The content in this section is organized according to the 11 domains of the AST Transition Readiness Assessment Checklists for early, middle, and late adolescence to be used by the multidisciplinary transplant team when working with AYAs during transition of care. The content is all-inclusive with the goal of providing clinicians with a better perspective of the psychosocial and developmental issues encountered during transition, as well as giving the psychosocial team a deeper understanding of the clinical issues that are essential for graft maintenance into adult care.
Transplantation has become standard of care for end-stage organ disease from chronic conditions, acute organ failure, and genetic/metabolic conditions. Transfer of care from pediatric to adult transplant providers is a period of significant vulnerability for the AYA. To ensure that transplant recipients maintain healthy outcomes and can achieve their full potential, a process of transition education should be initiated during early adolescence with the goals of educating the patient and caregivers about transplant care. The AYAs and caregivers should be provided with information about their care through various transplant educational materials, resources, and transition tools. A process for transplant education during the transition period should be developed that results in a comprehensive and efficient transition to adult providers with the young adult understanding and participating in their transplant care to the best of their ability. Focus areas of transplant education include a basic understanding and knowledge of organ function, their indication for transplant, medications, rejection (diagnosis, treatment, outcome), infection risks, and the role of adherence in maintaining their transplant health.
Partner with the AYA to achieve their transplant educational goals and to fully understand their transplant care. Completing a transplant “transition passport” is a helpful educational activity to stimulate discussion and engagement about their care. A simple one-page bullet point overview can be created with the teen so they can keep a picture of this important information on their phone.
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