Organ donation: blessing or burden, gift of life or sacrifice?

The ‘gift of life’ is a popular discourse associated with pro-donation and transplant activists, its use seemingly directed at heightening public awareness about the perceived benefits of organ donation. However such rhetoric does not reflect the depth and complexity of families’ decision-making process. A decision to facilitate the removal of organs from the deceased body, through post mortem surgical intervention, may be better represented as a ‘sacrifice’; a discourse that acknowledges the difficulties encountered by bereaved families in their decision-making about organ donation. To gain insights into the relevance of ‘gift of life’ or ‘sacrifice’ as discourses that inform families’ decision making about donation data from four studies carried out between 1996-2006 were interrogated for evidence of families’ literal, symbolic or metaphorical representations of ‘gift of life’ or ‘sacrifice’ in describing their experiences of donation. This presentation examines the relative value of these two discourses and whether they further our understanding of families’ motivation and decision-making about organ donation. Issues that may provide insights that could potentially contribute to enhancing families’ satisfaction with their decisions, improving support to families and increasing the incidence of donation. Findings indicated that whilst some families were motivated by the idea of the ‘gift of life’ others were de-motivated by deepseated concerns related to the sacrificial element of this gift giving. These concerns were revealed in explicit or metaphorical examples related to cutting, and mutilation, relevant to the cultic notion of sacrifice; examples which evidenced the nature of the hard-wrought decision-making by families. We propose that the discourse of ‘sacrifice’ and the manner in which it impinges on families’ decision-making may help to explain the high refusal rates in populations that appear generally aware of the benefits of organ transplantation