Coping with transplant failure: grief vs. denial.

A major drawback to kidney transplantation as a treatment for end stage renal disease is the common occurrence of rejection and failure of the transplanted kidney. We evaluated twenty-five dialysis patients, all of whom had suffered transplant failure during a ten year period. Of these, twenty-four had good psychological readjustment to chronic dialysis. Fourteen patients successfully grieved the loss of their kidneys. Ten denied any psychological difficulty in returning to dialysis and did not manifest the usual signs of grief. We suggest that the effectiveness of denial as a coping mechanism should be recognized and supported when present; in contrast, "grievers" should be helped through the grieving process and followed up to ensure resolution and proper readjustment to dialysis.