Abstract
A psychiatric consultant has two roles, one before and after one surgical operation, in terms of assisting a living donor during organ transplantation. Before surgery, a consultant refers his/her opinion to the transplantation team by evaluating the appropriateness of donor selection, which includes the confirmation of a donor’s self-motivation and excludes psychiatric illness. After surgery, the consultant follows up to prevent depression or provides therapy when depression occurs and supports the donor’s mental health condition. Currently, no definite psychiatric guidelines in organ transplantation exist in Japan. Concerning a living donor, the Japan Society for Transplantation (JST) lists requirements as follows: 1) the confirmation of decision-making should not be forced, 2) mental illness must be excluded, and 3) the certification of adulthood must be provided by a psychiatrist if a donor is a minor. According to the JST, a psychiatrist is expected to 1) be a witness of a donor’s self-motivation, 2) exclude a mentally ill donor, and 3) certify that the donor has an adequate sense of judgment. The author would add that a further role of the psychiatric consultant should include assisting the donor in understanding the implications of giving his/her organ to the recipient and helping his/her family support the donor’s decision. Therefore, the consultant must be conscious of the decision-making process when meeting a donor candidate. There have been no guiding principles except for a donor’s lack of sense when a consultant recommends denying transplantation surgery. The author would conclude that the execution of new psychiatric guidelines concerning donor selection is urgently needed.
