have a multidisciplinary conference where patient candidacies are discussed. The benefit of this approach includes the advantage of assessing people who have interacted with the team in different settings. Surgeons, other physicians, nurses, social workers, etc., in addition to the mental health specialists, all have observational skills important to understanding a patient situation. An opportunity for all staff to air support and concerns about a patient's candidacy results in consensus decisions that are usually, but not always correct. In addition, it creates a more cohesive staff and provides clearer messages to patients and families. It is important to realize that it is not only physicians caring for and taking responsibility for these patients. Health care providers such as nurse coordinators, social workers, ICU nurses and floor nurses feel acutely the stress of caring so intensely for transplant patients. Making everyone feel some part of the decision making and policy of selection is important. A number of prognostic rating scales for psychosocial functioning in transplantation have been devised. The Psychosocial Assessment of Candidates for Transplant (PACT) is a general rating scale that can be used for all solid organs. However, these rating scales need further validation and the fact is there will always be exceptions to the rule. Sometimes the experienced evaluator will have hunches or are able to draw on similar experiences with similar patients to help with patient selection.

The issue of patient selection is important to all transplants; however, as we will discuss later, areas such as liver transplantation in recovering alcoholics, still create controversy and misunderstanding. Sometimes there are situations where the patient clearly contributed to the rejection by noncompliance with medications. The experience for most patients who experience organ rejection is often one of shock, disappointment, sadness and unexpressed guilt. The decision to re-transplant has to be carefully weighted. The reasons for non-compliance have to be fully understood and the transplant team has to be convinced that it will not happen again. Unfortunately, at this time many patients die awaiting transplant, which is particularly difficult for families and medical staff to accept. Patient and family support groups can be very helpful to help with the process, give practical advice and emotional support. Many patients and families contribute time in organizations such as The Transplant Recipient International Organization (TRIO), which provides patient information and promotes donor registration.

Absolute v. Relative Contraindications for Transplant

A survey was conducted by UNOS regarding the transplantation selection processes of the vast majority of U.S. transplantation centers. At most centers active substance abuse and major psychiatric disorders such as schizophrenia were judged to be close to absolute contraindications for transplant. In the real world, however, exceptions are granted based on other important factors. In addition, the maturity of the transplant center and the expertise of its staff may play a crucial role in patient selection of difficult cases. A high volume, more established transplant center may afford to be able to transplant riskier cases. There are stated universal guidelines; however, there are few hard and fast rules to selection based on psychosocial criteria. The survey also highlighted that most transplant centers

Beat The Battle With The Bottle

Beat The Battle With The Bottle

Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.

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