9 Gift-of-life? The Psychosocial Experiences ... 217the exchange that takes place in the context of transplantation, gift-
giving entails a social contract based on three principles: the obligation
to give, to receive and to reciprocate. Following Mauss, a number of
social scientists (e.g. Fox and Swazey 2002 ; Gill and Lowes 2008 ; Sque
and Payne 1994 ) have argued that as organ donation does not involve
a monetary transaction, sociologically and psychologically, donated
organs can be thought of as gifts in the Maussian sense.
Accepting that donated organs can be understood as ‘free gifts’, what
then of the three interlocking principles (to give, to receive and to recip-
rocate) on which gift exchange is premised? Fox and Swazey ( 2002 )
suggest that although the organ donation system is founded upon the
tenets of voluntarism and altruism, the perception of organs as gifts
freely given and received is erroneous. Cultural mores suggest that if
the relevant circumstances present themselves, the (morally) correct
response for potential donors’ families is to give. Similarly, the immense
need of the potential recipient means that the person is obligated to
receive an organ if one is offered. This leaves the obligation to recip-
rocate, arguably the most problematic feature of the gift-of-life meta-
phor. Having received a ‘gift’ of inestimable value, the recipient feels
they must reciprocate in order to fulfil the terms of the social contract
into which they entered upon receiving the gift. In the case of cadav-
eric donation, the donor of the organ is no longer alive, and the debt
incurred via the receipt of the gift cannot be directly repaid. Although
some actions, such as expressing gratitude to the donor family and/or
helping others through support groups, might go some way towards
alleviating the sense of indebtedness, none of these is likely to be under-
stood as sufficient reciprocation for the priceless gift received. This may
feel onerous for the recipient and give rise to the ‘tyranny of the gift’, as
Fox and Swazey ( 2002 ) point out.
Sothern and Dickinson ( 2011 ) have likewise explored the ways
in which the obligation to reciprocate manifests in recipients’ lives,
and how this is interpreted given that transplantation does not return
recipients to a state of ‘perfect’ health, but rather represents the trad-
ing of one set of health problems (those associated with organ failure)
for another (those associated with immunosuppression). They argued
that, by virtue of organ scarcity (and therefore the value inherent in
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