Psychological effects of living related kidney transplantation - risks and chances.

BACKGROUND: Recipients of living donor kidney transplantation hope for an improved physical well-being after transplant. Furthermore the patients and their relatives frequently expect an improvement in their psychological findings in consequence of the living related transplantation. The present study examines the psychosocial effects of living donor kidney transplantation for donors and recipients under successful as well as complicated circumstances. MATERIAL AND METHODS: Based on 31 catamnestic interviews of recipient-donor couples and a content analysis of these interviews, hypotheses regarding the psychological requirements for a successful progression of a living kidney donation are deduced and put forward. RESULTS: The aspiration for an improvement of psychological problems, particularly anxiety and depression, as an effect of transplantation can on the basis of the present results not be supported. Living donor kidney transplantation between close recipient and donors must not be regarded as a means to solve psychological problems and familial conflicts. An attitude characterized by realistic and modest expectations as well as relationships, which have been cleared of extreme conflicts prior to the transplantation could facilitate a favourable psychological progression.

Donor-recipient interaction: the Heidelberg model of evaluation and consultation.

BACKGROUND: In order to avoid psychological complications in living-donor transplantation, careful evaluation and consultation of the donor-recipient system is necessary. This article describes the Heidelberg consultation procedure before and after transplantation. This approach emphasizes close collaboration between physician and psychologist in joint interviews. METHODS: Consultations focus on family genogram, the history of the donation idea; stability and balance of relationship; expectations; hesitations and doubts; discussion of complications; previous hospital experiences; the offer to provide crisis intervention when needed. RESULTS: In 20% of all cases, unresolved problems appear. These include: unilaterally dependent relationships; unrealistic hopes for change; anxious avoidance to reflect complications; lack of medical information; risky health behaviour; negative experiences with hospitals. When properly consulted, half of these couples resign from transplantation. CONCLUSIONS: Close physician-psychologist collaboration adds significant value to a 'psychologist-only' consultation. Discussing hesitations and concerns strengthens confidence in the professional transplantation system. Access to post-transplant consultation needs further improvement.

Psychological consultation before living kidney donation: finding out and handling problem cases.

BACKGROUND: Since 1996, a team of medical psychologists, nephrologists, and urologists at Heidelberg University Hospital has developed a family-oriented consultation procedure for donors, recipients, and family members before living kidney transplantation. Qualitative content analyses of these consultations and their follow-up histories are presented, with particular focus on "problem cases." METHODS: Sixty-seven consultation interviews were explored by rating family interaction, consultee-consultant interaction, decision-making process, and intervention strategies in problem cases. Subsequently, 33 catamnestic interviews 1 year or more after living donation were explored by qualitative content analysis for donor and recipient quality of life, quality of relationships, and health status. RESULTS: Generally, donors show themselves to be eager; recipients appear more reluctant. Expectations focus on spontaneity and a "normal life." Fears are usually expressed not about oneself but about the partner involved. Types of confrontation with possible complications are anxious avoidance, active consideration, and optimistic fatalism. Past family experiences of medical traumata may influence content and level of anxiety. Problem cases are characterized by unilaterally dependent close relationships, unrealistic expectations, anxious avoidance of problem confrontation, and negative experiences with the medical system. At follow-up, the majority are in good medical and psychological health. Few donors and recipients are suffering from disappointed expectations or unexpected treatment side effects. CONCLUSIONS: The Heidelberg consultation setting has proven useful for allowing open discussion about critical issues. In problem cases, prescribing a moratorium instead of rejecting donation helps to relax consultation anxiety. Psychological support after transplantation seems to be indicated for a minority with typical first-year problems.