While often considered as medication effects, placebo effects are well-documented in surgical contexts. Sham-controlled trials have shown that invasive procedures can lead to improvements even when therapeutic elements are eliminated in procedures such as arthroscopic knee surgery (Moseley et al., 2002), vertebroplasty (Buchbinder et al., 2009), and other interventions.

Mechanisms influencing these effects may be amplified in transplantation. The emotional importance of receiving an organ and the intensity of perioperative care create an environment saturated with expectancy. Many outcomes reported in the review, including reductions in pain, anxiety, or distress following music therapy or mindfulness sessions, are consistent with well-established placebo-responsive domains.

There is limited evidence supporting placebo and nocebo effects in transplantation. Kirchhof et al. (2018) found when immunosuppressive drugs were paired with a gustatory stimulus to create a learned association, renal transplant patients who received the taste-immunosuppressive pairing demonstrated reduced T cell proliferative capacity compared to those who did not, suggesting amplification of immunosuppressive effects. Relatedly, in a study of patients with Parkinson's disease, participants were randomized to receive either a sham surgery or a transplantation of human embryonic dopamine neurons and were blinded to their condition. Participants who believed they had received the transplantation reported better outcomes, regardless of their actual condition (McRae et al., 2004).

These findings do not suggest that placebo effects can replace needed solid organ transplantation or immunosuppressive drugs, but rather suggest that psychosocial mechanisms may improve transplantation-relevant psychophysiological factors, which could be addressed in psychological treatments to potentially improve biopsychosocial functioning in adults after transplant. There is a need for future studies that examine the associations among psychological factors, psychological treatment, and physiological outcomes of transplantation are considered.

Conditions for nocebo effects are also abundant in transplantation. The authors highlight the pervasiveness of psychological distress in many forms throughout their review, and psychological distress itself can function as a nocebo amplifier (Geers et al., 2020). This, along with well-intentioned but intensive patient education, may lead patients to expect complications, leading them to perceive benign sensations as problematic (e.g., signs of rejection). This phenomenon has been well-documented in pharmacological studies (e.g., Barsky, 2002), however remains unstudied in transplantation.

Several outcomes reviewed by De Pasquale et al.' (2025) (e.g., medication non-adherence, persistent anxiety despite successful transplantation) could plausibly reflect nocebo processes. Yet these effects are not addressed, leaving adverse outcomes individualized rather than contextualized. For example, while De Pasquale et al.' (2025) note that many patients must “cope with lifelong immunosuppressive therapies that can cause significant side effects—such as weight gain, tremors, or aesthetic changes—while contributing to anxiety, depression, and difficulties with body-image acceptance,” it is also possible that the experience of stress, anxiety, depression may lead to increased side effect experiences from immunosuppressive therapies.

There is, therefore, a need for focused research on nocebo effects in transplantation. Explicitly recognizing nocebo processes as relevant contributors to transplant outcomes would increase the issue's visibility and encourage future studies to incorporate expectancy, communication, and psychological context as integral components of transplant care to encourage biopsychosocial wellbeing.