Multicultural Awareness and a Comprehensive Team Approach to Liver Transplantation: A Case Report

  • Jessica L. HamiltonEmail author
  • Kalon R. Eways
  • Sara Fohn
  • Winston Dunn


Patients being considered for a liver transplant undergo a rigorous evaluation process to identify the medical and psychosocial factors that may impact transplant success. The American Association for the Study of Liver Disease outlines recommendations for medical factors, but guidelines for psychosocial factors, such as multiculturalism, are less clear. The aim of this unique case study was to highlight the importance of multicultural awareness in the context of liver transplantation. More specifically, the report follows an American Indian man from initial diagnosis through psychological assessment and transplantation in order to illustrate the benefits of a comprehensive, multicultural team approach. Various components of multiculturalism are discussed, including the patient’s ethnicity, intellectual functioning, socioeconomic status, and mental health history. Consideration of these factors by the patient’s treatment team ultimately led to the patient’s candidacy for transplant, as well as effective psychosocial support throughout the transplant process and recovery. Incorporation more specific psychosocial recommendations into national liver transplantation guidelines would likely improve the evaluation process and outcomes.


Transplant Psychological assessment Multicultural Multidisciplinary care 



Liver Transplant team at the University of Kansas Medical Center, and patient.

Compliance and Ethical Standards

Conflict of interest

Authors Jessica L. Hamilton, Kalon R. Eways, Sara Fohn, and Winston Dunn declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in this case report.


  1. Boat, T. F., & Wu, J. T. (Eds.). (2015). Mental disorders and disabilities among low-income children. Washington, D.C.: National Academies Press.Google Scholar
  2. Casaletto, K. B., Cattie, J., Franklin, D. R., Moore, D. J., Woods, S. P., Grant, I.,… & HNRP Group. (2014). The Wide Range Achievement Test–4 Reading subtest “holds” in HIV-infected individuals. Journal of Clinical and Experimental Neuropsychology, 36, 992–1001.Google Scholar
  3. Cohen, L., Solomon, T., Joe, J., Haring, R., Leslie, R., DeRoins, D., et al. (2015). Native American developmental disabilities needs assessment. Silver Spring, MD: Association of University Centers on Disabilities.Google Scholar
  4. Fineberg, S. K., West, A., Jongho, P. N., Oldham, M., Schilsky, M., Hawkins, K. A., & Hochang, B. L. (2016). Utility of pretransplant psychological measures to predict posttransplant outcomes in liver transplant patients: A systematic review. General Hospital Psychiatry, 40, 4–11.CrossRefGoogle Scholar
  5. Hill, J. S., Pace, T. M., & Robbins, R. R. (2010). Decolonizing personality assessment and honoring indigenous voices: A critical examination of the MMPI-2. Cultural Diversity and Ethnic Minority Psychology, 16, 16–25.CrossRefGoogle Scholar
  6. Jones, P., & Kanwal, F. (2016). Communication and trust: Critically important to eliminate disparities in liver transplantation. Liver Transplantation, 22, 881–883.CrossRefGoogle Scholar
  7. Kamin, D. S., Freiberger, D., Daly, K. P., Oliva, M., Helfand, L., Haynes, K., … Kim, H. B. (2016). What is the role of developmental disability in patient selection for pediatric solid organ transplantation? American Journal of Transplantation, 16, 767–772.CrossRefGoogle Scholar
  8. Kemmer, N. (2011). Ethnic disparities in liver transplantation. Gastroenterology and Hepatology, 7, 302–307.Google Scholar
  9. Martin, P., DiMartini, A., Feng, S., Brown, R., & Fallon, M. (2014). Evaluation for liver transplantation in adults: 2013 Practice guidelines by the AASLD and the American Society of Transplantation. Journal of Hepatology, 59, 1144–1165.CrossRefGoogle Scholar
  10. Morey, L. C. (1991). Personality assessment inventory. Odessa, FL: Psychological Assessment Resources.Google Scholar
  11. Morey, L. C. (2003). Essentials of PAI assessment. Hoboken, NJ: Wiley.Google Scholar
  12. Organ Procurement and Transplantation Network. (2018). National Data. Retrieved August 27, 2018, from,
  13. Pace, T. M., Robbins, R. R., Choney, S. K., Hill, J. S., Lacey, K., & Blair, G. M. (2006). A cultural-contextual perspective on the validity of the MMPI-2 with American Indians. Cultural Diversity & Ethnic Minority Psychology, 12, 320–333.CrossRefGoogle Scholar
  14. Pedersen, P. B. (1991). Multiculturalism as a generic approach to counseling. Journal of Counseling and Development, 70, 6–12.CrossRefGoogle Scholar
  15. Saracino, R. M., Jutagir, D. R., Cunningham, A., Foran-Tuller, K. A., Driscoll, M. A., Sledge, W. H., … Fehon, D. C. (2018). Psychiatric comorbidity, health-related quality of life, and mental health service utilization among patients awaiting liver transplant. Journal of Pain and Symptom Management, 56, 44–52.CrossRefGoogle Scholar
  16. Sun, S., Hoyt, W. T., Brockberg, D., Lam, J., & Tiwari, D. (2016). Acculturation and enculturation as predictors of psychological help-seeking attitudes (HSAs) among racial and ethnic minorities: A meta-analytic investigation. Journal of Counseling Psychology. Scholar
  17. U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to mental health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.Google Scholar
  18. Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.CrossRefGoogle Scholar
  19. Wechsler, D. (2008a). Wechsler adult intelligence scale (4th ed.). San Antonio, TX: Pearson.Google Scholar
  20. Wechsler, D. (2008b). Wechsler adult intelligence scale—fourth edition: Technical and interpretive manual. San Antonio, TX: Pearson.Google Scholar
  21. Wilde, E. A., Whiteneck, G. G., Bogner, J., Bushnik, T., Cifu, D. X., Dikmen, S.,… & Millis, S. R. (2010). Recommendations for the use of common outcome measures in traumatic brain injury research. Archives of Physical Medicine and Rehabilitation, 91, 1650–1660.Google Scholar
  22. Wilkinson, G. S., & Robertson, G. J. (2006). Wide range achievement test–4 (WRAT–4). Lutz, FL: Psychological Assessment Resources.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Internal MedicineUniversity of Kansas Medical CenterKansas CityUSA
  2. 2.Department of PsychologyUniversity of Missouri—Kansas CityKansas CityUSA

Personalised recommendations