Psychiatric aspects of organ transplantation
- John Vella, MD, FACP, FRCP, FASN
John Vella, MD, FACP, FRCP, FASN
- Associate Professor of Medicine
- Tufts University School of Medicine
The development of end-stage organ failure combined with the realization that life may no longer be possible without medical intervention can lead to depression, anxiety, nonadherence with diet or medication, and sexual dysfunction in the transplant patient . The administration of immunosuppressive drugs, such as glucocorticoids and cyclosporine, has also been implicated in causing psychiatric disturbances [2,3]; these include euphoria, delirium, generalized anxiety disorder, and hallucinosis.
These disorders frequently require treatment with psychopharmacologic agents. However, their administration may be hazardous because of adverse effects as well as specific interactions with immunosuppressive drugs.
This topic review will discuss some of the more common psychiatric disturbances that develop in transplant recipients with specific attention to their impact upon pharmacologic management and prognosis. Discussions related to psychotherapy are presented separately.
PSYCHOLOGICAL IMPACT OF TRANSPLANTATION
The altruistic act of kidney donation appears to confer psychologic benefit to the donor. In a study of donors followed after a period of 5 to 10 years, the majority of individuals, independent of the outcome of the procedure, expressed positive feelings towards having donated a kidney . However, in another survey, donating was perceived to have had a negative impact upon the health and finances of 15 and 23 percent of responding donors, respectively . Despite this perception, donors of kidneys live longer than others, due most probably to the screening process, which only permits healthy persons to be accepted for living kidney donation .
For the graft recipient, transplantation means more than an operation; it requires a certain degree of personal strength and adequate coping skills. In a study of heart transplant recipients, patients were grouped according to their response to a psychological survey :
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