Changes in the Mental Trajectory and Relationships of Living Liver Transplant Donors
Ishoku to Kazoku – Seitai Kanishoku Donaa no Sonogo［Transplants and Family: Living Liver Donors and After［Their Transplants］
From the perspective of a nurse, I am conducting research on my twenty years of experience in dealing with living liver donors (organ providers) and their assignment of meaning from. My book, Ishoku to Kazoku – Seitai Kanishoku Donaa no Sonogo [Transplants and Family: Living Liver Donors and After [Their Transplants], was published by Iwanami Shoten in March of 2016. It does not address medical topics concerning organ provision, but is instead a study that illuminates the mental trajectory of donors and their relationships with people involved in their lives.
The analysis model used in this study involved classifying existing research on organ transplants, my own clinical experience, a previously conducted pilot study, and data collected by conducting an interview survey of seventeen donors from whom consent had been obtained and plotting them chronologically on a schema using the induction method. The analysis model (schema) used was composed of three time axes, twenty-two factors, and seventeen categories of people involved, and illustrated how these three elements, time, factors, and people involved, acted on each other in simultaneous progression.
Donors provide a part of their livers through an operation that would not normally have been necessary. It can be said that in many cases donors were motivated to become donors because the responsibility of having learned of this life-saving procedure meant they could not very well refuse to save the person in question. But donors' subtle relationships with the family and relatives close to them are also reflected in the process of taking on [becoming] a donor, and it is not uncommon for conflicts to arise. It is not as though everyone becomes a donor out of love of family.
Schema: Analysis model (relational schema of factors in donor assignment of meaning). Note: 'Local doctors” are doctors at local hospitals or clinics, 'transplant doctors' are doctors at hospital A, 'internal medicine doctors' are doctors at Hospital A.
Donors almost never talk to a third party about these kinds of complicated circumstances within their families. I requested interviews from within a patient-nurse relationship. Consent was obtained from some patients because, “I want to have the nurse hear my story because I trust her.” In this way I have pursued research based on data that could never have been obtained without a relationship of mutual trust (rapport).
There are cases in which donors attach positive meaning to organ provision as a result of the transplant being a success, with both donor and recipient returning to their normal lives and no conflict within their immediate and extended families. On the other hand, there are also cases in which a donor attaches a negative meaning to organ provision even though the transplant was a success and both participants returned to their normal lives. For example, the behavior of a husband who unilaterally decided he would be a donor for his sister without considering his wife's feelings led to friction between husband and wife and years of discord arising between not only the donor and his wife and recipient sister but also their immediate and extended family. This kind of discord in family relationships was one factor that led to organ provision being viewed negatively.
There are also cases in which the donor's reward for “risking their life” and providing an organ turns out to be the death of the recipient, and they come to have negative feelings about organ provision. And there are cases in which there is a perception of having been abandoned by healthcare providers in the final phase after transplantation and negative relationships arising between donors and healthcare providers. In the case of those who became donors knowing that the chance of success was low, on the other hand, there was also a donor who through his family's support and consideration of his feelings of doubt and anxiety managed to preserve good relationships with healthcare providers and obtain a positive feeling about organ provision even though the recipient died and he himself experienced post-surgical complications or a new illness.
Donors' assignment of meaning to organ provision are influenced by several factors: the survival or death of the recipient, changes in their relationships to other people involved, and the length of the temporal axis of the period of these changes. This book makes it clear that steps to reduce negative changes in relationships that assign negative meaning to organ provision are needed, even if the deaths of some recipients cannot be avoided, and proposes measures that can be taken to this end. My next task is to determine how insights from the data not used in this book can be utilized in practice.
