Psychological

Liver transplantation can be a most stressful event, both for the patient and his or her family. Prior to transplantation the patient is confronted with his or her own mortality. Following the procedure the patient is often faced with uncertainty, multiple invasive diagnostic procedures, and a strange environment.

Following discharge from the hospital, the patient is often transformed from an ill-appearing, needy person to a healthy, self-sufficient individual. The patient's spouse, relatives and friends (being accustomed to the pretransplant persona) may withdraw from the patient both physically, socially and emotionally. Furthermore, the patient's new-found health and good looks may place stress on a marriage based on unilateral dependency. Such stress may threaten to dissolve the marriage. Divorce is not uncommon following liver transplantation.

Furthermore, many of these patients incur extensive medical bills and drug costs following transplantation. This financial strain and the uncertain ability to continue gainful employment also may be very stressful. Although the excellent rehabilitative and medical results of liver transplantation have been widely described, there is a continued reticence of employers to hire liver allograft recipients. This reticence may be due to fear of absenteeism or co-payment of high premiums or high future insurance bills for transplant-related medical and surgical problems. Currently there are state and federal laws that punish employers for this type of discrimination. It comes as no great surprise that these patients are very prone to severe depression following transplantation.

Even with all of these stresses only a minority of our patients appear to require psychiatric and/or psychological consultation. We urge patients with any of the symptoms of depression to seek such treatment and therapy. To further add social support for these patients, the nursing and social work staff have a support group which meets weekly. This group meeting utilizes classical group techniques to ventilate and resolve the personal stresses of the attendees.

Three special groups of recipients absolutely require special regimented psycho-social therapy and support. These are patients who are:

(1) recovering alcoholics;

(2) patients who took hepatotoxins (i.e acetaminophen) in a suicide attempt resulting in acute, fulminant liver failure; and

(3) adolescent recipients of liver allografts.