Standardized psychological evaluation pre- and posttransplantation: a new option.

A multicenter study was undertaken involving three teams in Italy to obtain a homogeneous psychological evaluation of patients needing organ transplantations. After a preliminary formulation of a common questionnaire individualizing 22 items, yielding a final score from 0 to 44, 294 forms were analyzed for correlations between variables. The sample responses were related to individual variables as well as by cluster analysis to aggregate typical profiles. Clustering of variables was observed in three areas that showed two variables (no. 6, "ongoing psychotic disturbances" and no. 10 "drugs") to be separate. Area 1 ("psychopathology") highlights psychic disturbances, cognitive disorders, and unhealthy behavioral styles; area 2 ("anxia") correlates anxious symptoms to pretransplant examinations and waiting time; area 3 ("depression") ties personal emotional resources and affective factors. Cluster analysis of the sample identified four groups: Group 1 (16.6%) "at risk;" mean score 25.2 (range 16-31); Group 2 (21.7%) "intermediate-at risk," mean score 32 (range 25-38); Group 3 (29.6%) "intermediate-ideal," mean score 35.3 (range 26-40); and Group 4 (31.9%) "ideal candidate," mean score 40.7 (range 36-44). The two "intermediate" groups were studied for mean values for area 1; namely, a cut-off value of 1.78 constituted a better or worse prognostic factor to assign the patient to either Group 2 or 3. Using a uniform method of psychological evaluation before transplantation reduced single operator subjectivity, obtaining comparable results in different transplant centers and allowing planning interventions for at-risk patients.

[Psychological assistance in organ transplantation]. / L'assistenza psicologica nei trapianti d'organo.

The aim of this report is introducing with a series of psychological, psychiatric and psychosocial problems, that can arise, at every point, in the procedure of organ transplantations. Different areas of intervention are considered: the assistance to the patients and their families during the pre- and post-operative periods; the evaluation of transplant recipients' quality of life; ethical and psychological problems of living kidney donation; psychosocial support to donors' families; the training of the intensive therapy units to entertain relationships with donors' relatives; the delicate psychological aspects of transplantation during childhood. The sense of awareness about these matters is growing in Italy too, and many initiatives of psychological and psychiatric help are being developed in collaboration with several transplantation centres.