The PACT: A rating scale for the study of clinical decision‐making in psychosocial screening of organ transplant candidates

Studied the reliability of clinical decisions regarding the acceptability of patients for heart and liver transplantation. 47 patients were interviewed by at least two clinicians who completed the PACT (Psychosocial Assessment of Candidates for Transplantation), a single page, 10 item rating scale. Interrater reliability was high (intraclass correlation = 0.85) with overall 96% agreement between raters on whether to transplant a given patient. Less than 5% of all pairs of ratings disagreed by more than one category. Partial correlations between individual items and final ratings ranged from 0.39 (drug and alcohol use) to 0.72 (personality and psychopathology). This scale will be a useful instrument for studying the pretransplant psychosocial evaluation process and will be helpful for learning how different programs weight various factors in selecting patients and how well these decisions predict clinical outcomes.