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Over half a century ago, the first whole-organ transplantation upended what was expected for patients with advancing illness. As surgical transplant techniques improved, immunosuppressive therapies grew more sophisticated, and organ transplantation became commonplace, the aim of medical therapy shifted from management and acceptance to cure and survival.
Despite the success of organ transplantation, transplant recipients continue to have significant healthcare needs. Perioperative complications, intensive care unit stays, family distress, and burdensome symptoms1'2 are only some of the reasons why transplant recipients may benefit from palliative care services even after transplantation.3 However, two major barriers interact to impede the routine integration of palliative care services for these patients: Misconceptions about the goals of palliative care and the quality care outcome measures that have the unintended consequence of disincentivizing its routine use.
The promise of organ transplantation is one of survival. Take liver transplantation as an example: Those with end-stage liver disease who receive a transplant now have a greater than 60% survival rate at 10 years.4 This dramatic turn tends to shade the reality that persists even after successful transplantation. First, patients with one failing organ tend to have other health concerns that remain after transplantation. In one study, 90% of kidney transplant recipients had a comorbidity.5 Second, living with a transplanted organ constitutes its own chronic illness, requiring frequent interactions with the healthcare system, immunosuppression, and an oppressive pill burden. Additionally, they have a new status within the healthcare system as organ recipients. They need support and attention as they navigate this new identity. Third, recipients and their families tend to have a significant number of physical and psychological symptoms.1'2 The psychological impact of living and coping with a serious illness does not disappear with transplantation; it continues to have a significant effect on we 11-being.
Palliative care is meant to provide for patients who experience the psychological and physical symptoms of advanced illness, and transplant recipients may benefit from such sendees. Over a decade ago, the American College of Surgeons published a position statement on palliative care:
If palliation is taken to apply solely to care near the time of death, or "comfort measures only," it fails to include the life-affirming quality of active, symptomatic efforts to relieve the pain and suffering of individuals...