Psychological Aspects of the Management of Chronic Renal Failure

Abstract

This paper has attempted to distil the many varied experiences gained over the past three and a half years. As programmes develop and numbers of patients and staff increase in the face of technical expertise, we must never lose sight of the complex emotional and social needs of the patient and his family. The psychiatric management of 47 patients in chronic renal failure undergoing treatment with recurrent haemodialysis, leading in 19 cases to homotransplantation from both living donors and cadaveric sources, is described, as are the problems of the psychiatric screening of 28 potential donors. The psychiatric contribution includes the initial assessment interview, the provision of specific therapy as the need arises, the interpretation to the staff of the problems of transference and countertransference, and the follow-up of recipients and donors. Anxiety levels both for patients and for staff in the programme diminished as experience was gained over the three-year period and crises became fewer. Selection of living donors requires a dynamic understanding of interpersonal relations, since a hostile dependency may ensue. There is evidence that the total experience leads to a greater maturity in the patient who adapts best. As programmes develop and numbers of patients and staff increase in the face of technical expertise, we must never lose sight of the complex emotional and social needs of the patient and his family. Our thanks are due to the members of the nursing and technical teams of the Renal Unit at the Queen Elizabeth Hospital, Adelaide, South Australia, who have been involved in this work since it began. © 1968, British Medical Journal Publishing Group. All rights reserved.