Psychological conflicts between relatives during the long-term course after successful living organ donation

The German transplantation law prefers living organ donation between close relatives and spouses, which is assumed to guarantee unequivocal altruistic motivation. Since 2001, 68 recipient-donor-pairs, who aspired to have a renal or liver transplantation, underwent a systematic psychosomatic evaluation. Meanwhile, 43 transplantations were performed including 34 renal and 9 liver cases. Seventeen recipient-donor-pairs were readministered evaluations by the department of psychosomatic medicine after 1 to 6 years after transplantation for long-term follow-up. In 10 cases of medically successful transplantation, we identified severe conflicts between donor, recipient, and next-of-kin. Major conflicts are presented by case vignettes regarding deterioration of a previously conflicted marriage, noncompliance of the recipient due to a marital stalemate, and family conflict revolving around refusal to donate. Based on these findings, concise assessments of donor-recipient-pairs are recommended regardless of family relationships. Particular attention must be paid to signs of conflict both before and after transplantation.