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June 6, 1977

The Kidney or the Machine?

JAMA. 1977;237(23):2532. doi:10.1001/jama.1977.03270500084041

WHEN a person's renal function fails, he has three options: renal homotransplantation, dialysis, or to do nothing. With the last, the uremic syndrome progresses to apathy, drowsiness, anorexia, depression and mild mental confusion, and eventually psychosis. The patient becomes more irritable and less able to control his impulses. He has a greater tendency to deny that he is ill. He covers his feelings of depression, anxiety, fear, and anger, and he tends to blame others for his weakness.

The use of kidney transplantation as a treatment for renal failure is rapidly gaining in popularity, yet physicians tend to prefer dialysis. Further, once the decision for dialysis is made, the possibility of transplantation is not often reconsidered. Both are important modalities of treatment, although the psychologic problems are often considerable.

Many articles provide information about the improving survival rate of patients receiving transplants; few, however, describe the sociopsychological aspects or the