The Psychological Implications of Organ Transplantation — A Selective Review

Abstract

Organ transplantation presents society with a number of ethical and legal problems such as the validity of removing healthy organs from healthy donors, and implanting them into recipients who cannot be guaranteed success, the competence of living donors to give their consent, and the problems of timing of death where cadaver organs are used. The selection of recipients is primarily a medical one with surprisingly few psychiatric contraindications. This is similarly true for living donors, but in both recipients and donors there are psychological issues which have been subject to considerable debate. Some workers have observed that almost exclusively positive effects in donors lead to the suggestion that growth by crisis resolution is the expected outcome, but other workers contradict this, noting that depression, resentment and hostility with an increase in psychiatric referral is the rule. Innovative surgery, particularly where it is dramatic and appealing to the information media, and also where it is accompanied by high risk always seems initially to be associated with undesirable psychological sequelae which diminishes in severity and frequency as the surgery becomes an accepted practice. No doubt several factors are involved, not the least of which is the psychiatric contribution to the prediction, prophylaxis and treatment of such sequelae. Organ transplantation provides an opportunity to learn more about some very early psychic phenomena such as introjection and incorporation, and what part psychic events have to play in the process of organ rejection. It is clear there is a continuing role for the psychiatrist both as a member of the treatment team and as a researcher in this field.