Early Palliative Care in Heart Transplant Evaluation

Palliative care (PC) is becoming increasingly integrated into the care of patients with advanced heart failure, although it is not yet widely incorporated into the heart transplant evaluation process. Patients undergoing evaluation for heart transplant carry a high burden of mental health morbidity, which can affect their ability to complete the evaluation and undergo successful transplantation. We describe the case of a 67-year-old male with ischemic cardiomyopathy on continuous inotropic support for decompensated heart failure, who initially declined to complete a transplant evaluation and expressed a desire for immediate hospital discharge. PC involvement clarified his prognosis without advanced heart failure therapies, and identified severe claustrophobia as the driver of his desire to end the transplant evaluation. With appropriate psychologic and psychiatric support, his claustrophobia became tolerable, and he underwent successful heart transplantation. With expertise in symptom management and effective communication, PC plays a crucial role as a bridge between medical and psychosocial teams, particularly when psychopathology is present. Appropriate PC involvement in the transplant evaluation process can identify and navigate barriers, and ensure goal-concordant, patient-centered care.