New Framework for the Psychosocial Evaluation of Pediatric Transplant and VAD Patients Endorsed by ISHLT
ISHLT has endorsed the recently published Consensus-Based Framework for the Psychosocial Evaluation of Pediatric Candidates for Cardiothoracic Transplant and Ventricular Assist Devices. Developed by a writing committee of 25 multidisciplinary experts in pediatric cardiothoracic transplantation/VAD from across several organizations, including the International Society for Heart and Lung Transplantation (ISHLT), the International Pediatric Transplant Association (IPTA), the Pediatric Heart Transplant Society (PHTS), the Advancing Cardiac Therapies Improving Outcomes Network (ACTION), and Transplant Families, this consensus-based framework represents the first of it's kind specific to both the content and process of the psychosocial evaluation for pediatric cardiothoracic transplantation/VAD, the purpose of which is to offer flexibility, promote consistency, and acknowledge the complexities of assessing pediatric patients.
The psychosocial evaluation plays a critical role in the multidisciplinary assessment of pediatric patients for thoracic organ transplantation or ventricular assist device (VAD) placement. However, there is considerable practice variation with regard to the content and process of the evaluation, with no known recent published guidelines. Furthermore, the pediatric evaluation necessarily differs from the adult evaluation in a number of substantive ways, including caregiver roles and decision-making.
Attention was paid to relevant ethical, cultural and health equity considerations inherent in the pediatric evaluation process. Rather than provide a proscriptive evaluation process, the goal was to create a flexible framework to encourage consistency across centers, while also acknowledging the complexities inherent in evaluating children and their families for cardiothoracic transplant and VAD.