Psychosocial Considerations of Heart Transplant: Keeping Apace with the Revolution in Cardiac Care

Abstract

The cardiac transplant social worker assumes a complex role on a transplant team: assessor, fixer, ethical conscience of the team, resource expert, ambassador to other consultative teams, and is one of the central figures to the patient and family as they move through all phases of care. The function of the cardiac transplant social worker has evolved in similar parallel fashion as has cardiac transplantation itself. Once tasked with responsibilities that included supporting patients and their families while patients waited in hospital for organs to become available, social workers now work with patients and families who, for the most part, wait at home, often for years, on left ventricular assist devices (LVAD) as a prelude to transplant. The steps between listing and transplant have elongated as has the need for critical assessment tools and skills in an ever changing and revolutionary cardiac landscape. Social workers in cardiac transplant have been called upon to acquire different skill sets to incorporate the cataclysmic changes in cardiac care. Developing a psychosocial assessment tool is the foundation of performing a comprehensive, thorough, and detailed evaluation of the transplant candidate and LVAD candidate and should incorporate guidelines from UNOS, CMS, and JCAHO. Assessing health literacy is crucial to ascertaining a patient and family’s ability to understand, comply, and execute required care. Including the palliative care team at consistent intervals is imperative. Collective team agreement on absolute contraindications to listing and/or implanting is crucial to a shared vision of candidacy.