Book Review

Psychiatric Aspects of Organ Transplantation

N Engl J Med 1993; 329:1663November 25, 1993

Article

Psychiatric Aspects of Organ Transplantation
Edited by John Craven and Gary M. Rodin. 243 pp. New York, Oxford University Press, 1993. $49.95. ISBN: 0-19-262073-8

This book focuses on an important aspect of organ transplantation. Psychosocial aspects of organ transplantation follow hard upon and often appear in tandem with pioneering medicine and surgery. Issues addressed by consultation-liaison psychiatrists and others interested in this area include the assessment of candidates for transplantation, changes in the quality of life as a result of the procedure, compliance and noncompliance, psychotic complications, and ethical considerations. The editors -- respected specialists in the psychiatric aspects of organ transplantation -- have put together what I believe to be the first book published in this field.

Social support, organic brain syndrome in transplant recipients, and psychological complications and their treatment are ably discussed. Psychological intervention can be helpful in various phases of the transplantation process and can ameliorate or cure such problems as anxiety, depression, and noncompliance. In an interesting chapter on religion and spiritual factors in organ transplantation, Dixon describes attitudes of various major religions toward transplantation.

As for specific organs, Rodin and Abbey succinctly summarize the psychosocial aspects of kidney transplantation. Emotional responses to cardiac transplantation are somewhat unusual, in part because the heart is seen as the spiritual center of life. The chapter on this topic summarizes six phases of cardiac transplantation, from its proposal to treatment after the procedure, in terms of the chief psychological tasks at each phase and the emotional responses to it. Surman describes psychological aspects of liver transplantation such as organic brain syndrome, depression, adjustment disorders, the process of selecting recipients, psychiatric treatment, family support, and the quality of life. The only nonsurgical transplantation is that of bone marrow. Wolcott and Stuber conclude that there are no systematic data on major issues related to bone marrow transplantation, even though it is widely performed. Pancreas transplantation is a rapidly evolving elective procedure performed exclusively in patients with diabetes to prevent or minimize the severe complications of this disease. Lentz, Popkin, Colon, and Sutherland -- three well-known psychiatrists and a distinguished surgeon -- have ably undertaken this new area of medical, surgical, and psychiatric research.

This book is well put together, largely free of psychiatric jargon, and readable by graduates and trainees in a wide variety of medical specialties. It is highly recommended for those interested in the emotional aspects of organ transplantation. The editors are to be congratulated on a fine piece of work.

Norman B. Levy, M.D.
New York Medical College, Valhalla, NY 10595