Psychosocial assessment of complex multicultural situations in paediatric liver transplantation with living donors: the benefits of a systemic approach

From 1984 to 2018, 1115 paediatric liver transplantations have been performed, of which 433 with living donors. With patients coming from 13 different countries, our centre has a strong international dimension. The Live Organ Donor Consensus Group has formulated a statement according to which “a psychological evaluation is necessary for each potential donor”[i]. In our centre, we systematically conduct pre-transplant psychological assessments, which consist in a clinical family interview. The complexity of the family situations having increased over the last few years, we aimed to address the relevance and efficiency of our pre-transplant interviews. Methods: Content analysis of 130 pre-transplant reports written between 1/07/2014 and 31/10/2018 were reviewed, as well as personal prospective notes by the psychologist, in the follow-up of the families after transplantation during the same period, with a systemic attention to the transplanted child’s family. Results: Our reflective work sheds light on the evolution of our practice of pre-transplant interviews, which has evolved from family interviews focused on the living donor, to interviews that consider all the aspects of the family dynamics, including the cultural dimension. The analysis of our prospective notes revealed that the potential risks are not only related to personal characteristics of the living donor candidate, but can also be connected with his/her environment. Moreover, the psychosocial risk does not concern the donor candidate alone, but may well extend to other significant family members, including those who remained in the country of origin. We are receiving families who have experienced unique life circumstances, such as histories of intra-familial tensions or violence, death of previous children, experiences of war or jail … Family dynamics are affected differently by such circumstances, with psychosocial risks at various level and for different family members as a consequence. As a result of embracing the complexity of such trans-national families, we moved from proceeding to a single family interview focused on the living donor candidate to conducting one or multiple interviews focused on the family situation (including psychiatric or social consultation). Conclusion: In order to prevent short and long-term psychosocial damage for families concerned with living-related donation, we recommend to extend the focus on the donor alone to a focus on the whole family system and history, and to pay attention to the cultural dimension, as this has an impact on important social processes and interactions, which in turn influences the psychological – and sometimes psychiatric - outcomes.