Psychological stressors exist for kidney transplant recipients and their families. These patients are faced with life and death scenarios which can bring about considerable ongoing trauma, especially when transplant complications are experienced. Continued psychiatric and psychological monitoring is important in kidney transplant patients and can increase transplant longevity and improve outcome. Variables in post transplantation that can contribute to poor outcomes for patients, include: stress associated with caring for an organ and fear of rejection; post-transplant substance relapse; new onset or exacerbated psychiatric conditions; immunosuppression noncompliance due to neuropsychiatric disorders and other intolerable side effects; economic stressors for medical care costs; and, major post-transplant family conflict and dissolutions.