Solid organ transplantation is a life-saving procedure for end-stage organ failure. However, many young patients face traumatic medical challenges along the way, including invasive diagnostic tests and procedures, life-threatening illnesses, and time in intensive care. These experiences can lead to post-traumatic stress symptoms, such intrusive memories, nightmares, avoidance of procedures, disturbed sleep, anxiety, fear, and anger. In transplant patients, post-traumatic stress symptoms are common and can have a major negative impact on their quality of life. More protective measures and treatments are needed to address post-traumatic stress symptoms in these vulnerable young people.
A study published in Pediatric Transplantation and led by Dr. Tom Blydt-Hansen, investigator and director of the Pediatric Multi Organ Transplant Program at BC Children’s Hospital and professor in the Department of Pediatrics at the University of British Columbia, found that post-traumatic stress symptoms were already evident in pediatric solid organ transplant patients before transplantation, suggesting that traumatic medical experiences accumulate over time. Researchers also found that, even years after transplantation, a significant number of these children were still experiencing trauma-related symptoms. Even though the connection between post-traumatic stress and organ transplantation is clear, it still isn’t as commonly recognized as a major risk factor.
Traumatic experiences may begin to add up well before transplant referral, stemming from procedures and complications associated with progressive organ failure. However, trauma-related symptoms may be overlooked during the pediatric transplant referral process due to the focus on the medical and surgical readiness of the patient. Following transplantation, post-traumatic stress symptoms may only be noticed once they are significantly disrupting the child’s medical care or daily functioning. Children may also be re-traumatized by complications and the ongoing need for diagnostic tests or medical interventions after transplantation — even in otherwise successful transplants.
Using the Child Trauma Screening Questionnaire — which screens for symptoms of PTSD after an injury or traumatic event — researchers found that more than one in five of the young transplant recipients screened (including heart, kidney, and liver transplant recipients) were at significant risk of PTSD. Increased recent hospitalizations and procedures, adverse drug events, and the number of medications were all associated with higher trauma scores. Involvement with foster care also resulted in higher scores, whereas a stable and supportive family environment was found to be protective against post-traumatic stress. While there are evidence-based psychological treatments available for children and adolescents with PTSD, participation can be hindered by the mental, physical, and logistical challenges of ongoing medical care. Proactive screening for at-risk children would allow for the integration of mental health support and services earlier in the transplant process.
This research emphasizes the importance of understanding the various risk factors contributing to post-traumatic stress in pediatric solid organ transplant recipients. Identifying these risks early and providing appropriate psychosocial interventions can significantly improve outcomes for these patients, helping to reduce the psychological burden associated with organ transplantation and improve the quality of life they experience with their transplant.
“The better we understand the risk for post-traumatic stress in pediatric solid organ transplant patients, the better equipped we’ll be to mitigate the risk beforehand and address it before it begins to have a detrimental impact on their daily lives,” says Dr. Blydt-Hansen.
Future research will explore additional protective psychosocial factors such as faith or community-based support. The aim is to develop a multi-centre approach to understand and address the mental health needs of these children and their families. By integrating psychological screening into routine care — ideally during the pre-transplant phase — clinicians can potentially identify those at risk and provide timely interventions.
“As transplantation medicine advances, we need to expand our focus beyond medical and surgical care to address the unique psychosocial needs of children and their families, both before and after solid organ transplantation,” says Dr. Blydt-Hansen. “Making sure we understand the mental health impact of transplantation is critical to improving the quality of life of these children and their families.”
