PhD/PsyD Organ transplant evaluations

[erg923]

1. Is there any suggestion that PAI vs MMPI would be better within the contect of organ transplant presurg evaluation? There is some light pressure for a PAI from someone here, but its really not their call, and frankly, I like the MMPI better due to my familarity with it.

2. I would assume pretty much any alcohol is too much alcohol in this context? Doesn't look like abuse, but towards upward end of what is probably health drinking levels. "Organs are precious" is my opinion, but maybe Im being too strict?

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[PsyDr]

1) PAI has a lower reading level, and pathologizes less. MMPI has a slightly higher reading level and pathologizes more. It's really a judgement call on your part.

2) Depends on the organ. Liver? Heart? Lungs? Cornea?

Engle, D. (2001). Psychosocial aspects of the organ transplant experience: What has been established and what we need for the future. Journal of Clinical Psychology, 57, 521-549.

Ethical and psychosocial challenges in liver transplantation J Psychosom Research Withers NW, Hilsabeck RC, Maldonado JR 2003; 55: 116.

Lacerda, S. S., Guimaro, M. S., Prade, C. V., Ferraz-Neto, B. H., Karam, C. H., & Andreoli, P. B. A. (2008). Neuropsychological assessment in kidney and liver transplantation candidates. Tranplantation Proceedings, 40, 729-731.

Olbrisch, M. E., Benedict, S. M., Haller, D. L., & Levenson, J. L. (2001). Psychosocial assessment of living organ donors: Clinical and ethical considerations. Progress in Transplantation, 11, 40-49.

Olbrisch, M. E., Benedict, S. M., Ashe, K. & Levenson, J. L. (2002). Psychological assessment and care of organ transplant patients. Journal of Consulting and Clinical Psychology, 70, 771-783.

Olbrisch, M. E. (1996). Ethical issues in psychological evaluation of patients for organ transplant surgery. Rehabilitation Psychology, 41, 53-71.

 

[CaliMac]

2. I would assume pretty much any alcohol is too much alcohol in this context? Doesn't look like abuse, but towards upward end of what is probably health drinking levels. "Organs are precious" is my opinion, but maybe Im being too strict?

What is the generally-accepted upper bound of healthy?

 

[erg923]

What is the generally-accepted upper bound of healthy?

For adult men, typically no more than 14 etoh drinks per week. But this is for healthy adult men, and this guy isnt exactly healthy.

Its a lung transplant

 

[AcronymAllergy]

I don't know if alcohol use would be an absolute contraindication in that situation. Smoking obviously would be (as it is in all organ transplants), but alcohol may just be up to the surgeon and how comfortable they are. I'd imagine (and this is a guess) that most would want or require the patient to be able to demonstrate a period of non-use, though, to show that they can at least entirely abstain while in acute recovery.

I believe the MMPI has a bit more research in organ transplant evals than does the PAI. You could also consider pairing either one with the MBMD. Either one should of course be able to pick up things like acute depression, suicidality, general emotional instability, etc.

I remember at NAN one year, Ben-Porath showed that the reading level of the MMPI-2 and PAI are actually very similar, they were just evaluated using different rating algorithms. At a VA, neither one should really be a problem.

Personally, I like the PAI more than the MMPI-2 because it's shorter, more straightforward to interpret, and the scales are orthogonal. I'm also becoming a fan of the RF for similar reasons, but there's obviously less research behind it than the MMPI-2.

 

[G Costanza]

I work in a UCC that is based in a hospital. While walking to lunch, I opened the door for a woman holding a cooler with "Organ Donation" written on the side. I asked what was in it and she said, "Eye don't know."

So based off that experience I'd go with the PAI.