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Living Donors and PTSD

Many people believe post-traumatic stress disorder (or Acute Stress Disorder) to be an affliction that affects only returning veterans or sexual assault victims. In truth, PTSD can develop after exposure to any traumatic event, including violent personal assaults (ex: domestic violence, mugging), natural or human caused disasters (earthquake, airplane crash), accidents, or even the unexpected death of a loved one.

 

The Difference Between Acute Stress Disorder (ASD) and PTSD: (150-152)

ASD symptoms last a minimum of two days and last a maximum of four weeks. 

ASD symptoms must be diagnosed within one month of the inciting event.

ASD symptoms are primarily dissociative(151):

  • numbing, detachment or absence of emotional responsiveness

  • reduction of awareness aka "being in a haze"

  • derealization - the world is perceived as being unreal

  • depersonalization - one's body is perceived as unreal, changing or dissolving

  • dissociative amnesia (ability to recall important aspects of the trauma)

 

Symptoms of PTSD:

  • Re-experiencing symptoms in the form of flashbacks, bad dreams, and frightening thoughts that interfere with a person's daily functioning.

  • Avoiding places, events or objects that are reminders of the experience.

  • Feeling emotionally numb, especially with people they were once close to.(148)

  • Experiencing strong guilt, depression or worry.

  • Losing interest in activities previously enjoyable.

  • Difficulty remembering a dangerous event.

  • Being easily startled.

  • Feeling tense or 'on edge'.

  • Difficulty sleeping.

  • Angry outbursts.

 

According to the AADA, symptoms must last at least one month following a traumatic event, and according to the DSM-IV, symptoms must cause significant life impairment. Some people don't develop symptoms until weeks or months after the event.

PTSD often occurs in conjunction with depression, anxiety disorders and substance abuse disorders. 

There is some thought that PTSD is the result of an altered fight or flight' response. Those afflicted may feel stressed or frightened even when there is no danger.(148)

 

How these symptoms can manifest for the living donor:

  • Avoidance of anecdotes, articles and news stories regarding living donor transplantation.

  • Avoidance or antipathy toward the recipient.

  • Dreams might include being physically maimed or deformed as a result of surgery.

  • Reluctance or refusal to talk about organ transplantation and/or living donation, whether personal experience or in general.

  • Depression or anxiety regarding the loss of the donor's 'whole' body, and the possibility of long-term health issues as a result of the donation.

  • Guilt about the recipient's health, especially if the graft fails, the recipient dies or does not regain some measure of health following the transplant. 

  • Guilt for feelings of resentment toward the recipient or other loved ones for feeling pressured to donate.

  • Panic, fear and overwhelming anxiety regarding the possibility of undergoing another surgery, no matter how minimal.

  • Anger toward the transplant center, recipient, family or others for feelings of abandonment.

  • Isolation from others; fear of being rejected by others.

  • Anger and rage upon hearing similar stories of injustice or betrayal.

  • Distrust and fear of doctors, medical personnel and the medical profession.

 

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Civilian (non-military) women have been noted to be at higher risk for PTSD, but studies are unsure if this is due to women's greater willingness to report symptoms, or greater exposure to childhood trauma (149).

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The symptoms of PTSD can be worsened by what is referred to as "Secondary Wounding", wherein the people (friends, family, recipient, physicians, social workers, etc) or institutions (transplant center, OPTN, UNOS, state medical board, legal system etc) who are supposed to protect and support fail to do so and worse, blame the living donor for her/his situation.

"This complication isn't related to the donation."

"You're just looking for attention."

"Stop feeling sorry for yourself."

"Why can't you let it go?" or "Why can't you get over it?"

 

The diagnosis of PTSD can only be made by a professional with experience and training in recognizing PTSD.

Treatment of PTSD includes (148, 153):

  • Information about trauma and its effects

  • Relaxation and anger management techniques

  • Healthy sleep, eating and exercise habits, which help reduce anxiety and alleviate depression

  • Identify and cope with feelings of guilt and shame. Some living donors feel responsible for aspects out of their control, such as their recipient's death or failure to thrive.

  • Controlled (under the supervision of a professional) exposure to the event as a way to recognize and control fear. This could include creative visualization or journaling.

  • Group Therapy or Support Group

 

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Last Updated: January 12, 2012