Fantasized Recipient-Donor Relationships Following Lung Transplantations: A Qualitative Case Analysis Based on Patient Narratives

By Neukom, Marius; Corti, Valentina et al. | International Journal of Psychoanalysis, February 2012 | Go to article overview

Fantasized Recipient-Donor Relationships Following Lung Transplantations: A Qualitative Case Analysis Based on Patient Narratives


Neukom, Marius, Corti, Valentina, Boothe, Brigitte, Boehler, Annette, Goetzmann, Lutz, International Journal of Psychoanalysis


The present study examines the relationships between lung transplant recipients and their unknown, deceased donors. Out of 20 semi-structured interviews, eight narratives, by three female and three male recipients respectively, were identified in which the figure of the donor played a role. These narratives were examined using JAKOB, a qualitative research tool that analyses relational configurations and diagnoses psychodynamic conflicts. Analysis revealed a broad range of varying themes and relationships with equally varying wish and fear themes. All the narrators dealt either explicitly or implicitly with whether and how they are connected to their donors. In five narratives, specific personality traits were attributed to the figure of the donor; in four narratives, latent feelings of guilt concerning the donor's death were expressed. Indeed, the figure of the donor was not always perceived as an independent person, separate from the narrator's self: in two cases, the donor appears as part of the recipient's self, while in another case, the donor is presented as a transitional object for the recipient. The findings of the narrative analysis are discussed within a theoretical model of psychical organ integration.

Keywords: fantasy formation, lung transplantation, narrative analysis, organ integration, recipient-donor relationship

Introduction

In contemporary medical practice, lung transplantation is a successful form of therapy for patients with terminal lung disease. The chances of survival one year after transplantation are ca. 80-85%, compared to ca. 65-70% three years later (ISHLT, 2008). Notwithstanding notable technical advances, many unanswered questions and difficulties remain, in particular in the area of psychosocial functioning, Thus, how the transplantation is psychodynamically processed has been studied relatively little; not uncommonly, non-compliance on the part of the organ recipient is a serious, clinical problem (Fine et al., 2009). Psychologically, transplantation constitutes an invasion into the self- and body images of the recipient. Under certain circumstances, exchanging one's own, diseased organ for a foreign, functioning one can threaten the integrity and unity of the recipient's selfand body images. Recipients are not only confronted with the physiological integration of the new organ, but must also successfully integrate it psychically as well. Additionally, in the case of postmortem donations - as is the case in lung transplantations - the implanted organ comes from a recently deceased donor, who remains anonymous under applicable law (such as in Switzerland and Germany). The fates of donor and recipient are intertwined through the life-giving organ; in stark contrast, however, the deceased donor and his or her relatives remain completely unknown. Organ transplantation thus induces a complex relationship between recipient and anonymous donor, in which the latter becomes immensely important to the life of the recipient: "The deceased and unknown person of the donor opens the way for an intense embellishment of fantasies, which are marked by active self and object representations" (Kirsch et al., 2003, p. 28).

Based on 20 semi-structured patient interviews following lung transplantation, the following narrative analysis contributes to an understanding of how organ recipients overcome the partly physical and partly psychic abrogation of boundaries between themselves and their donors. A total of eight patient narratives were investigated using the JAKOB narrative analysis (Boothe et al., 2002, 2010). This procedure allows for the qualitative analysis of narratives dealing with the relationship between organ recipient and donor from a psychodynamic perspective. This procedure, which is both systematic and directed toward a psychodynamic understanding of verbal analysis of narratives, enables a systematic exploration of the imaginative processes of lung recipients hitherto not presented in such detail. …

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