The Obligation to Say ‘Thank you’: Heart Transplant Recipients’ Experience of Writing to the Donor Family
American Journal of Transplantation
J. M. Poole1, M. Shildrick2, E. De Luca3, S. E. Abbey4, O. E. Mauthner3, P. D. McKeever5, H. J. Ross6,* Article first published online: 22 FEB 2011
DOI: 10.1111/j.1600-6143.2010.03419.x
Abstract
Transplant recipients are encouraged to write anonymous thank-you letters to the donor family. We prospectively explored heart transplant recipients’ embodied responses to the ‘obligation’ to write a thank-you letter using audio/video-taped open-ended interviews (N = 27). Fifteen of the 19 participants, who wrote letters to the donor family, expressed or visually revealed significant distress about issues such as the obligation to write anonymously and the inadequacy of the ‘thank-you’. Writing the thank-you letter is not a neutral experience for heart transplant recipients. Rethinking the obligatory practice regarding the thank-you letter and developing the necessary support for the recipient through this process is necessary.
Introduction
Clinical practice encourages heart transplant recipients to write a thank-you letter to the donor family. Canadian, US and UK national policies dictate that such letters are written anonymously (1) and to ensure compliance, bureaucratic structures are in place to both facilitate and vet any exchange of correspondence between donor family and recipient. Marcel Mauss suggested that the act of giving a gift is governed by the obligation to give, the obligation to receive and the obligation to repay (2). The notion of gifting was later applied to organ transplantation (3â€"5). More recently, authors have begun to examine the correspondence penned by recipients and donor families (6â€"9). Rare however, is the theoretical analysis of the ‘obligation to say thank you’.
Our transplant manual dedicates only one page to the issue of the thank-you letter, briefly acknowledging that writing the letter may be difficult for recipients. The Heart Transplant Coordinator vets the content of all letters removing identifying details and then forwards them on to the organ procurement agency. The Coordinator also ‘reminds’ recipients who have neglected to write, and while no moral obligation is explicitly spelled out in the manual, the implication is that the letter is a ‘mile post’ that should be passed.
We previously reported a high prevalence of distress and disruption related to bodily integrity and identity in heart transplant recipients (10). The aim of this paper was to prospectively explore how heart transplant recipients perceive, express and embody the experience of writing a thank-you letter to the donor family.
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{Register to be an organ,eye and tissue donor. To learn how, www.donatelife.net or www.organdonor.gov}
J. M. Poole1, M. Shildrick2, E. De Luca3, S. E. Abbey4, O. E. Mauthner3, P. D. McKeever5, H. J. Ross6,* Article first published online: 22 FEB 2011
DOI: 10.1111/j.1600-6143.2010.03419.x
Abstract
Transplant recipients are encouraged to write anonymous thank-you letters to the donor family. We prospectively explored heart transplant recipients’ embodied responses to the ‘obligation’ to write a thank-you letter using audio/video-taped open-ended interviews (N = 27). Fifteen of the 19 participants, who wrote letters to the donor family, expressed or visually revealed significant distress about issues such as the obligation to write anonymously and the inadequacy of the ‘thank-you’. Writing the thank-you letter is not a neutral experience for heart transplant recipients. Rethinking the obligatory practice regarding the thank-you letter and developing the necessary support for the recipient through this process is necessary.
Introduction
Clinical practice encourages heart transplant recipients to write a thank-you letter to the donor family. Canadian, US and UK national policies dictate that such letters are written anonymously (1) and to ensure compliance, bureaucratic structures are in place to both facilitate and vet any exchange of correspondence between donor family and recipient. Marcel Mauss suggested that the act of giving a gift is governed by the obligation to give, the obligation to receive and the obligation to repay (2). The notion of gifting was later applied to organ transplantation (3â€"5). More recently, authors have begun to examine the correspondence penned by recipients and donor families (6â€"9). Rare however, is the theoretical analysis of the ‘obligation to say thank you’.
Our transplant manual dedicates only one page to the issue of the thank-you letter, briefly acknowledging that writing the letter may be difficult for recipients. The Heart Transplant Coordinator vets the content of all letters removing identifying details and then forwards them on to the organ procurement agency. The Coordinator also ‘reminds’ recipients who have neglected to write, and while no moral obligation is explicitly spelled out in the manual, the implication is that the letter is a ‘mile post’ that should be passed.
We previously reported a high prevalence of distress and disruption related to bodily integrity and identity in heart transplant recipients (10). The aim of this paper was to prospectively explore how heart transplant recipients perceive, express and embody the experience of writing a thank-you letter to the donor family.
Continue reading
{Register to be an organ,eye and tissue donor. To learn how, www.donatelife.net or www.organdonor.gov}
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