NN&I - August 2010

Transplant 26 Nephrology News & Issues August 2010Subscribe to our free eNewsletter at www.nephronline.com patient and graft outcome. It is not to determine "social worth" or to affect rank order on the wait list. There are several factors known to contribute to poor patient and graft outcomes, as noted in the chapter, "Psychosocial issues in transplantation," in the book, Transplantation Nursing Secrets (2003). Poor social support \037 Mental health/psychiatric disorders \037 likely to negatively affect post trans -plant adherence Self-destructive behavior such as \037 alcohol or substance abuse A history of poor adherence with \037 medical and psychiatric treatment The patient's inability or unwill - \037 ingness to comprehend the need for improved adherence Dysfunctional personality traits and \037 disorders, and Financial issues that could inter - \037 fere with post-transplant medication adherence CMS requires transplant centers to inform all candidates of the medical and psychosocial risks of transplan -tation and obtain informed patient consent for transplant evaluation. The Final Rule has identified the psychoso-cial risks as depression, PTSD, gener -alized anxiety, dependence on others, guilt, possible future health and mental health problems, impact of receiving a transplant, and the impact on future medical, life, and disability insurance. The psychosocial evaluation interview is the appropriate time for social work -ers to review and discuss the psychoso -cial risks with the candidate. Social workers have specific ethi -cal responsibilities to transplant can -didates. The Code of Ethics of the National Association of Social Workers (NASW) establishes the ethical frame-work of Social Work practice in the United States. The Code is the eth-ical standard for State Social Work Licensing Boards and states that the social worker is first obligated to pro-mote the well being of the patient, and that the patient's interests are pri -mary. Patients and the public at large have a legitimate expectation that the social worker they meet with will first represent their self-determination and interests. It is not uncommon for trans-plant candidates to assume the trans -plant social worker and psychosocial evaluation is there to "only help them." However, the Code recognizes there are times when the social worker's obliga-tion is to others or to "society at large." In the case of psychosocial evaluation for transplant, the social worker is con-ducting an evaluation to determine if the patient meets psychosocial patient selection criteria focused on selecting patients that have the best probabil -ity of good patient and graft survival outcomes. Selecting such patients is the responsibility of transplant cen -ters, and it recognizes the obligation to "society at large" that has a public inter -est in how scarce organs are allocated. Social workers conducting psy -chosocial evaluations with transplant candidates are ethically obligated to inform the patient of the purpose of the evaluation, tell them the social workers will ask personal questions in the evaluation interview, and that the answers to these questions will be used to determine whether they meet psychosocial selection criteria. Once the patient acknowledges they have been informed, the social worker is obligated to then obtain consent from the patient to continue with the evalu -ation. Patients have a right to know the questions to be asked. It is appropri-ate to discuss the psychosocial patient selection criteria and explain how the results of the evaluation will be weighed with the psychosocial patient selection criteria. If the patient refuses to give consent, the case should be taken to the center's transplant committee for discussion. Medicare requires a psy -chosocial evaluation prior to place -ment on the waiting list. One of the most common grievances filed against social workers with State Boards is failure to obtain informed consent prior to providing services. The new Medicare regulations also raise the standard for Medicare trans -plant centers to obtain informed con -sent prior to the medical and psycho-social evaluations. Conclusion The CMS Hospital Conditions of Participation for Transplant Centers has changed how transplant centers evaluate and list patients for trans -plant. Social workers have a unique responsibility to inform patients of the psychosocial risks of transplant, fully explain the purpose of the psychosocial selection criteria and evaluation, and then obtain informed consent to pro -ceed with the psychosocial evaluation. ResourcesBuntin J. Live or die? That was up to the panel to decide. The Washington Post. August 23, 2009 Department of Health and Human Services 42 CFR Part 121, Organ Procurement and Transplant Network; Final Rule (63 Federal Register 16295, at 16332, April 2, 1998) Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 405, 482, 488, and 498, Medicare Program; Hospital Conditions of Participation: Requirements for Approval and Re-Approval of Transplant Centers To Perform Organ Transplants (Federal Register / Vol. 72, No. 61, March 30, 2007) Dhooper S. Organ transplantation: Who decides? Social Work, Vol. 35, p. 322-337,1990 Institute of Medicine, National Academy of Science, Organ Procurement and Transplantation, Washington, D.C. 1999 National Association of Social Workers, Code of Ethics, Washington, D.C. 2008 Thomas C. Organ donation and transplantation in the United States: Understanding the basics, Diabetes Self Management, New York, November 2005 Scientific Registry of Transplant Recipients (SRTR), Ann Arbor, MI 2010 Harrison J et al. Psychological issues in transplan- tation. Transplantation Nursing Secrets, Cuples S, Ohler L, ed., 2003 Transplant_NNI_0810_3TK.indd 26 7/15/10 6:12:00 PM