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Rational guidelines for transplantation in patients with psychotic disorders

Coffman, Kathy L. MD, FAPM*; Crone, Catherine MD, FAPM

Current Opinion in Organ Transplantation: December 2002 - Volume 7 - Issue 4 - p 385-388
Financial, ethical, and legal issues
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This study investigated the outcomes of psychotic patients after transplantation to develop guidelines for rational decision-making with this group of transplant candidates. A survey was distributed to transplant programs in the United States, Canada, and Australia over a 2-year period, yielding 35 cases from 12 centers. Noncompliance resulted in rejection episodes in 14.7% of patients, with reduced function or graft loss in 11.8%. Noncompliance with immunosuppressant drugs was noted in 45.5% of those living alone versus 9.5% of patients living with someone. Suicide attempts were recorded in 35.7% of patients with psychotic symptoms in the year before transplantation, versus 5.9% for those without psychotic symptoms for 1 year before transplantation. Risk factors associated with problems after transplant included antisocial features, history of assault, borderline features, living alone, positive psychotic symptoms such as hallucinations and delusions, and a family history of schizophrenia.

*Cedars Sinai Medical Center, West Hollywood, California, USA, and Inova Transplant Center/Inova Fairfax Hospital, Falls Church, Virginia, USA.

Correspondence to Kathy L. Coffman, MD, FAPM, 9201 West Sunset Blvd., #801, West Hollywood, CA 90069, USA; e-mail: kcoffman@earthlink.net

© 2002 Lippincott Williams & Wilkins, Inc.