RENAL FAILURE, ARTIFICIAL KIDNEY AND KIDNEY TRANSPLANT

This is a preliminary report of a study of patients with chronic renal failure who may receive hemodialysis or a renal homograft. In the few cases studied both of these procedures diminished the severity of the ego dysfunction concomitant with renal failure. Particularly following homograft there was a striking recovery of ego functions and return to previous levels of personality integration. Although some psychic symptoms were removed through dialysis, others were created by this procedure. Dependency on external devices which provide kidney function varied. In some cases the patient developed severe anxiety when he was away from the machine. The opposite extreme was noted in other cases in which the patient not only was not dependent on this apparatus, but was frightened by the discomfort and prolonged periods of confinement necessary to perform these procedures. Although all donors were consciously altruistic, there was considerable unconscious resentment toward the recipient and toward those hospital personnel who requested or encouraged the transplant. There was consistent hostility on the part of the donor for the much greater amount of attention shown the recipient. This led to a moderate degree of postsurgical depressive reaction in all the adult donors. In some cases there was considerable unconscious confusion of kidney and sexual function with the resultant fear of loss of sexual power as a result of the surgical loss of the kidney. The recipients were ambivalent toward the donors both before and after the transplant was performed. They tended to rationalize their indebtedness to the donor by thinking that they would have given their kidney to the donor had the situation been reversed. There was considerable preoccupation around the change in their bodies with the addition of someone else's organ. There was more confusion of sexual functioning in the female recipients than there was in the male recipients as a result of the insertion of a new organ in the pelvis. These are only a few cases, yet they are rich with human reaction to the new experience of giving and receiving body organs, as well as countertransference problems. These leads should be followed by more carefully controlled studies in several areas including the biochemical correlates of psychological function.