly associated with rejection for HT listing for psychosocial reasons.