Psychoanalysis of a patient who received a kidney transplant

A young man who had glomorulonephritis at age five was treated psychotherapeutically for an anxiety neurosis with phobic and obsessional features. He was referred for psychoanalysis at a time when he was approaching kidney failure, but was referred back for more psychotherapy with the possibility of future psychoanalysis. He underwent renal dialysis and then received a kidney transplant from a brother. The psychoneurosis became worse, and a psychoanalysis was begun about one year after the transplant operation. The clinical report illustrates the developmental effects of the childhood illness, as well as the patient's response to the adult treatment and the renal transplant. Nonanalytic observations by others on renal dialysis and transplant patients are reviewed and compared with the findings in this analysis. The psychoanalysis of a renal transplant patient is feasible if other indications for analysis are present. A previously unreported finding is the problem of changing a lifetime adaptation from illness to relative health. This involved the analysis of the narcissistic conflicts of the oedipal stage of development as well as the preoedipal maternal transference.