The person who gives consent to be a living organ donor should be competent, willing to donate, free from coercion and medically and psychosocially suitable. They should be fully informed of the risks and benefits of being a donor, as well as those of the recipient, and of the alternative treatment options available. According to the present ethical guidelines for living organ donors in Japan, third parties such as psychiatrists should confirm that the decision of a person to donate is being made voluntarily, without undue pressure or coercion from others. However, there is not yet clear guidance on how to evaluate voluntary intention. Here, we demonstrate a support and confirmation system for the decision-making process in living kidney donor candidates that was developed through a multidisciplinary consensus-building process in our hospital. The psychosocial evaluation aims not only to rule out unsuitable donors, but also to clarify psychosocial problems signaling the possible need for intervention to maintain the long-term well-being of the living organ donors.

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The roles of a psychiatric interview with the candidates for donors of living-donor organ transplantation include “confirmation of the intention to donate their own organ” and “evaluation of their psychological states.” In order to confirm the intention of the donor, three steps are required as follows: “judgment of the ability to decide the intention” by evaluation of mental states, “evaluation of the degree of understanding” about transplantation, and “check on compulsion” by the persons involved in the donation. On the other hand, we investigated the long-term psychosocial progress of 40 recipients and 30 donors several years after the occurrence of adult-to-adult living-donor liver transplantation. The results were that the psychosocial progress of the donors was influenced by the psychosomatic states of their recipients, and that the donors who were the spouses of their recipients were psychosocially more stable than the other donors. We could not recognize any evidence showing that the psychosocial progress of the donors was associated with their psychological states just before transplantation. When psychiatrists interview candidates as donors of living-donor organ transplantation, the relationship of the candidates with their recipients should be paid attention to, and the processes of donor selection should be investigated in detail.

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In Japan, there is no legal regulation in terms of the relationship of the living donor to the recipient. Instead it is determined by the ethical committee of each transplant center. In many centers, the living donor is determined by the recipient’s spouse or by his/her relatives within the second to fourth degrees of consanguinity. It seems difficult for us to evaluate the willingness of the donor to donate his or her partial liver to the recipient or to evaluate the profit that results. To donate one’s partial liver means volunteering to lessen the quality of one’s own life. It is hard to understand why one without a blood relationship to the donor would donate their partial liver. I think a clear regulation on the relation of the donor to the recipient is important as determined by the Japanese Transplantation Society. We consider a potential living donor among the candidates satisfying these conditions. The first step for selecting the potential living donor is their voluntarily will, which is confirmed by a transplant hepatologist and a coordinator. The medical evaluation was performed. The voluntary will to donate the partial liver is then evaluated by a psychiatrist at the final stage.

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The 1494 kidney transplants in Japan in 2009 accounted for approximately 90% of 1312 renal transplantation names. In healthy people who need not undergo surgery, the decision to have a kidney transplant is not an easy one. New ideas from the perspective of the recipient transplant coordinator's point of decision support are needed in the early stages of preparation so that the selection of the best graft for potential donors and families occurs. Early results involve appropriate preparation of the transplant donor candidate, which is often insufficient in its readiness, leadership assessment and intervention by the recipient transplant coordinator, all of which are considered essential.

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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.

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The necessity of mental care for medical staff is clear, and the development of a counseling system for medical staff by the psychiatry department among hospitals is hoped for. In the present study, the factors that influence counseling intention to the psychiatry department were examined to construct a mental care system. As a result, it was suggested that (1) young staff tend to resist counseling, and (2) the staff who had experience with the consulting psychiatry department tend to consult easily. Moreover, a relative evaluation for the system was investigated in terms of its application to staff, to the method used, to the counseling time zone, and to the record preservation method. As a result, it was shown that the staff member who accepts the request for counseling is a clinical psychologist, and communication by telephone was recommended. As a result, flexible counseling including overtime was required, and the records were preserved via a paper file without electronic medical record, and this staff member was easily consulted the most. In addition, it was also clear that the application to staff, and the application to the method are more valuable.

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Delirium is common in general hospitals and increases morbidity and mortality. This study evaluates how preoperative psychiatric intervention for esophageal cancer affects the incidence and courses of delirium. We also present recent information about the prediction and prevention for delirium. Our intervention reduced the incidence rate and severity of delirium, although their changes were not statistically significant. The insufficiency of the effect of our intervention was considered to be due to the fact that we simply provided the medical staff the information about the risk of delirium. We did not provide guidance for non-pharmacological treatment, which consequently resulted in an inconsistent approach with patients. This study suggests that educating medical staff and standardizing the care for patients are important for the prevention of delirium.

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This study aims to clarify the burden on family members of cancer patients and the need to provide them with psychological care/support. Five hundred family members of cancer patients were administered a self-reported questionnaire via the Internet. The survey results showed that 94.4% of the patients were notified of their diseases, and that the notifications were received favorably among 85.6% of the family members. The family members stated that they found the instance of disease notification the most stressful. Furthermore, only 15.1% of the family members were provided with psychological care/support by medical staff. On the other hand, 41.1 % of the family members consulted someone when they were distressed. In many cases, the person consulted was a family member other than the patient. Notably, the percentage of votes for “I would be more distressed if I was diagnosed with cancer rather than my family member,” “I would be more distressed if my family member was diagnosed with cancer rather than me,” and “This is a which came first, the chicken or the egg? issue” were approximately even. The family members hoped psychological care/support was tendered by the doctors throughout the course of treatment through measures such as empowerment, providing right information and sound advice, guidance on the appropriate behavior for a cancer patient, counseling, etc.

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