Whole-Child Healing: UCSF Redefines Kidney Transplant Care with Mental Health a Core Part of Treatment

UCSF is one of the first pediatric kidney transplant programs in the country to fully integrate psychology into every step of transplant care, and the data shows that mental health directly impacts organ survival. 

For a child facing kidney failure, survival is a monumental first step. As a national leader in pediatric kidney transplantation, UCSF achieves a one-year survival rate of 94 percent for transplant recipients, well above the national average. 

For these children and their families, a transplant is a complex, lifelong journey. Their reality involves intensive dialysis schedules, strict regimens, intense medical procedures, and the constant anxiety of living with a chronic illness. 

Recognizing how essential emotional resilience is throughout the transplant process, the UCSF Division of Pediatric Nephrology has established a pioneering model of care that integrates psychological support alongside clinical care, ensuring that a child’s emotional well-being is treated as a vital component of their health. 

The Integrated Model in Action 

Historically, mental health support for pediatric transplant patients has been fragmented, often relying on referrals to outside providers who may not understand the nuances. UCSF has replaced that fragmented model with comprehensive services embedded directly within organ transplant and dialysis programs. 

"Our mental health program succeeds through incredible teamwork," says Paul Brakeman, MD, PhD, medical director of the UCSF Pediatric Kidney Transplant Program. "It combines the expertise of our dedicated psychologist with tireless support from our social workers — Emily Lopez, Sarah Kinnier, and Taryn Shappell — to help families identify their needs and find concrete solutions.” 

Jason Tinero, PsyD, the child psychologist on the team, explains that he "follows patients across their entire transplant journey, from when they are first evaluated for transplant all the way through their operation and later transition to adult care teams."  

To ensure access for every family, this support is flexible — offered in-clinic, during hospital admissions, and via Zoom for families across California. 

Navigating the Transplant Journey 

For patients and their families, the hurdles of kidney disease and receiving a transplant are daunting. The team helps patients navigate issues ranging from medical trauma to depression that often accompanies a difficult diagnosis and the long journey ahead. 

"These children experience stressors unique to their situation," Tinero says. "Including the fear of procedures, the social isolation of missing school, and the difficulty of adhering to complex medications and fluid restrictions while just trying to be a kid." 

Collaboration is key to solving these problems. In one recent case, a teenage patient was struggling with severe anxiety about his illness, which led to him fearing the worst-case scenario at every check-up. 

The team mobilized a coordinated response: 

• Medical Communication: Tinero coached the medical team on how to deliver updates in a way that wouldn't lead to the patient's panic. 

• Family Support: The social work team secured financial aid, as the family wasn’t working while staying in San Francisco for the operation.  

• Coping Skills: Tinero helped the patient identify his personal values, using them as motivation to get back to "doing what matters." 

Mental Health is Medical Health  

"The scientific data shows that mental health symptoms negatively impact how long a transplanted organ lasts," Tinero notes. 

Untreated anxiety and depression can lead to difficulties maintaining the strict medical regimen required for the organ's survival. By addressing emotional challenges early and throughout the transplant process, the team helps children build a future with more freedom and fewer complications.  

"While life post-transplant is difficult and complex, I try to help our patients see that they have a new opportunity to live a life that is meaningful and important to them,” says Tinero.  

Setting a New Standard 

This program is the result of years of advocacy and collaboration led by Brakeman. He worked closely with other solid organ transplant leaders, including liver specialist Emily Perito, MD, and heart specialist Othman Aljohani, MBBS, MPH, to ensure this care is standard across all pediatric transplant programs at UCSF. 

UCSF’s integrated approach confirms that world-class transplant care requires more than just clinical excellence. The goal is not just to provide the best survival rates in the country, but to ensure that the life ahead for patients is full and vibrant.