(195) Psychosocial considerations and role of consultation liaison psychiatry in care of sole recipient of tracheal transplant

Abstract: There is limited guidance on the management of patients who undergo pioneering, first-time transplant surgeries, in which quality of life concerns intersect for the first time with the challenges of a transplant. Palliative care is a speciality that focuses on improving the quality of life of patients with serious illness (Kelley 2015), including transplant patients. Here we discuss a case of the first and only living tracheal transplant recipient for which psychiatry was consulted to guide in the management of suicidal ideation, and in which a recommendation was made to include palliative care for goals of care discussions.



This is the case of a 57 year old female with a history of asthma requiring prolonged intubation complicated by permanent tracheostomy, for which the patient received the first ever tracheal transplant. Though patient has no formal psychiatric history she reports prior suicide attempts in the context of quality of life concerns related to tracheostomy. Patient currently presented for a planned closure of her tracheal stoma, which was aborted due to concerns of airway patency. Following the aborted closure, the patient reported that she would be “better off dead” and decided to decline medical care. On evaluation, the patient characterized her suicidal ideation as chronic frustration with her quality of life after receipt of her transplant. Although the patient’s main goal for the transplant had been achieved, which was improved breathing, other expectations did not align with post transplant reality. Frequent interdisciplinary discussions were held with the patient’s medical teams and a recommendation was made to consult palliative care for a goals of care discussion centered on quality of life. Following these discussions, the patient’s mood improved with resolution of suicidal ideation rooted in frustration regarding quality of life.



This case highlights the challenges that can arise with undergoing a pioneering procedure, including the evolving nature of psychosocial circumstances impacting transplant care. Despite the potential benefit of palliative care in transplant care, very few transplant patients are enrolled in palliative care (Song 2009). This may partly be due to a limited understanding of the types of services that palliative care offers (Nolley 2019), with a frequent misconception of palliative care as end of life care. However, much of palliative care focuses on quality of life goals, which is critical to address in unprecedented procedures, in which ongoing challenges and suffering can result even with successful surgeries; a reality ever more important as we venture into new territories in organ transplant. Through goals of care discussions, palliative care can facilitate patient autonomy, interdisciplinary communication, and align the patient and medical teams’ goals. This case highlights the potential role of psychiatry in advocating for quality of life discussions throughout a transplant patient’s care.