The Change of Family Dynamics Caused by Kidney Transplantation―Case Report

Abstract

Background : At our hospital, psychological consultation is routinely provided for living kidney transplantation recipients and donors prior to surgery, then immediately and again 1 year after surgery. The procedure of living kidney transplantation has not only physical risk, but also psychological stress including mental conflict and anxiety for both recipients and donors. Furthermore, Haruki (2006) reported that underlying family problems tend to be heightened when the recipient and the donor are family members. Though the relationship improved in most of the cases at 1 year after the procedure, the author reported and discussed a case in which changes took place in family dynamics following living kidney transplantation.

Subjects : The recipient A, in his 40s, was a married man with a wife in her 30s and a child. Renal function in the recipient A had shown a drastic decrease 3 years prior, for which hemodialysis therapy was introduced. With further aggravation, living kidney transplantation from his wife, the donor B, was performed. The recipient A was an outstanding employee at his company, and the donor B was as a housewife.

Methods : The contents of psychological assessments and consultations performed preoperatively, postoperatively and 1 year after surgery were examined. As for the donor B, the contents of the psychological consultation performed occasionally was also examined.

Course : The recipient A, the work-oriented man, became depressive prior to the surgery, as hemodialysis therapy introduced obstacles to his ability to perform at work. However, his mental state recovered after the procedure, as his physical condition was improved. The donor B had been under stress from a family problem, which led to her mental instability after surgery. She continuously felt ill with a variety of physical complaints even at 1 month after discharge from the hospital, thus an additional psychological consultation was performed. A psychogenic disorder was suspected, and a psychiatric visit was suggested and accepted by the donor B. After approximately 6 months of psychiatric treatments, her symptoms remitted. A psychological consultation performed 1 year after surgery found that the relationship between the husband and wife had become closer, to the extent that they went out together every weekend.

Discussion : In this case, the work-oriented recipient changed his view of life based on the experience of kidney transplantation and began to play a role as a father in his family, which changed the family dynamics to the point that his wife, the donor B, could rely on the recipient A. Accordingly, we considered that psychological consultation contributed to improve the family relationship, which had reached a critical situation. Continuous mental support from the perspective of family dynamics is considered important for living kidney transplantation recipients and donors.