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Psychological Implications of Organ Transplants

The process of organ sharing has been viewed in the medical field as a breakthrough in
the evolution of the worlds increasing medical knowledge. It is often overlooked, however, how
the process of donating and receiving an organ can affect the mind of both people involved
because of the preoccupation of the knowledge that a life was improved or saved. The reality
most people do not see is the life of the donors and recipients after the transplant has been
completed, and depending on the type of transplant, how the people feel, act, and are overall
affected by the process. Organ donation is not as simple as giving and receiving - it is a multilevel process, one that can affect the psyche of both the donor and recipient in varying intensities
depending on the type of donation.
While the 21st century media outlook provides an often one-sided view on the topic
through television and articles, organ donation covers a varying spectrum of levels of donation.
The most common form of donation is the most overlooked, which is superficial donations, such
as hair donations for wig making and skin grafts, which can be used on another part of the
original donors body, or may be given to another person for skin grafts (Hansbrough, et. al). The
next, less common level of donation is living organ donation (LOD). This occurs when a patient
needs an organ, most commonly a kidney or a section of a liver, and another person who is alive,
usually a relative or spouse of the patient, donates what they can (Jackson 1294). Posthumous
organ donation, in comparison to LOD, occurs when the donor is deceased and the organs are
removed and given to patients who need them. Although this is the most commonly known one
and seen as a remarkable advancement in medicine, it frequently results in the most adverse side
effects on the psyche for the recipient of the organs. Depending on the level of donation that
occurs, the result produces ranges on the mental health of the donor and recipient of the organ.

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Superficial donations result in the most minimal of effects on the donor, but provide
considerable amounts of positive effects on the recipients. Since most of these types of donations
do not require specific blood and body type matching, the process and requirements are simple.
Most common among superficial donations is the act of cutting long amounts of hair off and
sending the resulting hair to a foundation who creates real hair wigs for those suffering from
long-term hair loss. Most requirements for this is the hair must be a certain length, not dyed, and
in good relatively good condition (Henquinet). The second most common form of superficial
donation is the donating of skin. Since skin is made of cells that are able to multiply and divide
easily, skin grafts are common amongst burn victims or those who have been stabbed or had
large areas of skin broken (Hansbrough, et. al). In many cases, the person receiving the skin graft
is also the one donating it. Since there is a large amount of skin on a person, if only a small area
needs to be covered or replaced, the skin may be taken from another area of the body. For a
successful skin graft to occur, the skin being donated needs to be healthy and able to be accepted
by the recipients body (Hansbrough, et. al). Donating both these organs involves a fairly simple
process, and those willing to donate and participate are greatly encouraged.
Receiving one of these forms of donation is often as simple as the donation process. To
become a recipient of a real-hair wig made from hair donations, most organizations require the
beneficiary have a long-term hair loss disease or side effect, often from chemotherapy. Once a
person is approved and able to get a wig, they are able to pick out the style and color of the wig
they choose (Henquinet). Since these wigs are often made to order, the person choosing their
wigs are able to express themselves in ways they were not previously able to. To be in need of a
skin graft, according to Doctors McCain and Sutherland of the American Journal of Nursing, the
person must have suffered a serious trauma, most likely a third-degree burn. Since these burns go

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through all layers of skin tissue and sometimes the tissues underneath the skin, there is little
chance of that skin healing on its own. Additionally, surgeries or reparations of broken skin often
require a skin graft to cover exposed areas of the body and offer faster healing times. In these
instances, skin color is often the only match needed to make, since blood type has no effect on
the acceptance of the skin grafts. The evolution of skin grafting has helped provide victims of
skin related injuries the chance to a better life and faster healing times. The entire process
produces an experience for the recipient resulting in a more positive life.
Due to the non or minimally invasive nature of superficial donations, the donor
experiences little mental effects while the recipients life is often greatly affected. Leading up to
the donation, the person giving the hair or skin may often feel apprehensive, regularly due to the
fact that they are giving away something of themselves (Henquinet). To donate hair, it needs to
be a certain length, which means the person giving it away will have had that hair for a
considerable amount of time. It is a large commitment to rid oneself of a major piece of
themselves. Likewise with the hair, to willingly give away a piece of themselves is a sizable
decision to commit oneself to. After the apprehension has surpassed and the donation has been
completed, the donor feels a content and proud feeling (Henquinet). The donator enjoys the
feeling of being able to help another person, resulting in an overall positive experience, one the
donor is likely to search out again when the next opportunity is presented. On the contrary, the
feelings of pride are replaced by gratitude in the person receiving the donations. The recipient is
often met with feelings of happiness and appreciativeness for the generosity of the donor since
they have received something they were previously lacking or in need of (Hansbrough, et. al).
Although the impact on the psyche of both the donor and recipient are minimal, they are both
considered positive which results in an overall progressive impact on those involved.

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Living organ donation, or LOD, increases drastically in the intensity of effects on the pair
if people involved in the donation process. To be eligible to donate an organ a person requires to
live, extensive testing needs to be done on the donor to ensure they are healthy enough. Since
LOD consists of the act of removing an organ from a living person and transferring it to a person
who would die without it, regularly one kidney or a section of a liver, since a person can survive
without those, doctors need to guarantee they will not influence the health of the donor (Jackson
1294). Another aspect of the testing is to confirm that the organ being donated will not be
rejected by the new body it is being placed in. An organ always has a chance of being rejected by
the body every time a transplant occurs, but it is less likely to take place if the organ matches the
new body in size, blood type, and the new organ is healthy and in good working condition. The
donor must impart in a variety of tests to assure the organ is a correct match. After the medical
testing is complete, the donor must then visit with a psychologist to ensure they are in the right
mental state to donate and undertake such an important act (Jackson 1294). Once the donor is
cleared, they are able to move on to the final step and go on with the surgery to remove the
decided upon organ and save another persons life.
The recipient of an organ must also undergo extensive testing, as with any transplant
which holds such importance. The body of the recipient is tested upon greatly to ensure the body
will accept the new organ. Since people with organ failure tend to be in poor health due to the
illness resulting in the need of a new organ, doctors are constantly monitoring the patient and
determining when the best time will occur for the transplant. Depending on the circumstance and
need for an organ, the patient is put on an organ waiting list, which places patients in order of
necessity (United Network for Organ Sharing). If the patient has a person in their life who is
willing to donate a necessary organ, they will not have to wait, and will go directly into surgery

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as soon as the doctors deem it safe. As a result, LOD results in many lives saved through the
donations of the people in their lives.
Since LOD is a personal and invasive experience, those who willingly donate an organ is
most often a relative or spouse of the patient. In one study done on the psychological effects of
organ donation, [a]ll donors were family members of the recipient: predominantly siblings...
followed by the mother or father... or a daughter (Lopes et al.). This provides a more personal
experience and promotes faster healing times physically and mentally for both the donor and the
patient. When a patient is given an anonymous donation of a major organ, a common result is a
greater is stronger mental side effects, which adversely affects the psyche of the patient.
Although the lives of the patients are greatly improved, when one receives a donation
anonymously, [r]ecipients ... need psychosocial assessment and follow-up. The presence of
psychopathologic symptoms (anxiety and depression), adaptative demands, new stressors after
transplantation, (posttransplantation regimens, potential medication side effects, guilt feelings
toward donors, and fear of rejection) demands psychosocial support for this group... (Lopes et
al.). Equal for both anonymous and known LOD, extensive testing must be done afterward to
ensure the mental and physical health of the patient requires observation posttransplant.
The final form of donation, posthumus donation, often results in great damage to the
human psyche. The act of taking a life sustaining organ from another person, who is no longer
living, can cause great feelings of guilt and depression in the recipients. For organs to be
donatable after the death of a person, the deceased must have been in relatively good health and
have strong enough organs to withstand the donation process. In the event a patient is put on life
support, and the patient has not explicitly stated what their plans were for their organs once they
die, the family dictates whether or not they will allow the doctors to remove the organs and send

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them to those who need it. In some cases, the family will decide who gets the organs, which
results in the most ethically problematic cases [where] the recipient is chosen on the basis of
race, religion, or ethnic group (Truog 446). This can result in controversy and additional
problems for the families after suffering such an extreme loss.
To receive and to qualify for an organ available, the person becomes placed on the
UNOS, United Network for Organ Donation, waiting list. For this to occur, the doctors at the
hospital where the patient is located sends their information into UNOS database, and when a
deceased organ donor is identified, UNOS computer system generates a ranked list of transplant
candidates, or matches based on blood type, tissue type, medical urgency, waiting time,
expected benefit, geography and other medical criteria (United Network for Organ Sharing).
This process usually takes a while, since specific organs often take a longer time to become
available. Due to this problem, patients often die while waiting and a great deal of people are
added to the list since organs are becoming increasingly difficult to come by, causing the number
of patients on the list to both increase and decrease daily.
Posttransplantation of posthumus donations cause the most adverse of effects on the
psyche of the recipient. Due to the knowledge of both the realities of having an organ that once
belonged to another person who is no longer alive, and the knowledge of their death signifying
another persons ability to live, the recipients major side effects are those of guilt (Lopes, et al.).
As shown by Dr. Lopes studies, the guilt and regret experienced by those posttransplant have the
ability to affect the healing process of the recipient. To combat these negative feeling, the family
of the recipient needs to provide proper after care, often involving extensive therapy and group
meetings of people experiencing the same problems (Lopes, et al.). Once the recipient accepts

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their newly improved lives, and no longer experiences feeling of guilt, they move on to feelings
of happiness and gratefulness to everyone that was involved in saving their lives.
Depending on the type of donation occurring, the effects on the donor and the patient
varies directly with the intensity and necessity of the donation. Due to every factor involved in
determining the direction the process will go and how invasive the overall experience is, the
mental health of the patients and donors require evaluation to ensure the health of both parties
are of great importance. When patients consider organ donation in the future, it is necessary for
an informed discussion to occur about every implication involved in the process. Because of
each aspect of the processes, the acknowledgement of the different side effects are required, and
it is necessary to understand the implications involved in each.

Works Cited
Hansbrough, John F., Christine Dor, and Wendy B. Hansbrough. "Clinical Trials of a
Living Dermal Tissue Replacement." Journal of Burn Care & Research 13.5 (1992): 519529.
Henquinet, Margaux. "Selfless Snip." RedEyeChicago. RedEye, 25 Jan. 2016. Web. 30
Jan. 2016.
Jackson, Trevor. "Living Organ Donation." BMJ (Clinical research ed.)327.7426 (2003):
1294-1294.

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Lopes, A., et al. "Depression and Anxiety in Living Kidney Donation: Evaluation of
Donors and Recipients." Transplantation proceedings. Vol. 43. No. 1. Elsevier, 2011. 12
Nov. 2015.
McCain, Dee, and Suzanne Sutherland. "Nursing Essentials: Skin Grafts for Patients with
Burns." AJN The American Journal of Nursing 98.7 (1998): 34-38.
Truog, Robert D., MD. "The Ethics of Organ Donation by Living Donors NEJM."
New England Journal of Medicine. NEJM, 4 Aug. 2005. Web. 16 Nov. 2015.
United Network for Organ Sharing. At a Glance. National Data - UNOS Web. 20 Nov.
2015.