Palliative care involvement in solid organ transplant: a narrative review.

Abstract

Background and objective: Solid organ transplant has increased within the last 50 years, particularly as surgical procedures, transplant outcomes, brain death criteria, and immunosuppressive therapies are improving. While transplant programs have specific criteria to help identify ideal transplant candidates, some programs are recognizing the emotional and physical burden that transplant candidates have leading up to the transplant decision; as such, a multidisciplinary approach to candidate evaluation which involves social work, psychiatry, nursing, and other disciplines is necessary for transplant success. Due to the complex nature of medical illnesses that lead to solid organ transplant, and the significant impact on quality of life, palliative care involvement both pre-transplant and post-transplant has been identified as a helpful support for patients. This narrative review summarizes relevant literature on the involvement of palliative care in transplant and provides a conversation guide for supporting patients through the transplant process from a palliative lens.

Methods: Authors ran a narrative review search in the National Library of Medicine (NLM) PubMed database. The search was restricted to English language articles, and publication date filters limited the results from January 1, 2015 to the day the search was run on April 2, 2026. An effort was made to exclude animal studies. Search terms included Medical Subject Headings (MeSH) terms as well as keywords, including terms for palliative care, palliative medicine, transplantation, solid organ transplant, conversation guide, heart transplant, liver transplant, lung transplant, kidney transplant, attitudes, perspectives, trajectory, utilization, outpatient, inpatient, early palliative care, referral, cost-savings, and their synonyms.

Key content and findings: While palliative care involvement in transplantation has been well studied, only certain transplant groups, particularly heart and liver, have formally updated guidelines to reflect this. Palliative care providers should continue to partner with transplant teams in order to better support patients and caregivers throughout all stages of end-stage disease, particularly pre- and post-transplant.

Conclusions: Further consideration should be given to healthcare outcomes with palliative team involvement in transplant populations. More research is needed to determine optimal timing, setting, and resource availability of palliative teams.