Expert Q&A: Cousino on the psychological care can be lifesaving for transplant patients

Receiving a heart or lung transplant is a journey that not only demands physical strength, but one that relies on mental and emotional resilience, especially for pediatric patients and their families.

Experts at University of Michigan Health C.S. Mott Children's Hospital are leading efforts to ensure mental health care goes beyond addressing crises, but also to foster resilience and wellbeing throughout the transplant process.

Melissa Cousino, Ph.D., a pediatric transplant leader at Mott specializes in caring for the mental health of pediatric transplant patients before and after their transplant.

Recently the International Society for Heart and Lung Transplantation appointed Cousino as the scientific program chair for their 47th annual meeting in 2027.

Here she answers questions about the importance of psychological care for pediatric heart and lung transplant patients.

Why is it important to address the psychological needs of pediatric patients experiencing advanced heart and lung diseases?
Cousino: We know mental health is deeply intertwined with physical health--especially in young people facing heart and lung conditions.

Children with heart disease experience a three to seven times higher likelihood of mental health diagnoses than their peers.

Nearly 50% of children currently receiving cardiac support from a ventricular assist device, also known as VAD, have a mental health diagnosis.

Pediatric patients with a depressive diagnosis prior to heart transplantation can experience higher rates of transplant graft loss and re-hospitalizations in the years following their transplant surgery.

While children with heart disease are at higher risk for mental health diagnoses, our focus is on proactive approaches such as identifying challenges early, supporting coping skills and building psychological resilience as part of routine care.

Prioritizing mental health from the start doesn’t only prevent problems, it lays the groundwork for a strong relationship with our mental health team, better recovery and improved quality of life.

How does psychological care help young patients?
Cousino: I have the privilege of seeing the life saving nature of psychological care in action.

Psychological care addresses mental health concerns, promotes problem solving and increases self-management skills which can be lifesaving for patients.

Upwards of two in every three adolescent and young adult transplant recipients struggle to take immunosuppressant medications as prescribed due to mental health struggles, which makes this psychological care crucial.

Many young patients are incredibly resilient when given the right support.

By working alongside families and medical teams, we can spot early warning signs of stress and address them before they escalate, while simultaneously helping patients recognize their strengths amidst challenges.

What does this psychological care look like?
Cousino: At Mott, psychological care is embedded within pediatric transplant programs.

We regularly meet with patients and families throughout the transplant process.

Our team works with doctors, surgeons and nurses as part of the team, not as external consultants.

Upon meeting patients and families in the medical settings in which they are already receiving care, our pediatric transplant psychology team will often provide 'in the moment' brief assessments. These recommendations are specific to mental health, coping, disease self-management and more.

How are the goals of this care catered to different patient needs?
Cousino: Developing a close relationship and trust with the patient is critical to therapeutic benefit.

The goals for my work with young patients are driven by their individualized preferences and needs.

We provide both in-person and virtual care, enabling us to increase access to specialized transplant mental health care throughout the state.

Our therapies are evidence-based, often including cognitive-behavioral therapies, acceptance and commitment-based therapies and motivational interviewing.

This flexible approach allows patients be part of the decision-making process. They do not need to be on screen for longer than they want, and patients have a say in how our conversations are structured.

How do you plan to bring your practice into ISHLT community?
Cousino: As the first transplant psychologist and allied health professional in this role, it highlights that multidisciplinary care is core to transplant medicine, while recognizing the biopsychosocial complexities of advanced heart and lung diseases.

Fueled by the work that brings us purpose and the patients that share bits of their lives with us, I am excited to partner with my ISHLT colleagues to bring together a program that will inspire and advance our collective mission to innovate and improve care in heart and lung transplantation.