The Role of Pediatric Psychologists in Solid Organ Transplant Candidacy Decisions: Ethical Considerations

The donor shortage in pediatric solid organ transplantation raises ethical considerations for transplant providers who must balance ethical responsibilities to the patient, the donor, and the general pool of transplant candidates. The United Network for Organ Sharing (UNOS) requires transplant centers to incorporate a psychosocial evaluation into a multidisciplinary transplant evaluation, but individual transplant centers differ in their approach to considering how psychosocial factors contribute to ethical decision making in candidacy decisions. Through psychosocial transplant evaluations and interventions to optimize a patient’s candidacy, pediatric psychologists offer unique expertise to transplant teams. However, they must actively balance professional ethics, bioethics, and legal mandates that often contribute to challenging transplant candidacy decisions. An adolescent case example is discussed to illustrate ethical problem solving in the pediatric transplant context.