Chief: Rosario Girgenti

The Clinical Psychology Service at ISMETT was established in 2000 with the clear purpose of providing psychodiagnostic assessment, psychological and clinical support, cognitive emotional behavioral therapy for single individuals, couples, and families, and well-being therapy for patients and families.

The clinical psychologist is available for patients and their families, and makes sure that they are provided with proper and understandable information and the necessary psychological support. If indicated, based on the psychologist’s assessment, a long-term therapy with daily sessions can be requested for the patient and his/her family members.

The psychologist’s assessment along the pathway towards the transplant. Transplantation is the only option for a disease with an unfavorable prognosis. Waiting can provoke doubts and fear in the patients and their families. In the post-operative period, anxiety can become fear of infections or organ rejection, which could be the end of all hopes.

The psychological intervention is divided into three stages:

• Pre-transplant phase: a psychological preparation, including an assessment of the psychic, emotional, and cognitive status of patients, analysis of defense strategies, risk factors, therapeutic compliance, and relationships within the family. Finally, the case is discussed with the members of the transplant team.
• Post-operative hospital stay, psycho-behavioral assessment, identification of relational behavior strategies between clinicians and patients, relevant assessment and indication for psychiatric drug therapy.
• Post-transplant outpatient consults to support the patient’s autonomy and assess his/her ability to return to the social and family environment, psychological support for therapy compliance, and assessment of emotional, family and social adaptation (quality of life).

Psychological assessment of pediatric patients
In this case, suitability assessment is addressed both to the patient and the parents.

According to the PSI TO (Italian working group on the psychological and psychiatric aspects of organ transplantation), the assessment is aimed at:

• Favoring the parents’ consent to the surgery, and the aware participation of the child through the identification of criticalities and available resources.
• Fostering the collaboration with treatment (therapeutic alliance) in the pre and post-transplant period.
• Planning support interventions in the critical areas identified in the child and in the parents.

Psychological assessment for living-related organ transplant
The donor must be thoroughly informed of the possible risks. The role of the psychologist is to understand the level of awareness of the patient. Another important aspect of the psychological assessment is to disclose any psycho-social pressure (coercion) within the family that could be harmful for the donor. Italian law requires an interview of the potential donor with a magistrate, who will verify the spontaneous donation and lack of external conditioning/coercion.

In the case of a living donation to a pediatric patient, the patient and his/her parents will be also evaluated according to national guidelines.