Transplant psychiatry: a new side of consultation-liaison psychiatry

Specific stressors in life can be expected. The death of an elderly loved one or the loss of a job at some point in life will most likely occur. Few, if any, would ever expect to undergo an organ transplant. A new psychiatric clinic at the Transplant Center at Baylor St. Luke's Medical Center, staffed by Baylor College of Medicine Menninger Department of Psychiatry and Behavioral Sciences faculty and led by Dr. Roy Williams Jr., aims to bring psychiatric care to those undergoing the complex and tiring transplant process.

Patients waiting to undergo organ transplants deal with a large variety of challenges, including the tension of the transplant evaluation process, the unknown amount of time spent on the transplant waitlist, and the healing process after surgery.

"Part of working with these patients is dealing with the anxieties that come along with this process. Patients may wonder: 'Am I going to be able to do this? Who's my support system? How am I going to navigate making it to all these appointments? How am I going to live with the limitations of my life going forward?' ," said Williams, psychiatrist and assistant professor at Baylor. "They can't do the activities they once did; they can't do the mountain climbing or traveling they used to do. They're limited, which can decrease or lessen their quality of life."

Williams follows patients for up to a year after transplantation. "A lot of what I do is trying to assess the stressors that each individual is dealing with and determine if they need medication, therapy or if they are appropriate coping with everything going on."

Data shows that approximately 20% of kidney, 30% of liver, and up to 60% of heart recipients develop mood and anxiety disorders after transplantation within the first year. Other factors, such as increased time on the transplant wait list and early post-transplant health problems, have been shown to increase the risk of developing psychiatric disorders.

"The evidence shows that patients who see a psychiatrist and receive treatment during the process and after the transplant have better outcomes. They're able to care for themselves a lot better, their quality of life is improved, and therefore, it helps them overall," Williams said.

With this new role, Williams not only becomes the first transplant psychiatrist to be on staff in the Baylor St. Luke's Transplant Clinic, but he has also become a mental health advocate for transplant patients. As a member of the evaluation team that determines if someone is fit for transplant, he works to dispel negative mental health stigmas that might harm transplant opportunities. He advises the transplant evaluation team on mental health treatment options that might have kept patients off the transplant list in the past. "I like what I do because I'm able to come in and feel like I'm making a big difference on behalf of those patients. I'm able to stand in the gap and advocate for them," he said.

Williams hopes to continue growing the psychiatric clinic within the Transplant Center at Baylor St. Luke's. In the future, he aims to collaborate with an addictions specialist or clinic to help treat patients facing transplants due to addictive behaviors.

Contributed by the Menninger Department of Psychiatry and Behavioral Sciences

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