The authors have reviewed the literature with a view to trying to establish the psychiatric disorders associated with organ transplantation and open up a discussion of the psychodynamics involved. Psychiatric complications fall roughly into 4 categories, namely those specific to the 3 stages of transplantation, i.e. whether the patient is awaiting a transplant, has recently received a transplant or is in the post-transplantation stage, and those associated with the underlying psychopathology of long-term illness.