Despite advances in bone marrow transplant technology, major psychological stresses remain. Donor selection has become psychologically more complex with the option of seeking an unrelated donor. Family dislocation continues to be necessary for many families despite the proliferation of transplant centers. The range of choices between treatment options, level of room sterility, and the like can leave families open to guilt about their choices. Unpredictability of the transplant course, difficulty for patients in assessing the seriousness of symptoms, and the need to rely on a changing roster of teaching hospital physicians contribute to patient anxiety. Contrary to patient expectations, post-discharge recovery is often longer and more complicated, physically and psychologically, than expected. Follow-up studies on BMT patients show that a majority have a return to a satisfactory level of activity, although some physical symptoms may remain. Behavioral symptoms did increase, with estimates ranging from 15-35 percent of the survivors showing symptoms a year or more post-transplant. Staff impact is briefly addressed. The need for more research on psychosocial follow-up is stressed.