Gift of life or sacrifice?: key discourses to understanding organ donor families' decision-making

Abstract Globally, there is a critical shortage of donor organs to meet the demands for human organ transplantation. An understanding of what motivates families to agree to donation is therefore essential to maximise organ availability. The “gift of life” is a popular discourse long associated with pro-donation and transplant activists, its use seemingly directed at heightening public awareness about the perceived benefits of organ donation. However the potential pressure and obligation implicit within such rhetoric could be detrimental to donor families. It has been suggested that the donation event is better represented as a “sacrifice” as this discourse acknowledges the suffering of the bereaved family and the possible difficulties encountered in their decision-making about organ donation. Drawing on data from three studies that explored the bereavement experiences of donor families, this paper examines the relative value of gift of life or sacrifice as discourses that contribute to a greater understanding of organ donor families' decision-making. We propose that the compelling nature 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. Insights into the relative importance of gift of life or sacrifice to families when making decisions could potentially contribute to enhancing families' satisfaction with their decisions, improve support to families and increase the incidence of donation.