With case examples and step-by-step frameworks for intervention, the authors illustrate the challenges and solutions in establishing an effective ward-based psychotherapy service for renal dialysis and transplant patients. They describe clinical patterns of presentation and how psychotherapeutic intervention was refined over time in a clinically meaningful and evidence-based manner. Each chapter is focused on specific emotional disorders among renal patients.The authors introduce the concept of loss of an imagined past' (aspirations and ambitions) never realized, or compromised, as a result of renal disease and as a major cause of post-transplant depression. Emotional issues which have received little prior attention in the literature-including substance abuse, eating disorders, gender disorders and emotional body image-are addressed in depth. Practical advise, including that against referencing the transplanted organ as a gift, is offered.