Psychological Aspects of Cardiac Transplantation

  • Brigitta Bunzel


Heart transplantation is more than the mere exchange of an organ that no longer functions. Losing one’s own heart and having to accept one, to ensure survival, from a brain-dead donor constitutes a threat to one’s physical and psychological integrity and demands a high degree of coping skills from the patient. In the present chapter, the phases of the transplantation process as well as their psychological correlates are examined in terms of their meaning for the patient and the patient’s spouse or partner: evaluation, the waiting period for a donor heart, time spent in hospital, the first postoperative year, and long-term survival. Additionally, as many patients receive ventricular assist devices (VAD) (external pumps to aid a failing heart) as a bridge to transplantation, information is provided on how to handle the psychosocial aspects of living with such a life-saving device.

Chronic cardiac insufficiency reduces the affected patients’ quality of life much more than many other chronic illnesses. If, despite all types of therapeutic efforts, the advancing illness and thus the threat to human life and to the quality of life (increasing limitation of living space, physical susceptibility, decreasing endurance, occurrence of psychiatric comorbidities such as depression, compromising of sexuality and partnership) cannot be impeded, for some decades now, this downward spiral no longer ends, as it once did, necessarily with the death of the patient, but rather first by considering a heart transplant. The decision to undergo transplantation is a difficult one, both from the side of the doctors as well as that of the patient. “Heart transplantation is a process that continues for the remainder of the recipient’s life,” warns Peter Shapiro, one of the most experienced psychiatrists from the area of transplantation psychiatry (Shapiro, 1990).


Heart Transplantation Left Ventricular Assist Device Ventricular Assist Device Donor Heart Transplant Team 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This chapter was translated from German by Charlotte Eckler.


  1. Bernazzali, S., Basile, A., et al. (2005). Standardized psychological evaluation pre- and posttransplantation: A new option. Transplantation Proceedings, 37(2), 669–671.PubMedCrossRefGoogle Scholar
  2. Bunzel, B., Laederach-Hofmann, K., et al. (2002). Survival, clinical data and quality of life 10 years after heart transplantation: A prospective study. Zeitschrift für Kardiologie, 91(4), 319–327.PubMedCrossRefGoogle Scholar
  3. Bunzel, B., Laederach-Hofmann, K., et al. (2007). Mechanical circulatory support as a bridge to heart transplantation: What remains? Long-term emotional sequelae in patients and spouses. The Journal of Heart and Lung Transplantation, 26(4), 384–389.PubMedCrossRefGoogle Scholar
  4. Bunzel, B., Titscher, G., et al. (1991). “You need a new heart”. The problem of diagnostic disclosure from the viewpoint of the affected cardiologic patient. Psychotherapie Psychosomatik Medizinische Psychologie, 41(11), 419–428.Google Scholar
  5. Bunzel, B., Wollenek, G., et al. (1992a). Living with a donor heart: Feelings and attitudes of patients toward the donor and the donor organ. The Journal of Heart and Lung Transplantation, 11(6), 1151–1155.PubMedGoogle Scholar
  6. Bunzel, B., Wollenek, G., et al. (1992b). Psychosocial problems of donor heart recipients adversely affecting quality of life. Quality of Life Research, 1(5), 307–313.PubMedCrossRefGoogle Scholar
  7. Christopherson, L. K. (1987). Cardiac transplantation: A psychological perspective. Circulation, 75(1), 57–62.PubMedCrossRefGoogle Scholar
  8. Christopherson, L. K., & Lunde, D. T. (1971). Selection of cardiac transplant recipients and their subsequent psychosocial adjustment. Seminars in Psychiatry, 3(1), 36–45.PubMedGoogle Scholar
  9. Cimato, T. R., & Jessup, M. (2002). Recipient selection in cardiac transplantation: Contraindications and risk factors for mortality. The Journal of Heart and Lung Transplantation, 21(11), 1161–1173.PubMedCrossRefGoogle Scholar
  10. Collins, E. G., White-Williams, C., et al. (1996). Impact of the heart transplant waiting process on spouses. The Journal of Heart and Lung Transplantation, 15(6), 623–630.PubMedGoogle Scholar
  11. De Bleser, L., Matteson, M., et al. (2009). Interventions to improve medication-adherence after transplantation: A systematic review. Transplant International, 22(8), 780–797.PubMedCrossRefGoogle Scholar
  12. Dew, M. A., & DiMartini, A. F. (2005). Psychological disorders and distress after adult cardiothoracic transplantation. Journal of Cardiovascular Nursing, 20(5 Suppl), S51–66.PubMedCrossRefGoogle Scholar
  13. Dew, M. A., & Dimartini, A. F. (2006). The incidence of nonadherence after organ transplant: Ensuring that our efforts at counting really count. Liver Transplantation, 12(12), 1736–1740.PubMedCrossRefGoogle Scholar
  14. Dew, M. A., DiMartini, A. F., et al. (2007). Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation, 83(7), 858–873.PubMedCrossRefGoogle Scholar
  15. Dew, M. A., Kormos, R. L., et al. (2000). Human factors issues in ventricular assist device recipients and their family caregivers. ASAIO Journal, 46(3), 367–373.PubMedCrossRefGoogle Scholar
  16. Dew, M. A., Kormos, R. L., et al. (2001). Quality of life outcomes after heart transplantation in individuals bridged to transplant with ventricular assist devices. The Journal of Heart and Lung Transplantation, 20(11), 1199–1212.PubMedCrossRefGoogle Scholar
  17. Favaloro, R. R., Perrone, S. V., et al. (1999). Value of pre-heart-transplant psychological evaluation: Long-term follow-up. Transplantation Proceedings, 31(7), 3000–3001.PubMedCrossRefGoogle Scholar
  18. Freeman, A. M., III & Watts, D., et al. (1984). Evaluation of cardiac transplant candidates: Preliminary observations. Psychosomatics, 25(3), 197–199, 202–203, 207.Google Scholar
  19. Frierson, R. L., Tabler, J. B., et al. (1990). Patients who refuse heart transplantation. The Journal of Heart Transplantation, 9(4), 385–391.PubMedGoogle Scholar
  20. Grady, K. L., Meyer, P. M., et al. (2003). Change in quality of life from after left ventricular assist device implantation to after heart transplantation. The Journal of Heart and Lung Transplantation, 22(11), 1254–1267.PubMedCrossRefGoogle Scholar
  21. Grady, K. L., Meyer, P. M., et al. (2004). Longitudinal change in quality of life and impact on survival after left ventricular assist device implantation. The Annals of Thoracic Surgery, 77(4), 1321–1327.PubMedCrossRefGoogle Scholar
  22. Haugh, K. H., & Salyer, J. (2007). Needs of patients and families during the wait for a donor heart. Heart & Lung, 36(5), 319–329.CrossRefGoogle Scholar
  23. Herrick, C. M., Mealey, P. C., et al. (1987). Combined heart failure transplant program: Advantages in assessing medical compliance. The Journal of Heart Transplantation, 6(3), 141–146.PubMedGoogle Scholar
  24. Kuhn, W. F., Davis, M. H., et al. (1988). Emotional adjustment to cardiac transplantation. General Hospital Psychiatry, 10(2), 108–113.PubMedCrossRefGoogle Scholar
  25. Levenson, J. L., & Olbrisch, M. E. (1993). Psychosocial evaluation of organ transplant candidates. A comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics, 34(4), 314–323.PubMedCrossRefGoogle Scholar
  26. Mishel, M. H., & Murdaugh, C. L. (1987). Family adjustment to heart transplantation: Redesigning the dream. Nursing Research, 36(6), 332–338.PubMedCrossRefGoogle Scholar
  27. Petrucci, R., Kushon, D., et al. (1999). Cardiac ventricular support. Considerations for psychiatry. Psychosomatics, 40(4), 298–303.PubMedCrossRefGoogle Scholar
  28. Rivard, A. L., Hellmich, C., et al. (2005). Preoperative predictors for postoperative problems in heart transplantation: Psychiatric and psychosocial considerations. Progress in Transplantation, 15(3), 276–282.PubMedGoogle Scholar
  29. Rodgers, J. (1984). Life on the cutting edge. Psychology Today, 18(10), 58–67.PubMedGoogle Scholar
  30. Rose, E. A., Gelijns, A. C., et al. (2001). Long-term mechanical left ventricular assistance for ­end-stage heart failure. The New England Journal of Medicine, 345(20), 1435–1443.PubMedCrossRefGoogle Scholar
  31. Savage, L. S., & Canody, C. (1999). Life with a left ventricular assist device: The patient’s perspective. American Journal of Critical Care, 8(5), 340–343.PubMedGoogle Scholar
  32. Shapiro, P. A. (1990). Life after heart transplantation. Progress in Cardiovascular Diseases, 32(6), 405–418.PubMedCrossRefGoogle Scholar
  33. Shapiro, P. A., Levin, H. R., et al. (1996). Left ventricular assist devices. Psychosocial burden and implications for heart transplant programs. General Hospital Psychiatry, 18(6 Suppl), 30S–35S.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Brigitta Bunzel
    • 1
  1. 1.Department of Cardiac SurgeryMedical University of ViennaViennaAustria

Personalised recommendations