Family Dynamics & Kidney Transplant

Chronic disease affects not only our bodies, but our family dynamics as well. This is particularly true with respect to kidney transplant because transplant often follows a long and arduous period of chronic kidney disease, during which the patient's physical function has been subtly and not so subtly impaired. This experience places an increasing burden on family members whose hopes vacillate with fears as they take on an increasing caregiver burden.

Children

• If the transplanted patient is a child, it is not uncommon for parents to polarize. One parent (usually the mother) may become the primary caregiver, while the other parent (usually the father) acts as if the disease never occurred. This dynamic is painful for the couple and may serve to drive them apart, as the caregiver never feels truly supported. Just as it can be very helpful for the caregiver parent to realize that the other parent does have the child's needs in mind, bridges can be created if the non-caregiver takes over all patient care for a day. Lists may have to be made to bring the non-caregiver up to speed regarding the patient's needs.

Marital Stress

• Chronic disease can cause financial and emotional issues in a marriage, particularly in the later stages of renal disease. Resentment may arise if the non-chronically ill spouse does not have sufficient support.

  If one spouse felt tied to the relationship because of the illness, they may believe that their "tour of duty" is officially over once the patient has recovered from the transplant. This existence of this dynamic usually suggests the presence of larger issues in the marriage than renal disease.

Family donors

• A different set of issues arises if the patient received transplanted kidney from a family member. A study from the University of Minnesota Medical School examined the family dynamics when a family member was an organ donor. The study showed that "donors have a higher quality of life than the general population, confirming they have an increased self-worth and positive self-esteem." The study reports that "an overwhelming 96 percent would donate again." Donation was more stressful if there were complications or if the donor was female. The familial stress associated with poor post-operative results has been repeatedly noted. This is why hospitals screen for mental stability among prospective donors.

Family Hierarchy

• A fascinating study was done at Hospital Infantil de México, which examined changing post-transplant dynamics in which a family member was the kidney donor. This study found "after the renal transplant there was a close association between the donor and the recipient that led to the creation of an alliance or the reinforcement of an alliance already present before the transplant." This close association had the effect of improving or disrupted the overall family dynamic, depending upon where the donor ranked in the the family hierarchy. It should be noted that this study involved a small number of research subjects; therefore further study is necessary.

Contemporary Approaches

• Greater awareness of the effect of kidney transplant on family dynamics has begun to shape treatment perspectives. More hospitals, including the transplant center associated with the University of Southern California, are factoring in the role of family into treatment plans.