The gift of life metaphor is pervasive in discourses related to the donation of body tissues. Despite the ubiquitous nature of the metaphor, it has been absent in key contexts and issues that occur post-transplant, such as high instances of non-adherent (NA) behavior expressed by renal transplant recipients. The underrepresentation of issues such as NA in the extant literature has been acknowledged by researchers. This paper investigates the gift of life discourse through the lens of NA among renal transplant recipients, focusing on the central question: How does the gift of life discourse in live donation awareness and education influence nonadherent behavior among renal transplant recipients?
Using critical discourse analysis, this paper assesses a breadth of publicly available living donor awareness and education texts, including donor and recipient testimonial videos, images/other written texts (e.g., transplant process guides, live donor outreach letter templates, posters, etc.) circulated from institutions and figures of authority in the Canadian healthcare system. Texts were selected based on content containing symbolism and meanings associated with the gift of life metaphor, and where live kidney donation information was included. The data were analyzed for content line-by-line, ideas and concepts were hand-coded iteratively with emerging concepts classified along themes of morality, giving, receiving, and reciprocating.
The gift of life, synonymous with altruistic morality, was shown to dialogically enable donors and recipients in their respective obligations to give and to receive. However, the language of the gift of life is noticeably absent when it comes to repaying; thus, diminishing the duty of recipients to care for their donated organ and potentially influencing patient NA behaviors. This fissure in the gift of life rhetoric offers a fresh perspective that may provide insight into why issues of medication NA is plaguing the transplant community. Positing the gift of life metaphor into notions of reciprocity found in live kidney donation education and awareness texts move towards balancing the moral asymmetry across giving and receiving, and repaying, that is conjured within transplant discourse.
This study provides a nuanced understanding of the gift of life discourse within the context of live kidney donation. The ways in which the donor and recipient are discursively positioned within live kidney transplant texts serve to simultaneously magnify and undermine notions of reciprocity. Further, the symbolic meanings associated with the gift of life are replaced by biomedical language in the post-transplant context (i.e. when the giving and receiving have been completed), leaving the recipient constrained when reconciling conflicting feelings of guilt and gratitude around the impulse to repay by avoiding NA behaviors. This observation provides a possible explanation for the high instances of NA among renal transplant recipients.