Psychiatric assessment of kidney transplant candidates and living donors: An eight-year prospective study

Background: Post-transplant outcomes are strongly influenced by psychosocial and behavioral factors, particularly medication adherence, which has been identified as a key determinant of graft survival [1,2]. Given the prevalence of psychosocial vulnerabilities in transplant candidates, integrating psychiatric expertise into the pre-transplant evaluation has been shown to improve risk identification and support decision-making [3]. Structured psychosocial assessment tools, such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), further standardize this process and help clinicians evaluate candidates more comprehensively [4].

Objectives: To characterize psychiatric morbidity among kidney transplant candidates and living donors, to describe the implementation of a specialized psychiatric consultation program, and to assess its feasibility and preliminary outcomes.

Methods: This prospective, single-center study (January 2018–October 2025) was conducted at Mohammed V Military Hospital in Rabat. All transplant candidates, recipients, and potential living donors underwent comprehensive psychiatric evaluations using semi-structured interviews based on DSM-5 criteria [5]. The assessment protocol included individual evaluations and joint donor–recipient sessions.

Results: 30 transplant candidates/recipients (mean age 43.1 ± 12.3 years; 65% male) and 30 potential living donors were evaluated (N = 60). Among candidates, the most frequent psychiatric diagnoses were anxiety disorders (40%), depressive episodes (13.3%), and adjustment disorders (30%). Among the 26 patients with 6-month follow-up, medication adherence was 90.4%. Post-transplant psychiatric complications occurred in 6.75% of cases, all successfully managed. Living donors—95% of whom were first-degree relatives—showed lower rates of formal psychiatric diagnoses (16.7%) yet reported high levels of procedure-related anxiety (93.3%). Donor satisfaction was high (94.6%).

Conclusions: This study highlights the substantial psychiatric burden among kidney transplant candidates and demonstrates the feasibility of systematic psychiatric assessment in transplant programs. The high adherence rate (90.4%) underscores the value of integrated psychiatric care [9,10]. Psychiatric evaluation should evolve beyond a gatekeeping function to provide continuous therapeutic support throughout the transplant process.