Reimagining the Transplant Evaluation Process: A review of the Ethical and Evidentiary Basis Behind the Psychosocial Evaluation of Lung Transplantation

Abstract

Despite decades of changes in allocation policies for lung transplantation, the field is plagued by outdated and ethically problematic processes that impact candidate selection. Transplant centers screen potential organ recipients with a psychosocial evaluation in an attempt to identify potential barriers to post transplant success. Professional guidelines note the problematic nature of basing transplant candidacy on social factors. The prohibitive nature of the process in conjunction with the coercive pressures of impending demise forces individuals and their social support systems to make concessions that directly impact their individual dignities. Precluding eligible candidates based upon nonadherence does not improve clinical outcomes and thus does not benefit the net population. Psychosocial evaluation needs to be reimagined. The current practice, as it stands, fails to meet national ethical standards, but with its diverse widespread utilization, the psychosocial evaluation can become a tool to identify potential gaps and empower transplant teams to support individuals in addressing perceived deficiencies.Urban Bioethic