What You Need to Know About Cataract Surgery and Choosing the Right Replacement Lens

Cataracts result naturally as a part of the aging process.  Beginning at age 50, your ophthalmologist will monitor your cataracts and advise when the time is right for surgery. During cataract surgery, the cloudy natural lens is removed and replaced with an intraocular lens (IOL) that will enable you to see more clearly.

In this Q&A, Kira Manusis, MD, Co-Director, Cataract Services, at the New York Eye and Ear Infirmary of Mount Sinai (NYEE), explains some of the options available to patients that may reduce dependence on glasses after surgery.

What is a cataract?

A cataract develops over time and causes your eye’s natural lens to become cloudy, making it hard to see clearly. If you experience poor night vision, see halos around lights, or notice that your vision is not as sharp as you would like, it is time to schedule an eye exam.

If surgery is needed, your ophthalmologist will meet with you and discuss your eye health and lifestyle needs to prepare you for the upcoming surgery. Your natural lens will be removed and replaced with an artificial intraocular lens. Your physician will explain the IOL options available and help you decide which lens is best suited for your visual needs.

What happens during cataract surgery?

Cataract surgery is a routine outpatient procedure that involves removing the cloudy natural lens and replacing it with an artificial lens.  There are several procedures for cataract removal. Your doctor will recommend the best surgical option for your cataract. Each eye is operated on separately, a few weeks apart, and most patients recover quickly.

Kira Manusis, MD

What are the different types of intraocular lens options (IOLs) available? What are the benefits of choosing premium lenses?

An intraocular lens is a permanent replacement for your natural lens. Our ability to see can be broken into three main zones: far distance, intermediate, and near. Some intraocular lenses can correct for only one of these distances while others can correct for multiple distances. At NYEE, we offer patients standard intraocular lenses and premium lens that not only correct for different visual zones, but can also permanently correct astigmatism. After a thorough examination and evaluation, you and your surgeon will discuss the various lens options based on your eye health and your personal lifestyle needs and wants. Here are four options:

Monofocal lens implants: This basic lens provides great quality vision and allows you to see clearly at one distance, either near or far.  If you choose to see distance, you will need to wear eyeglasses for close up activities such as reading or working on an iPad. This lens is typically covered by insurance.

Premium Lens Options:

Multifocal lens implants: These lenses allow vision correction at multiple distances. Patients who want to reduce dependence on eyeglasses or contact lenses may benefit from this type of a lens. There are many multifocal lenses to choose from.  Each lens has its advantages and disadvantages, which will be discussed with your surgeon.  Premium lenses are not covered by insurance, and patients need to weigh the cost vs. value when choosing a lens. People with an active lifestyle can benefit from these glasses-free options.

Extended depth-of-field implants: An extended depth-of-field lens is a type of lens that enables clear distance and intermediate vision. For most patients, this advanced lens technology reduces your dependence on glasses for most activities except reading small print.

Toric lens: These implants can permanently correct astigmatism at the time of cataract surgery. The toric lens implant corrects the irregularity in the curvature of the cornea.  Patients with astigmatism can achieve good distance vision with significantly less dependence on glasses.

What else should I discuss with my doctor?

During your exam, you and your doctor can discuss your eye health, consider your lifestyle needs, answer any questions, and help you decide which lens will provide optimal vision. When considering which type of lens to choose, you should consider the following lifestyle preferences:

  • What do you spend most of your time doing at work? At home?
  • What are your hobbies?
  • How important is distance vision to you? (Driving, golf, skiing, theatre)
  • How important is mid-range vision to you? (Computers, cooking, grocery shopping,)
  • How important is near vision to you? (Reading, smartphones, sewing, crafts, puzzles)
  • After surgery, will you mind wearing glasses for distance, mid-range, or near vision?

TelePrEP? PrEP on Demand? Here’s the Latest on Pre-Exposure Prophylaxis for HIV.

We’ve come a long way in HIV medicine since the 1980s—the height of the HIV/AIDS epidemic in the United States, when contracting the virus was considered a death sentence. Today, not only can we prevent HIV with pre-exposure prophylaxis (PrEP), we can also treat HIV and manage it to undetectable levels, in which virus counts are so low that they cannot be transmitted sexually.

For LGBTQ+ Pride Month in June, Richard Silvera, MD, MPH, Assistant Professor of Medicine (Infectious Diseases), and Medical Education, at the Icahn School of Medicine at Mount Sinai, provides the latest developments on PrEP and explains how these medications are more convenient to access than ever. 

“Pride Month is a great time where the LGBTQ+ community gathers and celebrates our achievements, as well as commiserates over our shared struggles,” says Dr. Silvera. “It is important to know that despite our breakthroughs, HIV is still out there, and that we have excellent tools to treat and prevent it.”

There are now different methods for accessing and delivering PrEP. “These different methods are really about trying to find a strategy that will fit into someone’s life most easily,” says Dr. Silvera. He discusses three recent developments with PrEP, and how you can find one that best suits your needs.

Richard Silvera, MD, MPH, Assistant Professor of Medicine (Infectious Diseases), and Medical Education, at the Icahn School of Medicine at Mount Sinai.

What is PrEP?

PrEP is a prescription medicine taken to prevent getting HIV. It reduces the risk of contracting HIV from sex by 99 percent, and from injection drug use by at least 74 percent, according to the Centers for Disease Control and Prevention (CDC).

PrEP is suitable not only for LGBTQ+ populations, but also cisgender straight men and women, especially if they have unprotected sex, have a partner with HIV, or have used injected drugs.

What is TelePrEP?

Usually, people go into a doctor’s office to get a prescription for PrEP, and get their blood work and sexually transmitted infection (STI) tests done there, says Dr. Silvera. But for some people who don’t want, or are unable, to make the trip to a clinic, there’s an online option for them known as telePrEP, he adds.

Here’s how telePrEP works:

  • An individual fills out a medical and insurance inquiry to ensure they are covered for telePrEP services. Once done, they can begin scheduling video calls with a provider.
  • During the video call, the provider walks the patient through what PrEP is, how and when to take it, and required tests.
  • For the required lab tests, which includes a blood draw and other routine STI tests, the patient can go to any commercial lab or testing center covered by their insurance network.
  • The patient can then pick up the medication at a pharmacy, or have it mailed.

“We have an excellent telePrEP program available through our Institute of Advanced Medicine, which specializes in care for the LGBTQ+ community, people living with HIV/AIDS, and people who experience domestic violence,” says Dr. Silvera. “For people whose lifestyle might not allow them to take time off to go into a clinic for PrEP visits, telePrEP can be a convenient option.”

What is PrEP on Demand (PrEP 2-1-1)?

For people who might have concerns about taking PrEP medications daily—or are unable to for health reasons—there is a dosing schedule called “PreP on demand,” says Dr. Silvera. Also called “PrEP 2-1-1,” this is where someone who knows they might be at risk of HIV exposure takes two pills anywhere between two hours and 24 hours before sex, then one pill 24 hours after sex, and then another pill 24 hours after that.

This dosing schedule has been shown in studies to be effective in preventing HIV for gay and bisexual men who have sex without a condom, according to the CDC. This benefit may also extend to transgender women, or those who were assigned male at birth, notes Dr. Silvera. However, for heterosexual couples and those assigned female at birth, the evidence for this method of PrEP is not conclusive, he adds.

Accessing PrEP on demand works similar to daily PrEP: the patient makes an appointment with their provider, and lab tests will need to be done every three months.

[Sidebar: What have studies shown about the effectiveness of PreP on demand?](See below for full text)

Although the CDC has provided a guideline for this dosing schedule, it is not approved by the U.S. Food and Drug Administration (FDA).

What is Long-Acting PrEP?

Instead of taking a pill every day, there is now an injectable PrEP that lasts longer called Apretude® (cabotegravir). Currently the only long-acting PrEP approved by the FDA, Apretude is given first as two initiation injections administered one month apart, and then every two months thereafter.

“Apretude has the advantage of not being excreted through the kidneys, unlike oral PrEP,” says Dr. Silvera. “So if someone has kidney disease, Apretude might be suitable for them.”

What have studies shown about the effectiveness of PreP on demand?

PrEP on demand has been long studied for its effectiveness. In 2012, a randomized, placebo-controlled study named IPERGAY was one of the first studies on this dosing schedule. It enrolled 400 men and transgender women, with a median follow-up of 9.3 months. Findings were published in The New England Journal of Medicine in 2015. Here’s a summary of the findings:

  • Taking PrEP on demand reduced the risk of contracting HIV by 86 percent among participants.
  • The most common side effects of those who took the treatment were related to the digestive tract and kidneys.
  • There was no significant difference in how often people had unprotected sex before and after they had PrEP on demand.
  • The proportion of people who had STIs before and after they had PrEP on demand remained similar.

Studies have shown that the long-acting drug, injected once every eight weeks, is safe and more effective than daily oral PrEP at preventing HIV acquisition among both cisgender women and cisgender men and transgender women who have sex with men, according to HIV.gov, an official U.S. government site.

Accessing long-acting PrEP and its testing is slightly different: the patient has to go to the clinic every two months to receive the injection, as it cannot currently be self-administered. The patient would also do the required lab tests.

Discontinuing long-acting PrEP is also slightly more complicated than stopping daily oral PrEP, notes Dr. Silvera. “When someone wishes to stop long-acting PrEP, there will continue to be some amounts of medication in their body after stopping the injections.” The patient will be switched to daily oral PrEP until it is certain the long-acting medication has been cleared from the body, and then the oral PrEP can be stopped. “What we want to avoid is someone having enough medicine in their body such that if someone were exposed to HIV, the virus can learn to avoid that medicine, but also not having enough medicine in the body to prevent an infection,” he says.

Pride Month is a time for great joy and celebration, and LGBTQ+ people should keep themselves safe—and not just from HIV, says Dr. Silvera. Mpox (formerly known as monkeypox) cases have been increasing in New York City and other major cities in the United States, and other STIs are important too. “PrEP works great for protecting against HIV, but it does not protect against other things out there too,” he says.

Kenneth L. Davis, MD, at Commencement: A Career of Driving Change

Kenneth L. Davis, MD, at Commencement: A Career of Driving Change

Kenneth L. Davis, MD, Executive Vice Chairman of the Mount Sinai Health System Boards of Trustees, giving the Commencement address

A career in medicine or research can be much more than just a doctor healing a patient, or a scientist generating new discoveries. Every individual graduating from the Icahn School of Medicine at Mount Sinai has the potential to drive change and fix a broken health system, said Kenneth L. Davis, MD, Executive Vice Chairman of the Mount Sinai Health System Boards of Trustees, speaking at the school’s 55th Commencement, held at the David Geffen Hall at Lincoln Center on Friday, May 10.

As the outgoing students discussed their experiences during their time at medical and graduate school, and their dreams of their futures, Dr. Davis highlighted how the graduates can improve health care, drawing on a lifetime’s experience at Mount Sinai, beginning at the medical school and including 20 years’ service as Chief Executive Officer of the Mount Sinai Health System. In recognition of his contributions, he received a Doctor of Humane Letters from Icahn Mount Sinai.

“Class of 2024, 51 years ago, I was sitting in your seat, as a graduate of the class of 1973,” said Dr. Davis. “At that time, I couldn’t wait to get up and get moving with my career. Nowadays, I’m glad to take a seat whenever I can.”

The torch Dr. Davis was passing was this: health care in the United States is not serving those who need it the most—many barred by income, race, language, citizenship, and insurance. And as a new generation entering the field, Icahn Mount Sinai’s graduates can—and should—strive to close those gaps. Here’s a look at the themes Dr. Davis brought up in his speech, which reflect his career-long efforts to improve the U.S. health care system.

Restoring Social Safety Nets

The United States pays some of the highest costs—if not the highest—for health care compared to other nations around the world, yet health outcomes remain inadequate. Medical expenditures add up to 17 percent of the country’s gross domestic product, compared with an average of nine percent for other advanced economies. Despite that spending, among large wealthy nations, the United States has the lowest life expectancy, said Dr. Davis.

The answer, he said, is restoring the social safety net, and addressing social determinants of health. “Inequity runs deep in U.S. health care. Communities of color have higher levels of serious disease, higher rates of infant mortality, and shorter lifespans than other Americans,” Dr. Davis said.

Increasing spending on social programs is not just about reducing crime or increasing productivity, but also has an effect on lowering federal health care costs, Dr. Davis said, a theme he raised in an Op-Ed for The New York Times.

Similarly, more funding is needed for Medicaid to help provide care for low-income Americans. Its underfunding has led to inadequate access and has left health systems under-reimbursed, he said, pointing out that health systems like Mount Sinai lose 35 cents on every dollar spent to take care of Medicaid patients.

High Cost of Drugs

Americans pay three times what citizens of other wealthy nations pay for pharmaceuticals, said Dr. Davis. “Why do we have to subsidize the cost of drugs for the rest of the world?”

The United States is the source of virtually all pharmaceutical companies’ profits, and that needs to change, he said, adding that the United States’ trading partners need to pay their fair share for pharmaceuticals.

One way to achieve that is increasing the ability of the government to purchase drugs and negotiate prices, and another is including drug prices in trade talks, points Dr. Davis previously raised in Becker’s Hospital Review. “In trade negotiations with other countries, our country must request foreign governments raise their drug prices and then tell pharmaceutical companies not to just put this money in their pockets, but pass the savings on to Americans.”

Making Insurance Work

Fighting denials from insurance companies, paying outrageous prices for needed medications because they might not be covered, or traveling long distances and waiting months to see an in-network specialist are signs that the current insurance system isn’t working, said Dr. Davis.

“Denial of care is not an ethical business model,” he said. “That has to change.”

As graduates of Icahn Mount Sinai, the audience will be more than doctors who heal patients, and more than researchers who generate innovative science, said Dr. Davis. “Whether you’re at a dinner party or community meeting, testifying before a state legislature or a Congressional committee, engaged in a political campaign or leading a major health care organization, I want you to raise your voice and speak out.”

As CEO of the Mount Sinai Health System, Dr. Davis was known for his role in what has been characterized as one of the largest financial turnarounds in academic medicine—forming one of the largest nonprofit systems in the country through the combination of the Mount Sinai Medical Center and Continuum Health Partners. The Health System in 2022 generated $11 billion in revenue and comprised 48,000 employees, eight hospitals, the Icahn School of Medicine at Mount Sinai, the Mount Sinai Phillips School of Nursing, and more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester County, Long Island, and Florida.

In addition to the honorary degree conferred at Commencement, Dr. Davis’s achievements were celebrated at the 39th annual Crystal Party, held Tuesday, May 21. Here’s a look at his career, and how it all started at Mount Sinai.

1973

Graduated from the Mount Sinai School of Medicine (now Icahn Mount Sinai), valedictorian of the second graduating class, received the Harold Elster Memorial Award

1979-1987

Chief of Psychiatry at Bronx Veterans Affairs Medical Center

1987-2003

Chair of Psychiatry at the Mount Sinai School of Medicine

2003-2007

Dean of the Mount Sinai School of Medicine

2003-2023

President and CEO of the Mount Sinai Medical Center, which became the Mount Sinai Health System in 2013

2024-present

Executive Vice Chairman of the Boards of Trustees of the Mount Sinai Health System

Before becoming an executive, Dr. Davis was also known for his contributions to research and psychiatry, particularly in Alzheimer’s disease and schizophrenia. Here’s a look at some of his research milestones:

  • Discovering the links of acetylcholine to Alzheimer’s disease, and the benefits of using cholinesterase inhibitors such as physostigmine in patients with Alzheimer’s disease, in the 1980s.
  • Designed the original Alzheimer’s Disease Assessment Scale, published in the American Journal of Psychiatry in 1984. The cognitive measure is used as a primary measure for Alzheimer’s disease clinical trials in the United States even today, either in its original or modified form.
  • Key roles in proof-of-concept studies and clinical trials that led to the approval of four of the first five compounds for the treatment of Alzheimer’s disease.
  • Beginning in the late 1980s and through the 1990s, key studies that identified dopamine dysregulation in schizophrenia, and dopamine as a drug target for schizophrenia.
  • The creation of a brain bank for postmortem studies in schizophrenia, leading to findings that schizophrenia is not characterized by classical, histologically identifiable neuropathology, and that chemical markers that are altered in Alzheimer’s disease and other dementia were also abnormal in schizophrenia: choline acetyltransferase, catecholamines and indolamines, neuropeptides, and synaptic proteins.
  • Elected to the prestigious National Academy of Medicine in 2001 for his contributions to neuroscience and brain disorders, and his leadership led to him being awarded the Yale University George H.W. Bush Lifetime of Leadership Award in 2009.

Mount Sinai Recognized for Improving Access to Outpatient Services

From left: Sadiqa Horne, RN, BSN, Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC, and Marcy Cohen

Two Mount Sinai initiatives to improve access to medical services performed on an outpatient basis were recognized with awards at a recent symposium.

Marcy Cohen, Senior Director, Ambulatory Capacity Management, Mount Sinai Doctors Faculty Practice, received a Best Practice Award for the Ambulatory Capacity Management team’s “New Patient Triad Strategy.” Sadiqa Horne, RN, BSN, Senior Director of Access Center Operations, Mount Sinai Doctors Faculty Practice, received an Honorable Mention for the Patient Access Center’s initiative titled “Enhancing Employee Engagement and Retention in Mount Sinai Health System’s Patient Access Center.”

The awards were presented to both teams at the Patient Access Collaborative annual symposium hosted by Emory Healthcare in Atlanta on Wednesday, May 15.

“The innovative approach to patient access by Mount Sinai serves as a model of excellence and inspiration for the health care industry as a whole,” said Elizabeth Woodcock, DrPH, MBA, FACMPE, CPCFounder and Executive Director of the Patient Access Collaborative.

“These initiatives epitomize Mount Sinai’s dedication to innovation, collaboration, and excellence in health care delivery,” said Adrin Mammen, MBA, MS, Vice President and Chief of Ambulatory Patient Access, Mount Sinai Doctors Faculty Practice. “As we continue to lead the charge in patient access and engagement, we are honored to be recognized for our efforts and remain steadfast in our commitment to advancing the standard of care for our patients and employees alike.”

The “New Patient Triad Strategy” is a pioneering, integrated strategy that created more appointments and a quick and easy way to notify patients. As a result, patients are getting appointments much sooner and there have been significant improvements in patient satisfaction and operational efficiency.

The “Enhancing Employee Engagement and Retention” initiative underscores Mount Sinai’s commitment to fostering a supportive workplace culture at the Patient Access Center. By prioritizing employee satisfaction and professional development, Mount Sinai ensures a motivated workforce dedicated to delivering patient care. This initiative has boosted morale and staff retention rates while elevating the overall patient experience.

The Patient Access Collaborative serves as a platform for representatives from the nation’s leading health systems to discuss and advance initiatives to improve patients’ access to ambulatory care. The group represents organizations that provide 25 percent of all ambulatory visits in the United States.

The Power of Nursing in Health Care and Beyond

From left: Brendan G. Carr, MD, MA, MS; Ann Kurth, PhD, RN;  David Reich, MD;  Terry Fulmer, PhD, RN; Sean Clarke, PhD, RN;  Beth Oliver, DNP, RN, FAAN;  David Feinberg; and Ernest J. Grant, PhD, RN

In celebration of National Nurses Month, Mount Sinai Nursing invited four nationally recognized nurse leaders to participate in a panel discussion titled “Making a Difference: The Power of Nursing in Health Care and Beyond.”

Moderated by Chief Nurse Executive Beth Oliver, DNP, RN, FAAN , the conversation was lively and inspiring, pointing to all of the intersections of care where nursing can lead, both in health care and beyond, touching on topics of diversity and equity in our communities, climate change, and advocacy. The event was held Monday, May 6 at The Mount Sinai Hospital. The panelists were:

  • Sean Clarke, PhD, RN, FAAN, Ursula Springer Professor in Nursing Leadership and Executive Vice Dean, NYURory Meyers College of Nursing, and Editor-in-Chief of Nursing Outlook
  • Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation
  • Ernest J. Grant, PhD, RN, FAAN, Vice Dean for Diversity, Equity, Inclusion, and Belonging, Duke University School of Nursing, and Immediate Past President, American Nurses Association
  • Ann Kurth, PhD, RN, CNM, MPH, FAAN, FACNM, President of the New York Academy of Medicine

Brendan G. Carr, MD, MA, MS, Chief Executive Officer of Mount Sinai Health System, kicked off the presentation by thanking the nurses of Mount Sinai for their work in keeping the patient at the center of care and noted the special connections nurses make with both patients and their families.

David Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens, said that Mount Sinai Nurses are the “best in the universe” and pointed to the many honors and awards earned by Mount Sinai that would not be possible without the efforts of nurses. Dr. Oliver echoed the thanks of Drs. Carr and Reich, underscoring the National Nurses Week theme that nurses make a significant and immeasurable difference in health care.

The panelists responded to Dr. Oliver’s questions and discussed topics including the impact of the COVID-19 pandemic and other challenges facing the nursing profession; the most creative innovations in nursing; how to address safety, quality and diversity in a new era of nursing; and career advice for nurses.

For Transplant Patients and Donors, Mount Sinai’s Transplant Psychiatrists Offer Unique Assistance

For a patient and their loves ones, preparing for an organ transplant is never easy, and the same holds true for someone considering donating an organ. Mount Sinai’s transplant psychiatry program is one of many resources there to help with the process and, in the end, help save lives.

Mount Sinai Transplant is a premier program for organ transplantation, offering comprehensive treatment for patients who desperately need organs such as hearts, lungs, kidneys, and livers. Among the program’s renowned specialists are transplant psychiatrists who are specially trained to help both organ recipients and living donors.

Ambika Yadav, MBBS

“Across the United States, about 100,000 people require an organ transplant. There’s a huge need,” says Ambika Yadav, MBBS, Assistant Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, who specializes in transplant psychiatry, focusing on liver and kidney donors and recipients.

“The goal of transplant psychiatry is to mitigate whatever psychosocial risks exist so we can help as many people as possible get the organs that will save their lives,” she says.

Transplant Psychiatry at Mount Sinai

Mount Sinai’s transplant psychiatrists are based at the Recanati/Miller Transplantation Institute, where they work closely with other members of the transplant team. They provide a range of services for organ recipients and for living donors who choose to donate a kidney or portion of a liver. Those services include:

  • Evaluating a patient’s suitability as a transplant donor or recipient
  • Establishing treatment plans for patients with preexisting psychiatric conditions
  • Helping patients develop coping skills and manage expectations around organ transplantation
  • Managing psychiatric symptoms that can arise as a result of surgery or medication side effects
  • Dealing with complicated emotions after transplant

 

Helping Organ Recipients Prepare for Transplant

All transplant recipients receive an extensive medical and psychosocial evaluation to determine their suitability for transplantation. Typically, a transplant social worker provides the initial psychosocial evaluation. But transplant psychiatrists often get involved to further assess patients and mitigate any risks.

The goal of that assessment isn’t to rule out whether a person is a suitable candidate for a new organ. Rather, the transplant psychiatrists focus on identifying factors that might cause setbacks and find ways to manage those factors.

“Our goal is always to optimize patients for organ transplant. By identifying risks, we can come up with a plan ahead of time so they can get the organ they need and continue to have a life,” Dr. Yadav says.

For example, when patients have diagnoses such as anxiety or depression, psychiatrists can work with them to develop a treatment plan to reduce the risk that symptoms will get in the way of their transplant recovery. Psychiatrists can also come up with plans to support patients with alcohol use disorder or other substance use disorders, a common history among patients with liver failure.

“In those cases, we’ll do a risk assessment of the severity of their substance use disorder and determine how we can best help prevent them from relapsing so they can be good stewards of their new organ,” Dr. Yadav says.

When possible, these meetings happen in an outpatient setting. But in many cases, patients are evaluated for transplant after they become critically ill and so are already in the hospital. “Because Mount Sinai is a major transplant center, many patients are transferred here because they are surgically complicated or otherwise high-risk,” Dr. Yadav says. She and her colleagues meet regularly with hospitalized patients to assess their needs and help them prepare for transplant.

Managing Life After Organ Transplant

Psychiatrists also help people manage issues that arise after an organ transplant. Agitation and delirium can be side effects of surgery, and immunosuppressant medications that prevent organ rejection can cause psychiatric side effects and may also interact with other psychiatric drugs in complicated ways, according to Dr. Yadav.

“Community psychiatrists may not have much experience managing those psychiatric side effects and interactions,” she says. “Once a patient is stabilized after transplant, we can refer them to a community psychiatrist and provide our recommendations for managing their treatment.”

Psychiatrists also help patients deal with complicated emotions following a transplant. Patients might feel guilty or unworthy after receiving an organ from a deceased donor. They may expect life to be completely different after a transplant and feel let down by ongoing medical challenges and other life stressors. “We can help people manage their expectations and find ways to cope,” Dr. Yadav says.

Supporting Living Organ Donors

On the other end, transplant psychiatrists play a key role in assessing living donors and helping them prepare for the procedure. Living organ donors can donate a kidney or a portion of their liver to recipients—including friends and family members, and in some cases, anonymous recipients. Psychiatrists screen patients for preexisting psychological conditions that could affect their decision and well-being, and ensure they understand the risks they’re taking.

Increasingly, living donors contribute kidneys in “paired exchanges”—for example, a donor who is not a match for his wife may donate to a stranger on the waiting list, while someone related to that stranger donates to the first man’s wife. Such paired exchanges can involve multiple steps of exchanges. “Given the intricacies and the many points at which things might not go as planned, we hold these patients to a higher standard and make sure they know what to expect,” Dr. Yadav says.

Donating an organ is a big decision. “These are people who are completely healthy, undertaking a surgical procedure with zero benefit to themselves,” Dr. Yadav says. Mount Sinai’s transplant programs go above and beyond to keep living donors’ well-being at the forefront. “Our living donor team is really special. They put the donor first, and always prioritize their needs separate from the needs of the organ recipient,” she adds.

Moving Transplant Psychiatry Forward

Dr. Yadav and her colleagues are also engaged in research to improve their approach to assessing patients and mitigating psychosocial risks.

“As a major transplant center, Mount Sinai has many complicated cases and we have a lot of data regarding our risk assessments and patients’ psychosocial outcomes,” she says. “We’re always trying to use data to come up with better assessment tools and ultimately improve outcomes for patients.”

Transplant psychiatry is a subspecialty of the Consultation Liaison Psychiatry services at the Icahn School of Medicine at Mount Sinai. Learn more about Mount Sinai Transplant and Living Donor Transplantation.

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