European Stars and Stripes (Newspaper) - September 21, 1977, Darmstadt, Hesse                                The greatest present in the world the psychological stresses by Virginia Adams new York times n june 4,1969, Odevia Field of East Orange n.j., received some Flowers and a card that read dear mom a year ago you gave me the greatest present in the world. Thank ,  the present that Kenyon b. Field had received was on of his Mother s kidneys. He was 21 at the time. In 1966, As a Sophomore at Hamilton College in upstate new York he fell seriously ill with kidney disease. Since his transplant he has graduated from College and fro the new Jersey College of Medicine spent three years at Johns Hopkins Hospital As an intern resident and senior resident and has decided to become a Nep urologist or kidney specialist. This month now married and the father of a daughter few weeks old he begins a two year Fellowship at the Rogosin kidney Center of new York Hospital. Without that present from his Mother Kenyon would probably not have lived to become or. Field. Psychoanalyst Roger Money Kyrle once wrote that the gift of life places one with the  few of the men and women who have saved the lives of kidney disease patients by giving up one of their own kidneys would pre sume to go so far. Yet Renee c. Fox a sociologist at the University of Pennsylvania has reported that making  gift often becomes a transcendent experience Akin to a religious one that enhances self knowledge self esteem and feelings of Unity with Humankind. And so it seems surprising that for some physicians and other people kidney transplantation from living donors is one of the most controversial Issue sin medical ethics. In fact or. Robert s. Morison of the Massachusetts Institute of technology has pro posed a social prohibition not unlike the incest taboo against transplantation Between close rela Tives. Some critics of live As opposed to cadaver donation argue that the donor gives up something important with out getting anything or at least not enough in return. Others have philosophical objections to taking an Organ from a live donor because the procedures makes a Well person ill even if Only for a few weeks. Still others worry because As or. Fox and Judith  observe in their Book on transplantation the courage to fail the very magnitude of the gift makes Itu repayable it can keep donor and recipient forever bound to each other in a psychologically destructive creditor debtor relationship. Such factors explain Why some transplant teams rely chiefly on kidneys from cadavers. But there is a powerful medical argument for permitting relatives to give the closer donor and recipient Are genetically the More Likely it is that the transplanted kidney will function. Nationwide about 20 per cent of transplanted kidneys Are from living related donors. A few behavioural scientists have begun to take an interest in the psychology of Organ  g. Simmons a sociologist and her colleagues at the University of Minnesota have studied scores of donors and their families and found that for Many the Choice of a donor is a formidable  donors run Only a Small risk of death from the operation and they know that one kidney can do the work of two. Just the same operations Are painful the Prospect of losing any Organ is frightening and there May be a nagging worry what if something should go wrong someday with the remaining kidney As a result some potential donors May be a least unconsciously reluctant. At the same time be cause someone s life is at stake they May be subject to Subtle pressures a kind of moral blackmail to give. Sometimes a kidney patient s spouse asks relatives straight out if they will donate provided their blood an tissues match the patients but the sick person himself is Likely to take an oblique approach. In one of Simmons s cases for example a woman in need of a transplant told her brother if they won t accept Mother Yod d be the Only  the initial and sometimes the Only response touch a request is often silence leaving the desperately ill patient feeling isolated and deserted. An explicit verbal refusal occurs occasionally. Sim Mons tells of a Case in which a potential donor s behaviour spoke More clearly than words having entered the hos Pital to donate he simply walked out the night before the operation. Ambivalent donors Are rarely aware of their own reluctance and May express it in ways that Only a psychiatrist attuned to the unconscious can inter pret. Or. Norman b. Levy and or. Jorge Steinberg psychiatrists at downstate medical Center in Brooklyn have interviewed More than 40 pairs of donors and recipients. They Tell of a recipient who received a kidney from he Mother but said my sister was better matched but she got  Levy and Steinberg believe that the preg Nancy was probably not an Accident but was brought about by unconscious design to escape the need to donate. Many relatives Volunteer As soon As they learn that kidney is needed and or. Carl h. Fellner a psychiatrist at the University of Washington school of Medicine i Seattle has found that family members May even com Pete to be chosen. Mothers Are especially Likely to come Forward  the doctor mentioned transplantation right there and then i was determined to do it said mrs.  stress does not necessarily end with the Choice of a donor. The person selected May be confident of the new York tires Edward Hausner Kenyon Field with wife and daughter lives because Mother right donated him a kidney. Wednesday september 21, 1977 outcome but the rest of the family May be frightened or even resist. I had Faith in the doctors that they would take care of me said mrs. Field who works As a teacher s Aid. Buther husband William who is a court attendant was anxious she was going to jeopardize herself he said. He imagined losing both his wife and his son. As for what motivates donors or. Fellner the Seattle psychiatrist thinks that most act not out of compassion or altruism but essentially for them selves from an inner imperative to do what is needed so they can face themselves. One typical donor a woman of 60, told him people say to me what a Brave thing to do i say there was no bravery connected. It was just a thing i had to do with most psychiatrists Levy and Steinberg the Brooklyn Center psychiatrists believe that altruism is surface thing and that probing beneath it discloses the real goal of All kinds of giving to satisfy certain conscious or unconscious psychological needs. Sometimes the Black sheep of a family seeks to expiate is guilt and through kidney donation re enter the family fold. Very often a donor Hopes his gift will bring him emotional closeness or More surprisingly that twill help him maintain a psychological distance that he finds comfortable. Steinberg interviewed a sister whose Wistful Hope was that she might mend a broken family by giving her younger brother a kidney. Hell be like Myson she told the psychiatrist. Another donor who thought of herself As unlikely to marry told Levy if my sister has children they la be half  in a quite different vein a Mother who Felt Little love for her son and lived in a Distant state had to move to help look after him As his kidney disease worsened. One of he reasons for giving him a kidney Steinberg came to understand in interviewing her was to restore her son to health so that she could move away from him once  of warmth Between donor and recipient is not particularly rare. Levy cites a woman who donated to he sister the family favorite of whom she was jealous. Now the donor said Shell become like me thatis she would no longer be preferred. Her remark reflects the common unconscious fantasy that transplantation conveys not just an Organ but something of the donor s personality. The two downstate medical Center psychiatrists Tell Ofa family who talked one sister into accepting a kidney from another sister who was alienated from the  Hope was to bring the relatives together. The sick woman agreed but reluctantly believing that her sister would make her pay for the gift in one Way or another. On the other hand the alienated sister told the psychiatrists after i give her the damned kidney i never want to seeker  they hated each other Levy said. He and Stein Berg predicted correctly that the transplanted kidney would not function Long. Indeed they speculate that a kidney graft is most Likely to be Success Ful if the fantasies of donor and recipient  to that theory the transplant Between the two Sisters might have worked if both had believed that the operation would reconcile them. Though the two psychiatrists recognize that there Are Many physical causes of rejection they think it possible that psychiatric screening and counselling of donors May prevent some cases of rejection that Trace at least in Pareto psychological factors. When a kidney graft does fail donors occasionally react with anger. The rejection of the Organ May be perceived perhaps correctly As a rejection of the donor himself Levy said. When the graft takes the recipient May feel too grate Ful perhaps hesitating to complain if the donor does things that annoy him. The donor May feel consciously or unconsciously that he deserves a special kind of inti Macy with the recipient or that he has a right to dictate about the recipient s life and habits. 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