The organ grind

HEALTH

Ever since organ transplants were first performed almost forty years ago, transplantation psychiatrists have helped ease the ordeal of getting new body parts. Today's health care climate is now demanding a transplant of their expertise to other medical realms.

These psychiatrists deal with the psychological fallout of imbalances in supply and demand for new hearts, lungs, and livers. Almost all transplant centers in the country use some kind of psychosocial assessment to select organ recipients. "They have an ethical responsibility to use each organ optimally," says James Levenson, M.D., transplant psychiatrist at the Medical College of Virginia. He reports that many transplant centers rule out people with schizophrenia, dementia, personality disorders, drug addiction, or suicide risk. Patients who neglect their medication or ignore their doctor's instructions may also be excluded.

Unfortunately, difficult decisions of patient selection are no longer confined to the transplant unit. As researchers develop highly advanced and very expensive treatments that can be given to only a few-especially under managed care--transplantation psychiatrists are now being called upon to assist doctors in cardiology, oncology, AIDS treatment, and other fields in which demand far outstrips supply.--C.C.

ILLUSTRATION

Tags: difficult decisions, drug addiction, healthcare, levenson, livers, medical college of virginia, ordeal, organ transplant, organ transplants, personality disorders, physical health, psychiatrists, risk patients, suicide risk, treatment

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