The Gift of Life: Understanding Organ Donation and Gift Exchange through Literature

My training as a transplant surgeon included intensive education about the anatomy and physiology that makes transplantation feasible, but we rarely examined the act that makes transplantation possible: organ donation. Here I use literature to explore the idea of gift giving as it relates to transplantation. Although organ donation is commonly referred to as giving the “gift of life,” the metaphor of giving a gift may not completely encompass the complicated emotions, motives, and expectations involved. In Chapter 1, I present a brief history of organ transplantation and discuss how the concept of organ donation has been defined legally and administratively in the United States. Chapter 2 explores the idea of gift giving, focusing on the work of Marcel Mauss and comparing his construct with the idea of charitable gift giving. Chapter 3 is a close reading of Richard Selzer’s short story “Whither Thou Goest,” in which a widow deals with the aftermath of donating her husband’s organs. In the final chapter, I examine John Irving’s novel "The Fourth Hand" as it explores the relationship between the recipient of a hand transplant and the widow of the donor. Selzer’s story better reflects the current process of organ donation consistent with charitable gift giving, whereas Irving’s novel provides a potentially helpful alternative view of the relationship between donor and recipient. Both stories highlight the emotional complexities involved in the relationships between donor and recipient, but neither work completely conforms to Mauss’s construct of gift exchange. These stories provide a way to explore organ donation and its effects on both donor and recipient.