The feelings of the kidney recipient towards his or her donor are complex and may affect behavior in the post-transplant period. We studied 152 DDRT recipients, using an anonymous 21-question survey that addressed feelings about their donor using a 4-point Likert scale, as well as questions about adherence. There were 49 women (33%), 88 men (58%), 104 Black (69%), 119 unemployed (79%). Mean age was 54.2±0.96, mean time on dialysis 6.3±0.28 years. 64 (42%) were US born, the rest came from the Caribbean, South and Central America, Africa and the Middle East. 57 (38%) reported that they often thought about their donor. 24% (36) felt that their feelings towards the donor affected their adherence to transplant medication (POSFEEL). POSFEEL did not differ from those who did not believe that feelings about the donor affected adherence (NEGFEEL) in age, gender, time on dialysis or employment status by t-test. POSFEEL were more likely to agree with the statements "my donor lives through me", "the feelings I have about my donor influence the way I take care of myself"," I often think about my kidney donor", "I feel that I have developed a relationship with my deceased donor that no one else understands", "I feel that my deceased donor knows me", "I sometimes think I have inherited some of my donor's characteristics", "I feel I owe something to my deceased donor" and "I sometimes feel anxious or afraid when I think about my deceased donor" (all at p<0.05 vs NEGFEEL). 92 (63%) denied ever missing transplant medication. There was no difference in reported feelings towards the donor and actual report of adherence by t-test. 57 (38%) reported being depressed sometimes or frequently. Patients who were depressed did not have different feelings towards their donor, but did report stopping immunosuppression more frequently because it made them feel worse (p<0.005). We conclude in our inner-City population: 1. Over one third of patients thought of their donors often; 2. One quarter felt that their feelings about the donor affected adherence to medication, and also felt they had a special relationship with their donor and that they owed a their donor a debt 3. Feelings of depression were related to stopping immunosuppression but not attitude toward the donor, 4. The complex relationship between appreciation, guilt and projection and that affects the donor-recipient bond and its relationship to adherence should be explored further.

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