As psychiatrists who work with people who wish to donate their organs to others, we reflect upon the psychological underpinnings of gifting all year round. In our roles as evaluators tasked with assessing the candidacy of potential donors, the inquiries we find ourselves making of candidates include: Why does the person in front of me seek to gift a kidney to a stranger?
When a young, healthy person says she would not be able to live with herself if she did not offer one of her kidneys to her sister, but also has doubts because of the risks to her own health and her tumultuous relationship with this sister, how do we make sense of her desire to donate? During the holiday season, we also find ourselves asking questions about the act of gift giving more generally.
Some background: Living kidney donation is a relatively safe procedure. Based on a study by Segev et al., worldwide mortality rates for donors are only 0.03% — lower than that for elective C-sections; based on a systematic review and meta-analysis of available studies done by O’Keeffe et al., only a small fraction also later suffer from hypertension, pre-eclampsia, and end stage renal disease.
It may be important to note that humans require only one kidney to survive, so the loss of a second kidney is highly unlikely to affect the donor’s health. In contrast, patients awaiting kidney transplantation — of which there are nearly 100,000 in the United States — die at a rate of 4,500 annually in the United States, according to data from the Living Kidney Donor Network. That is more than 12 Americans each day, whose lives might be saved by living donors.
While the buying and selling of organs has been unlawful since the passing of the National Organ Transplant Act of 1984, the recipient’s insurance does pay for the procedure, and certain living donors are eligible for help with expenses such as travel and child care. Thus the living organ donation enterprise is essentially a gift economy. People may gift organs to loved ones and acquaintances — the most frequent practices — but also to complete strangers.
An organ is, in a sense, the perfect gift: one that is life-saving and perennially useful. Yet, in a world where everything seems to come with a price tag, many view giving a priceless gift to a stranger with considerable suspicion. Human relationships are infinitely complex. Even donating a kidney to a relative may prove disappointing: a spouse may engage in infidelity; a parent may not leave an inheritance.
Some donors have been stunned by the recipient’s subsequent indifference or lack of gratitude. While many donors look back upon their gift with great satisfaction, others experience regret, as evidenced by a study by Wirken et al. Predicting those who thrive and those who will rue their choices is not always easy or possible.
During the holiday season, gifting appears ubiquitous: “Secret Santa” swaps in school, white elephant exchanges at work, placing gifts under a tree. For those who express themselves through gift-giving, the pressure of this act is perhaps offset by the delight of anticipating the recipient’s joy. Yet some individuals may resent the financial burden and commercialization of the holiday season or the clutter that gifts often bring. Giving and receiving gifts is clearly not joyful for everyone, much as organ donation is not a choice that feels natural to all.
An expensive gift can be a gesture of generosity and affection. However, that gift can also create a sense of indebtedness, one that ultimately damages the underlying relationship or reinforces existing power dynamics. This is why the conflict of interest inherent in certain relationships is considered by psychiatrists when evaluating potential organ donors. A gift is not just about the giver and the recipient, but about the relationship between them.
At this time of year, we are reminded of an insight acquired during hundreds of donor evaluations: Helping others and expressing love takes many forms. Organ recipients benefit from the generosity of donors, but also from the altruism of caregivers and the support of relatives and friends. These gifts, too, are associated with better outcomes. Similarly, spending time with a child may prove as valuable as the latest toy or game.
What living donors teach us is that giving is most rewarding when it stems from an inner desire to give, not from external incentives or pressures. Perhaps this is wisdom worth reminding ourselves of in a season of customary gifting.
Mutalik is a transplant psychiatrist at Mount Sinai Hospital. Appel is director of ethics education and a psychiatrist at Mount Sinai. Velicu is a senior psychiatry resident at Mount Sinai with a special interest in organ transplant.
from New York Daily News https://ift.tt/oSPXnIL