신장이식에 대한 정신의학적 연구

Psychiatric Aspects of Kidney Transplantation

The preoperative and postoperative psychiatric reactions were studied on 23 pairs of donors and recipients undergoing kidney transplantation. In 22 recipients, kidneys were donated by living family members. Female was more than male in donors, and youn-ger sisters and mothers were most. However, 22 of 23 recipients were males, and oldest sons and fathers were most. In whole, the recipients were older and in higher socioeconomic status than the donors were. In donors, the presented motivation of kidney donation was altruism in most cases. But they had unconscious conflicts associated with intrafamiiial pressure and loss of organ, which were revealed through, anxiety, tension, depression, somatic concern and various somatization symptoms such as palpitation, headache, and paresthesia and, especially in dreams. Those symptoms gradually impro- ved after operation. Most recipients had already suffered from depression associated with chronic renal failure, and dialysis. Confronting the new problem w other some one in the family would willingly donate the kidney, they had more serious conflict. Already before the operation, they showed depression with marked guilt feeling, resentment, and anxiety for operation, various somatization symptoms such as insomnia, palpitation and headache, and even paranoid trends. They were expecting many things such as survival and healthy life from the kidney transplantation. Some patients had improved from depression after operation. However, more patients showed grave prognosis than donors did. The possibility of rejection phenomenon the patients might imagined, seemed to remarkably influence on postoperative prognosis. One patient showed a brief psychotic episode. Prognosis was better when the donors were female, married, the parents of recipients and in lower socioeconomic state. As fo r the recipients, prognosis was better when they were older, the parents or children of donors, in higher or lower in education level and particularly when the rejection phenomenon was less likely to occur. With these finding, the authors had discussed on the possible psychiatrist*s role of psychiatrist who would contribute h elpfully in kidney transplantation