What question did this study set out to answer?

To evaluate the timing and patterns of palliative care utilization in solid organ transplant recipients across multiple centers.

January 18, 2026

Palliative Care Utilization and Timing for Patients Undergoing Solid Organ Transplantation in a Large Multicenter Cohort

Key Points

To evaluate the timing and patterns of palliative care utilization in solid organ transplant recipients across multiple centers.
Retrospective analysis of 12,676 transplant cases across heart, liver, lung, and kidney from 2018 to 2024.
Classified palliative care encounters into pretransplant, peritransplant, and posttransplant stages.
Analyzed correlations between timing of palliative care and patient outcomes, including survival and hospital readmissions.
Only 8.3% of transplant recipients engaged with palliative care, with variation by organ type and timing.
Earlier engagement in palliative care was linked to longer survival rates, while later engagement occurred nearer to death.
Pretransplant palliative care led to fewer hospital interventions and higher rates of goals-of-care discussions.

Abstract

Background. Although solid organ transplant prolongs survival in end-stage disease, recipients face high symptom burden and complex decisions at multiple junctures. Palliative care (PC) may address these needs, but referrals in transplant programs are infrequent, often reactive, and the benefits remain unclear. Methods. We retrospectively studied 12 676 heart, liver, lung, and kidney transplants across 3 Mayo Clinic sites (2018–2024). PC encounters were classified as pretransplant (≤1 y before admission), peritransplant (during hospitalization), or posttransplant (≤1 y after discharge). Results. Only 8.3% engaged PC, with patterns varying by organ and timing. Heart programs demonstrated the highest overall engagement, primarily pre- and peritransplant, whereas lung and kidney referrals occurred more often after discharge. Earlier timing coincided with longer survival, whereas peri- and posttransplant encounters occurred closer to death. In heart transplantation, pre- and peritransplant PC were observed in recipients with lower procedural volume and fewer short-term readmissions. Liver and lung cohorts displayed variable patterns. Kidney referrals occurred infrequently and were concentrated among recipients with higher morbidity. Timing of inpatient consultation showed a strong positive correlation with hospital length of stay, and pretransplant PC coincided with higher rates of goals-of-care discussions and fewer hospital interventions. Adapting screening criteria to focus on high-risk recipients, PC was associated with fewer short-term readmissions for heart and lung recipients. Conclusions. PC among solid organ transplant was infrequent and varied. Referral timing often aligned with patient morbidity and mortality. Structured, prospective validation of screening methods may identify patients most likely to benefit from palliative involvement.

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