The intrapsychic integration of a new organ: a clinical study of kidney transplantation

9 recipients of family donated kidneys and 19 recipients of cadaver kidneys were observed. Pre existing family conflicts in the consanguineous recipients were heightened by the transplantation. Specific dyadic relationships reflected particular psychodynamic patterns, such as the dynamics comparable to those of parturition exhibited in the mother donor child recipient cases. Recipients of cadaver kidneys seemed affected by their fantasies about the cadaver and their attitudes toward death and dying. They identified with the lifeless, inert traits of the donors, and 2 patients took death related jobs. Cross sexual and homosexual aspects of transplantation were observed to affect the patients. Conflict over guilt and indebtedness was also present. Although most transplantation patients make a satisfactory adjustment, some have serious difficulties integrating the new organ into their body image, and pathologic introjections, denial, and other ego disruptive sequelae may follow. The evidence demands that psychological screening be as thorough as physiological screening of kidney recipient and donor.