A272 Aims: Little is known about the psychological patterns of patients with end-stage organ disease awaiting transplantation (Tx). This study explores patients concerns and expectations prior to Tx. Methods: In this IRB-approved prospective study, we enrolled 36 adult patients (age m=52.1) that had been accepted in the organ waiting list. Four groups of patients were studied: liver (N=9), kidney (N=14), heart (N=8), and lung (N=5) awaiting patients. All agreed to participate in a semi-structured interview exploring their illness history until decision of organ Tx, and their present concerns in a non-evaluative context. Interviews were conducted by a psychologist at the patients’ home or in a place of their choice, audio-recorded and transcribed. They described their concerns during follow-up. A qualitative analysis was performed. Results: All the patients described an emotional “shock” upon learning the need for Tx, and were ambivalent about this “no-choice situation”. However Tx was seen as a possible rebirth or a perspective for a better quality of life, especially for kidney-awaiting patients on dialysis, in which case Tx was expected to help recover freedom. Patients experienced the routine physical and psychological evaluation (conducted during the screening process for Tx selection) as an emotional pressure, but a necessary step. All felt they had to prove their physical aptitude and mental strength to undergo Tx. They also emphasized their positive mental predisposition, their ability to handle negative thoughts, and their will to remain in a good physical shape in spite of increasing physical complications. All of them talked about their feeling of stigmatization and misunderstanding because of their physical decline. Patients who needed oxygen (1/8 heart and all lung patients) had to deal with the constant staring of people when walking outside. Others (8/9 liver) mentioned the lack of confidence from professionals and relatives, and the burden of being seen and evaluated as former alcoholics or drug-addicts, this negative “image” being reinforced by the physical transformations due to their failing liver functions. Finally, kidney-awaiting patients (11/14) mentioned that dialysis constraints induced heavy social marginalization. All patients pointed out the availability of psychological support from the coordination team, physicians, relatives or former transplanted patients, but they often felt they could not overtly express their anxiety, negative thoughts, as they feared to overload them with their recurrent questionings. Some (N=8) received psychological help in the hospital but they felt they could not talk freely because of fear of negative consequences that might endanger their eligibility for Tx. A subset of patients (7/36), called upon spiritual or magical resources in order to reduce their anxiety while waiting on the list. The non-evaluative context of the interviews performed in this study allowed patients to express freely all their concerns. Being able to talk freely was considered as a necessity. Some spontaneously asked for a follow-up before transplantation (36%), and all agreed to an additional interview six months later, if not yet transplanted. Conclusions: These results emphasize the importance of psychological support in the waiting period prior to Tx, and they suggest that a non-evaluative context approach appears to be appropriate to optimize the analysis of patients’ concerns. Thus, patient management should not only address medical issues relevant for a long-term Tx success, but it should also focus on the patient’s psychological needs.