The Stage-Based Psychosocial Adaptation Model for Lung Transplantation (SPA-LT): A Proposed Longitudinal Conceptual Framework for Clinical Care

Lung transplantation is a life-saving intervention for patients with end-stage respiratory failure, yet it involves a uniquely complex and prolonged psychosocial trajectory. Despite growing recognition of psychological factors, they are often conceptualized as secondary outcomes and assessed at isolated time points rather than across the full transplant process. This conceptual article integrates empirical findings, theoretical perspectives, and clinical expertise to examine psychological functioning and quality of life across pre-transplant, early postoperative, and long-term phases of lung transplantation, and to develop a longitudinal framework for psychosocial care. Evidence suggests that psychological functioning in lung transplantation is dynamic, stage-dependent, and closely embedded within medical processes. The pre-transplant phase is characterized by uncertainty, distress, and identity disruption; the early postoperative period by neurocognitive vulnerability, reduced agency, and acute stress responses; and long-term adjustment by chronic vigilance, fear of rejection, and challenges in role reintegration. Existing models provide valuable but incomplete perspectives, often lacking temporal specificity and insufficiently accounting for medically driven discontinuities. To address these gaps, this article introduces the Stage-Based Psychosocial Adaptation Model for Lung Transplantation (SPA-LT), a longitudinal framework conceptualizing psychological functioning as an evolving process across the transplant trajectory. Using a narrative conceptual synthesis, literature was identified through structured searches of PubMed/MEDLINE, Scopus, and Google Scholar, supplemented by citation tracking, with priority given to adult lung transplantation studies and relevant extrapolated evidence from transplantation, intensive care, and chronic illness literature. This approach integrates assessment and intervention across stages of care and emphasizes relational continuity and contextual interpretation of distress. Reframing psychological functioning as a core component of transplant outcomes may support more effective, patient-centered care and inform future research on integrated psychosocial interventions.