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The MBMD™ Test at Core of Evaluation of At-Risk Candidates for Organ TransplantSome medical patients continue to smoke despite having lung disease. Others continue to drink alcohol despite needing a liver transplant. These are the kinds of problems that Robert Harper, PhD, seeks to discover in the psychological evaluations he conducts with patients requesting organ transplants. Social workers and physicians at the Multi-Organ Transplant Center of The Methodist Hospital and Baylor College of Medicine, Houston, initially evaluate the patients. Candidates who seem to have some psycho social risk are referred for more intense evaluation to Harper and his psychiatric colleagues at the Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine. Careful screening is criticalThe candidate screening process is key to helping identify patients whose attitudes and behaviors may contribute to difficulties during both the candidacy and post-transplant phases. The transplant team needs to under stand a patient's coping skills, support system, how he or she may handle stress and illness, and especially if the patient will follow through with treatment. "There is a large array of medicines with side effects that are absolutely critical for transplant patients to take. If patients aren't religiously compliant with taking their immunosuppressants, they can end up causing organ failure," says Harper. "This is not a small matter when a donated organ that could have better served someone else fails due to a recipient’s non-compliance." More than ten years ago, Harper and his colleagues searched for a psychological instrument that could help them screen transplant candidates. They chose the MBHI™ (Millon™ Behavioral Health Inventory) test. "We've never been sorry," says Harper. "It helps address some factors that none of the other instruments I use capture." Understanding how patients copeIn April 2001, Harper replaced the MBHI assessment with the newly released MBMD™ (Millon Behavioral Medicine Diagnostic) assessment and is still gaining experience and collecting data with it. He notes that coping scales are at the core of both instruments. "We can't overemphasize the value of under standing how patients cope. This may not be obvious, as seen with introversive, non complaining individuals who may under-report critical complaints," says Harper. The Millon instruments help Harper identify individuals who will need encouragement to actively participate in their healthcare. Harper's battery of tests also includes the Mini-Mental™ State Examination for cognitive screening, Beck Depression Inventory®, the Psychosocial Adjustment to Illness Scale, and the HSQ® (Health Status Questionnaire) to help assess quality of life and level of functioning, along with a brief structured interview. Enhancements unique to MBMD testIn addition to the expanded coping scales, the MBMD test features other pertinent scales, such as spirituality, response patterns, and negative health habits. Harper appreciates the spirituality scale because recent studies indicate that spirituality is a factor in patient recovery. Other enhancements he has found especially helpful include:
Absent a clear behavioral or psychiatric contraindication to performing a transplant, patients are not excluded from transplant candidacy for psychological reasons. Rather, Harper and his colleagues look for treatable psychological and behavioral risk factors the medical team would need to help the patient overcome (e.g., smoking) before proceeding with candidacy. Harper recognizes that no instrument will perfectly capture a patient and there will always be an occasional instance where a patient isn't going to reveal everything. He thinks both the MBHI and MBMD tests are excellent instruments and says, "I'm going with the newer [the MBMD test] because it has the same sensitivities, but is just a little broader in scope. And, if I was limited to just a single instrument to use, the MBMD would be my choice." Robert G. Harper, PhD, is Associate Professor at the Baylor College of Medicine Department of Psychiatry and Behavioral Sciences. His research has been published in several professional journals.
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