Psychological and Social Problems Encountered in Active Treatment of Chronic Uraemia

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Abstract
Kidney donors (64) were interviewed by a psychiatrist and given the Rorschach test 6 mo.-6 yr after the transplantation. Of these donors 23 were also interviewed before the operation. An analysis was made of the central dynamics of the donors'' personalities, of how they had experienced the donation, and of how they had adapted to it. No psychic trauma was observed in 20 of the subjects, and in 5 of these the operation had apparently had a beneficial effect on their psychic well-being. That no trauma was observed in 8 additional donors was due largely to the effects of a multitude of other traumatic life experiences. Mild trauma had been experienced by 24 donors and moderate to severe by 12. In this study, the donation of a kidney to a sibling turned out to be more traumatic than the donation to a child, and a transplantation with an unsuccessful outcome was more often associated with psychic trauma to the donor than was a donation with a successful outcome. Psycho-social factors that substantially lessened the likelihood of trauma were: good inner resources, flexible defence mechanisms, good mental health and mild compulsive traits. Factors that favored traumatization were: poor living conditions, interpersonal problems, limited inner resources, low self-esteem (narcissistic problems) and severe psychic deviancy. Potential donors should be given adequate time not only to consider their decision but also to prepare themselves for the actual donation. Supportive help should be offered, both before and after transplantation, to donors whose psycho-social profiles reveal them to be vulnerable to traumatization.

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