Since there are considerable differences in organ transplantation from country to country, we touched on the basic differences in organ transplant medicine between the USA and Japan and have provided a discussion on the issues surrounding living-related transplant psychiatry in Japan. In spite of completely successful living-related organ transplantation, six subjects (four recipients and two donors) exhibited psychiatric disorder in a paradoxical form. Although the five subjects had strong conflicts related to the transplanted organ, they could not verbalize their inner feelings before transplant. We discussed paradoxical psychiatric symptoms after transplant. We also demonstrated a psychological trial using the integrated HTP (house-tree-person) drawing test before transplant.