The Role of Pediatric Psychologists in the Pre-Transplant Evaluation: A Practice Survey

Elizabeth S. Christofferson, Department of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
Jill M. Plevinsky, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Kelli N. Triplett, Department of Psychiatry, University of Texas Southwestern, Dallas, Texas, USA.
Kaushalendra Amatya, Department of Psychiatry and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Zachary Arcona, Children's Hospital Colorado, Aurora, Colorado, USA.
Katherine Bedard-Thomas, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Lillian Christon, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Melissa K. Cousino, Department of Pediatrics and Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Anne E. Dawson, Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA.
Ana F. El-Behaldi, Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.
Leah A. Grande, Children's Hospital Colorado, Aurora, Colorado, USA.
Debra S. Lefkowitz, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Gillian Mayersohn, Division of Pediatric Psychology, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA.
Kristin Rich, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Lauren M. Schneider, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.

Document Type

Journal Article

Publication Date

11-1-2025

Journal

Pediatric transplantation

Volume

29

Issue

7

DOI

10.1111/petr.70209

Keywords

best practices; pediatric transplant psychology; pre‐transplant evaluation

Abstract

BACKGROUND: The psychology pre-transplant evaluation is an integral component of the pediatric transplant process and serves to identify both risk and resilience factors that may contribute to peri- and posttransplant outcomes. Despite guidelines with general considerations, the pediatric pre-transplant psychological evaluation is not standardized. This study presents results from a practice survey of pediatric transplant psychologists to inform the standard of care. METHODS: A workgroup of members of the Society for Pediatric Psychology Solid Organ Transplant Special Interest Group designed a survey assessing pre-transplant psychological evaluation practices. A total of 88 psychologists were identified and asked to complete the survey. Descriptive statistics were used to summarize survey results. RESULTS: Forty-seven psychologists representing 38 medical centers provided complete responses. Respondents represented multiple solid organ groups: 70% kidney, 68% heart, 47% liver, 19% lung and multi-visceral respectively, 13% intestinal, and 9% pancreas. Psychology is routinely involved in evaluations, though psychology evaluation practices are impacted by various barriers (e.g., time, insurance) and patient characteristics (e.g., medical acuity, age). The most commonly assessed domains were developmental history, allocation of treatment responsibility, social history, patient psychiatric history, motivation for transplant, understanding of transplant, treatment adherence, and medical coping. Although domains assessed were largely consistent among respondents and represented important risk and resilience domains, there was reported variability in the role of psychology on selection committees and listing decision-making. CONCLUSIONS: Despite a lack of standardization of the pre-transplant psychological evaluation, areas of consistency exist. However, variability in practice among pediatric solid organ transplant centers remains, necessitating the development of a common foundation for the pre-transplant psychological evaluation. Results also emphasize the importance of psychology's role within pediatric transplant teams.

Department

Psychiatry and Behavioral Sciences

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