Transplant psychologist meets patients during one of their most difficult times

Every organ donor and recipient at IU Health undergoes a psychological evaluation. One team member tells why that process is important.

By TJ Banes, IU Health Senior Journalist, tfender1@iuhealth.org

Dr. Rachel Holmes has worked alongside countless patients who have decided to become an organ donor, and those awaiting a life-saving transplant. At IU Health, psychologists are part of a team of patient supporters who include nurses, surgeons, physicians, social workers, transplant coordinators, financial navigators, procurement specialists, and other staff members dedicated to excellent clinical care.

In her specific role, Holmes works with patients who receive or donate organs for abdominal transplantation. At IU Health many recipients receive kidney and liver transplants from living donors. Living donors help give renewed health and may reduce the wait time for needing a new kidney or liver. As of February, surgeons at IU Health performed 25 adult and pediatric kidney transplants; four adult and pediatric pancreas transplants; and 30 adult and pediatric liver transplants for 2025.

April is “Donate Life Month,” a time to raise awareness about organ, eye, and tissue donation, and to encourage people to register. Dr. Holmes received her undergraduate degree from DePauw University, her master’s degree from Boston University, and PhD from the University of Tennessee. Here, she shares what she likes about her role in transplantation and the importance of evaluating donors and recipients.

Q: Explain the process of psychologic evaluation.
A: Patients preparing for transplant spend an hour with us as we go over substance abuse history, current mental health symptoms and treatment. My priority would be untreated mental health issues. And if they do have symptoms and they don’t know where to go for treatment that doesn’t mean they are ineligible to become a donor or recipient. I would view a person who has no symptoms the same as I would view a patient who is appropriately treated for mental health. After we talk, we may do a brief intervention and then connect them with the appropriate services.

Q: What are some areas where you may want to incorporate additional services?
A: I think I would be concerned about heavy substance abuse and severe untreated mental health. Beyond that, I would also look at environmental support - do they have a safe place to recover from surgery, is there unresolved conflict in the house? We also want to be sure they are ready for the process. We identify the pros and cons and identify anything that can get in the way of the process. For instance, if English isn’t their first language, do we need to work with an interpreter to communicate with them? Do they have other special needs that we need to address?

Q: What do you like best about your job?
A: I really like helping patients through this difficult point in their life. For me personally the most gratifying aspect is we see a lot of patients who have not had any mental health experience. This is a place to talk about and learn coping strategies. I feel like my patients walk out of my office feeling a little lighter. There are many emotions they may be experiencing. Some feel guilty if they are working toward liver transplant and their disease was caused by alcohol use. Others feel guilty because there’s a misconception that someone must die so they can get a transplant. They question if they are deserving. Others worry about the burden to their families.

Q: Do you follow up with patients and donors after the transplant?
A: Yes. The physician can ask us to follow up with a patient, or the patient can reach out directly. Dr. Holmes also facilitates a monthly support group for donors, recipients, and their family members. The group meets virtually the second Thursday of every month. To register call: (317) 944-7320. The group is patient driven. We want to give people a space to bring up their questions and concerns.

Personal: Dr. Holmes is married, and the mother of a baby girl.