CASE STUDY Posttraumatic Stress Disorder (PTSD) after Heart Transplant: The Influence of Earlier Loss Experiences on Posttransplant Flashbacks* LUTZ GOTZMANN, M.D.** ULRICH SCHNYDER, M.D.*** The incidence of posttraumatic stress disorder (PTSD) after heart transplant is about 17%, mak ing it an important psychosocial complication. This case study discusses the relationship between early traumatizing experiences loss and the lead symptoms of PTSD (e.g., flashback s, nightmares). It is demonstrated how the encoding of a traumatic experience into existing representations leads not only to a reactivation of an earlier trauma, but may constitute a protective function in the processing of a PTSD. INTRODUCTION The way in which an organ transplant is experienced and dealt with depends considerably upon the recipient's individual psychic disposition, life history, and quality of relationships (1-3). The relationship with the organ donor has a special and unique quality that is capable of influencing the psychic state of the recipient. But the ideas that the patient may have concerning the transplanted organ may also be conceived as a symbolic representation of the donor. These psychic occurrences are frequently independent of whether the donor is real [as with a living donor], or imaginary [as with the donation from a dead person] (2). They depend on the introjection and projection mechanisms that shape the relationship of ^Supported by the Swiss Science Foundation (Project number 4046-05661). * * Head Physician, Dept. of Psychosocial Medicine, University Hospital Zurich. Mailing address: Department of Psychosocial Medicine, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland, E -mail lutz.goetzmann@ psy.usz.ch ***Professor, Head of Psychiatric Department, University Hospital Zurich. AMERICAN JOURNAL OF PSYCHOTHERAPY, Vol. 56, No. 4, 2002 562