Although postoperative quality of life of living donors for organ transplantation has been reported to be better than that of the normal population, it is reported that they also experience various psychiatric and psychological problems. In this report, we review psychiatric and psychological problems and consider effective mental interventions for living donors. It is inferred that there is a specific psychological mechanism in the donor, such as obtrusion in donors, rebirth fantasy, rebound neglect, or ambivalent feelings about donor selection. In addition, donors sometimes exhibit physical, economic, and social anxiety and a depressive state arising from feelings of guilt towards the recipient. It is important for caregivers to recognize these mechanisms and understand the donor’s psychology. The death of the recipient, delay in returning to society, lack of family support, economic burden, and past history of mental illness are the risk factors for donors’ low psychological quality of life and require intensive support. Donors who are not fully aware of their own psychological ambivalence before donation also tend to experience decline in the psychological quality of life. In Japan, third parties evaluate the spontaneity of providing donor organs in an interview. In this interview, asking about donors’ ambivalence may contribute to donors’ mental well-being. Focusing on positive aspects of donation, such as post-traumatic growth and resilience, is also important.