Multiple Meanings of “Gift” and its Value for Organ Donation

Abstract

The "gift of life" metaphor is used to promote organ donation where commercialization is prohibited. In this article, we explore how multiple parties involved in organ transfer procedures think of gift terminology by drawing on interview data with transplantation specialists, organ transplant recipients, living directed donors and living nondirected donors. The interviews took place across New Zealand between October 2008 and May 2012, in participants' homes and hospital workplaces. The interviews were transcribed verbatim, coded manually, and thematically analyzed. Although gift language is often viewed as clear-cut, the gift trope has multiple meanings for different constituent and cultural groups, ranging from positive descriptors to obscuring and romanticizing the complexities of transplantation processes. To account for these multiple perspectives, we suggest new ethical models to capture the nuanced phenomenon of organ transfer in ways that recognize the full range of donation and reception experiences.

Rethinking elements of informed consent for living kidney donation: findings from a New Zealand study

“…This article discusses the theme of donor support in relation to the information disclosure elements of informed consent. Material about organ donation as a gift, donor motivation and decision-making, shared corporeality and identity, and resource allocation and financial support is discussed elsewhere (Shaw, 2012(Shaw, , 2014Shaw & Webb, 2014). The abbreviation 'M' or 'F' in the interview extracts cited in this article refers to 'Male' or 'Female'; 'LND' refers to living non-directed donor, 'LDD' refers to living directed donor; 'PD' refers to living donors who were part of a donor-recipient 'pair'; 'PR' refers to paired recipient; and the number immediately following the letters indicates the order in which the interviews were conducted.…”

Expanding the conceptual toolkit of organ gifting

“…For Māori, organ and tissue exchange is treated as tapu (sacred, prohibited, restricted), because it not only affects the relations between donors and recipients but the entire kin network ( whakapapa ), including ancestors, land, forests, fisheries and animals (Salmond ). Donating an organ will therefore implicate these wider relationships, the spirituality of the original giver, and associated cultural expectations around reciprocity to fulfil the gift‐exchange cycle (Shaw and Webb , Webb and Shaw ). In this relational ontology, the gift exchange extends beyond the symbolism of dyadic gift relations to incorporate temporal interconnections between individuals, groups of individuals, objects, things and the natural world.…”

“…The proposed model is both analytical and empirically oriented, drawing on research that links a series of qualitative sociological studies (Shaw , , , , Shaw and Webb , Webb and Shaw ) . These studies were informed by debates in sociology and anthropology about gift theory (for example, Berking , Komter , Mauss ) and phenomenological accounts of organ exchange (for example, Haddow , Leder ).…”

“…In all, 15 living organ donors, organ recipients and whānau (extended family), 12 of whom identified as Māori, were interviewed for a connected study by an associate investigator. As this article provides an overview of the data, details about study methods are documented elsewhere (Shaw , , , Shaw and Webb ).…”

“…Empirical studies show that people think about organ donation in multiple, complex and contradictory ways (Sharp and Randhawa , Shaw and Webb ), yet the prevailing cultural discourse governing organ and tissue exchanges in the western context privileges notions of altruism and the gift. This article summarises how different constituent and cultural groups conceptualise the notion of the altruistic gift as a descriptor of organ donation, in order to better communicate the multiple meanings that people attribute to this process, before presenting an expanded, alternative ontology of organ exchange.…”