Professional Documents
Culture Documents
Exchanging Spare Parts or Becoming A New PersonPeopl E's
Exchanging Spare Parts or Becoming A New PersonPeopl E's
Abstract
The present study explored the publics feelings and ideas about receiving organs, and how this inuenced their
attitudes toward accepting a transplant themselves. Also the willingness to donate was examined in order to provide a
complementary perspective. The main aim was to identify consistent attitude patterns that would include attitudes
toward both receiving and donating organs and the motives behind this. Sixty-nine individuals with varying sociodemographic background, selected from samples who had responded to a questionnaire on receiving and donating
organs and tissues, were interviewed in-depth. The approach to analyse the interviews was hermeneutic. Seven typical
attitude patterns emerged. By an attitude pattern was meant a specic set of attitudes and motives, that formed a
consistent picture that was logical and psychologically meaningful.
In the discussion, two dierent conceptions of the body were focused. One of them meant that the body was easily
objectied and conceived as machine-like, and did not represent the self. This machine model paved the way for the
understanding that body parts needed to be replaced by spare parts. The other conception meant that a new organ
would transfer the donors qualities, i.e. inuence the identity of the recipient with regard to behaviour, appearance, and
personality. This belief may be explained by analogy thinking based on our everday experience of how mixed entities
take on the qualities of all components. Another explanation would be a kind of magical thinking and the law of
contagion, which is often connected to oral incorporation. The consequences of these conceptions when patients are
confronted with the factual situation of a transplantation, were discussed. # 2001 Elsevier Science Ltd. All rights
reserved.
Keywords: Transplantation; Xenotransplantation; Public attitudes; Organ donation; Body
Introduction
Transplantation surgery has been successful in
prolonging life for people with life-threatening diseases,
and new caders of recipients are continuously included
in the projects. However, the expansion of the activity is
hampered by the lack of donors (i.e people who have
developed a state of brain death during respirator
treatment, who are medically suited to become donors,
and who have themselves or via relatives agreed on/not
*Tel.: +46 18 66 35 64; fax: +46 18 50 64 04.
E-mail address: margareta.sanner@socmed.uu.se (M.A.
Sanner).
0277-9536/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 7 7 - 9 5 3 6 ( 0 0 ) 0 0 2 5 8 - 6
1492
Method
Sample
The rst step was a survey of representative samples
of the public, registered bone-marrow donors, and blood
donors. The mailed questionnaires included items about
receiving and donating organs and tissues. The questionnaire to the public also included a special question
about receiving organs of dierent origins (viz. from a
deceased, a close relative, an animal, and articial
organs). Departing from these three surveys it was
possible to invite respondents with varying sociodemographic background to in-depth interviews. The
participants of the interviews were selected also to
represent varying willingness to receive and donate
organs. Also people with varying readiness to receive
organs of dierent origins (a relative, a deceased, an
animal, and articial organs) were invited. In these ways
the interviewees formed a strategic, or purposive, sample
(Patton, 1990).
The design of the study is displayed in Table 1.
Thirty-one registered bone-marrow donors, 17 blood
donors and 21 individuals from the general public
participated in the interviews. Eight persons who were
invited to the interviews did not participate for dierent
reasons. They were replaced by other persons with
similar characteristics with regard to sociodemographic
background and willingness to receive and donate
organs. In Table 2, the 69 participants are presented
together with the characteristics that made them t in
this strategic sample. As can be seen, the number of
individuals that were negative to receive organs was
small, which reects the fact that people in general
would accept at least one kind of transplants if their life
is at stake (Sanner, 1998).
The interview
Conceptions of receiving and donating body parts are
rather dicult to access, dealing with partly subconscious beliefs, not yet completely articulated by most
people. Therefore, the interview method was very open
and the questions were not structured in advance. The
interviewers had the ambition not to take anything for
granted and to be as naive as possible. A non-
1493
The public
Registered bone-marrow donors
Blood donors
1500 persons
460 persons
800 persons
21 persons
31 persons
17 persons
Table 2
Background charateristics and attitudes toward organ donation and reception of the informants (according to statements in the
questionnaires)
The public
Blood donors
BM-donors
Total
Age
1829 yr
3059 yr
6069 yr
4
11
6
3
12
2
11
20
0
18
43
8
26
62
12
Sex
Men
Women
10
11
9
8
18
13
37
32
54
46
Education
510 yr
1012 yr
>12 yr
3
8
10
2
1
14
7
7
17
12
16
41
17
23
60
10
3
4
24
7
0
44
21
4
64
30
6
13
2
2
25
0
6
53
5
11
77
7
16
In the questionnaire to the public was included also an item on attitudes toward receiving organs of dierent origins. Tweleve of the
informants accepted an organ from a relative, eight an organ from a deceased, four an organ from an animal, nine an articial organ,
and four all kind of organs.
1494
Results
Seven typical attitude patterns
The attitude patterns were based on the informants
statements in the interviews. As was seen from Table 2,
11 persons were undecided toward receiving organs and
four were undecided toward donating according to
statements in the questionnaires. During the interviews
it turned out that most of these persons arrived at a
denite opinion, which mostly was negative. It was
evident that these interviewees had hidden negative
attitudes, i.e. were people who found it more socially
acceptable to indicate that they could not take a stand
instead of stating a denite no. Also, the 11 informants
who had reservations against one or more kinds of
organs changed their minds when they had reected
more closely on the alternatives; i.e. they accepted one or
two more or all kinds of organs.
In the following presentation, citations from the
interviews illustrate the descriptions in order to give
the reader a sense of the quality of the statements.
Willingness both to receive and to give: One of the
attitude patterns was characterized by the perspective of
the body as a machine where the parts could be easily
exchanged. The main worry was about the function: An
1495
1496
Discussion
Methodological issues
The informants were selected in order to maximize the
variation of feelings and ideas. Also, the interviews
displayed a great number of dierent reactions to
transplantation. We can assume that all these reactions
can be found in people in general, even if we cannot state
that they are conclusive. Most of the informants were
Scandinavian; a few came from other Western countries.
It is possible that other samples of people would yield
still other attitude patterns besides those described here.
Also the sampling does not indicate how the various
attitude patterns are distributed in the population. This
was not the aim of the study, however.
The interviews have been conducted by two interviewers who regularly listened two each others tape
records and checked their work with each other. The
prerequisites of the interview are important, as they
ultimately determine the reliability and validity of data
(Kirk & Miller, 1990). The analysis of the interviews was
accomplished by a single person, the author, who also
conducted most of the interviews. This means that there
is a risk that certain phenomena have not been
discovered and that others have been exaggerated.
Two dierent conceptions
In this section I would like to discuss the two radically
dierent conceptions of the body that were revealed in
some of the attitude patterns, the body-as-machine and
the inuenced body. In the nal passages the consequences of this in health care will be focused.
The body-as-machine: The rst conception was held by
those who easily objectied their bodies and conceived
of them as machine-like, not expressing their personal
identity or self. In this context some words must be said
about the inevitable dualism of body perspectives } the
phenomenon of both having and being a body. Toombs
excellently describes the shifting of perspectives in her
book The meaning of illness (Thoombs, 1993). If
focus is on the lived body, i.e. the body experienced at
the pre-reective level in a non-objective way, we are our
bodies, and there is no separation between body and
self. On the other hand, if we focus on the objective or
physiological body, i.e. the body apprehended at the
reective level as a material object among others within
the world, then we denitely have or possess a body.
However, we explicitly recognize these bodies as our
bodies. Still, we apprehend the body as Other-thanme. The act of reection is needed to make the body
stand out as body, i.e. to turn our lived bodies into
objects for us as subjects.
1497
eects on behaviour, appearance, and personality sometimes do occur. These factors represent a kind of
analogy thinking which constitute a fundamental
pattern of everyday reasoning and is a rational way of
thinking even if the analogies sometimes prove to be
false. Implicitly this way of thinking means that the
body parts are conceived as segments of the whole and
also express the being in its totality.
An alternative or additional explanatory factor would
be a kind of magical thinking. (Magic presupposes that
an object or a person can be inuenced by supernatural
forces, not only by natural laws.) Magical patterns of
thought are common even in our high-tech Western
world where it exists more or less beneath the surface of
our scientic thinking. Superstition is one example.
People are often not aware of it, and it may even
contrast with their explicit beliefs but it nonetheless
inuences them (Nemero & Rozin, 1989). It can be
compared to the Freudian concept of primary process
thinking.
In the context of organ transplantation, which is a
concrete form of incorporation, the association to food
(oral incorporation) and ingestion is near at hand. Belief
in You are what you eat, in the sense of acquiring the
attributes of ingested foods, is not unusual. This has the
same intuitive appeal as in the analogy thinking
discussed above. However, it might also be an example
of sympathetic magic and the law of contagion (Rozin,
Millman, & Nemero, 1986). This law states that things
that have been in contact with each other or have
belonged together may inuence each other through
transfer of some of their properties via an essence. Such
a contamination remains after the physical contact has
ceased and may be permanent. The rule is once in
contact, always in contact. You are what you eat can
be considered as a derivative of the law of contagion. It
is easy to understand that to receive an organ from
another person or an animal may evoke the same ideas
and feelings. Some of the informants associated to
cannibalism when thinking of receiving human organs,
while others expressed disgust at receiving animal
organs, which are obvious associations to oral incorporation. Also in this magical thinking the body parts
are conceived as representatives of the whole. With
regard to animal organs there are (beside rational
deliberations on compatibility, infections, and function)
also the ancient human concern of distinguishing oneself
from other animals. When accepting an animal organ as
a transplant this challenges ones humanity.
Consequences for the encounter between health care
personnel and transplantation candidates
Certainly, it should be easier to accept a transplant of
any kind for those who embrace the idea of the body as
a machine with interchangeable parts, than for those
1498
Acknowledgements
This study was funded by the Swedish Council for
Social Research and the Vardalstiftelsen.
References
Basch, S. H. (1973). The intrapsychic integration of a new
organ. Psychoanalytic Quarterly, 42, 364384.
Belk, R. W. (1990). Me and thee versus mine and thine: How
perceptions of the body inuence organ donation and
transplantation. In J. Shanteau, A. Jackson, & R. Harris,
Organ donation and transplantation: Psychological and
behavioral factors (pp. 139149). New York: American
Psychological Association.
Callender, C. O., Bayton, J. A., Yeager, C., & Clark, J. E.
(1982). Attitudes among blacks toward donating kidneys for
transplantation: A pilot project. Journal of the National
Medical Association, 74, 807809.
Evers, S., Farewell, V. T., & Halloran,, P. F. (1988). Public
awareness of organ donation. Canadian Medical Association
Journal, 138, 237239.
Featherstone, M. (1982). The body in consumer culture.
Theory, Culture, and Society, 1, 1833.
Featherstone, M., & Turner, B. S. (1995). Body and society: An
introduction. Body and Society, 1, 112.
Gallup (196898). The US publics attitudes toward organ
transplant/organ donation. Princeton: The Gallup Organization Inc.
Gallup/Partnership for Organ Donation (1993). The American
publics attitudes toward organ donation and transplantation.
Boston, MA:The Gallup Organization.
Guba, E. G. (1978). Toward a methodology of naturalistic
inquiry in educational evaluation. CSE Monograph series in
evaluation, Vol. 8. Los Angeles.
Helman, C. G. ( 1994). Culture, health and illness. (pp 236).
Oxford: Butterworth & Heinemann.
Kirk, J., Miller, M. L. (1990). Reliability and validity in
Qualitative Research. London: Sage.
Kvale, S. (1996). Interviews. London: Sage.
1499