Reexamining psychosocial clearance: A procedural framework for psychosocial evaluation in liver transplantation

Psychosocial and nonmedical phenomena are commonly encountered in liver transplantation (LT) evaluations. They are simultaneously crucial decision-making factors and some of the most difficult and controversial clinical matters clinicians confront. Epidemiology, societal trends, and the preponderance of psychological and behavioral factors underpinning common end-stage liver diseases ensure that LT teams will continue to encounter highly complex psychosocial patient presentations. Psychosocial policies, practices, and opinions vary widely among clinicians and LT centers. Liver clinicians already report insufficient psychosocial expertise, which creates a large gap between the stark need for psychosocial expansion, improvement, and innovation in LT and the lack of accompanying guidance on how to achieve it. While the clinical domains of an LT psychosocial evaluation have been well-described, few articles analyze the procedures by which teams determine candidates' psychosocial clearance and no conceptual frameworks exist. This article proposes a framework of core domains of psychosocial evaluation procedures, common pitfalls, and practical improvement strategies.

Automated summary

Psychosocial and nonmedical phenomena are common in liver transplantation evaluations and pose challenges to clinicians. There is a lack of consensus among clinicians and centers regarding psychosocial policies and practices. This article proposes a framework for psychosocial evaluation procedures, identifies common pitfalls, and suggests practical improvement strategies.