| 特集名 | 移植腎機能喪失後の透析再導入とケア | |
|---|---|---|
| 題名 | ［総説］生体腎移植に関連するドナー，レシピエントの精神医学的問題 | |
| 発刊年月 | 2006年 09月 | |
| 著者 | 春木 繁一 | 松江青葉クリニック |
| 【 要旨 】 | 日本では，約80 %が血縁者 (家族，親族) からの腎提供である．生体腎移植では，ドナーは身体脆弱化の不安や恐怖，合併症や障害への不安，ケースによっては死の不安を抱く．移植前には贖罪感，自責感，報酬要求や補償要求の気持ちも存在する．移植後はレシピエントとの共生，依存，退行，恩着せなどの心理が出現する場合もある． 一方，レシピエントでは，若い人のなかには，手術前不安が強く，強い怒り，攻撃，さらにはイライラ，行動化を示す人たちもいる． 抑うつはドナー，レシピエント双方にとって重要な問題である．移植不成功後の抑うつは理解しやすいが，成功後にも抑うつが生じることがある． |
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| Theme | Dialysis Re-initiation and Related Cares after Functional Loss of Transplanted Kidney | |
|---|---|---|
| Title | Japanese psychiatric problems with renal transplants from living relatives | |
| Author | Shigekazu Haruki | Matsue Aoba Clinic |
| [ Summary ] | There has been an increase in the number of the renal transplants from living relatives, in Japan. Over 80 % of all renal transplants are in this category, with under 17 % being from cadaveric sources. The number of cadaveric donors is decreasing. In relation to living donors, anxiety, fear of physical vulnerability, possible complications (including disabilities, or death) triggered by hospitalization may be negative factors for donors. A sense of guilt and / or self-blame, or an effort to receive rewards or compensation is seen with recipients and donors and introjection, probiosis, regression, are often seen in post transplant donors. In relation to recipients, anxiety, guilt and anger are very common psychological issues before the operation. There are a number of young adults who display marked anger and short tempers along with aggression and acting-out behavior as their defense mechanisms. Depression is one significant problem in both recipients and donors after failed transplants, but also after successful renal transplants. This condition is called “paradoxical depression”. | |