226 G. O’Brien
taken up by all liver recipients and gratitude was not a strong feature of
their narratives. Few spoke of gratitude in direct relation to their trans-
planted liver, perhaps because of the context in which liver recipients
receive their transplant. Sensitised by the social stigma surrounding liver
disease, the experience of transplantation for some liver recipients (i.e.
receiving an ‘unearned gift’, one they do not deserve) might be strongly
inflected by shame.
Exline ( 2012 ) questioned the understanding that kind acts will have
uniformly positive effects, finding that some people on the receiving
end of kindness perceive themselves to be diminished by the experience.
Exline et al. ( 2012 ) found that gratitude was more likely to be experi-
enced in response to normative acts of kindness than non-normative
(i.e. ‘amazing’) kindness. People who received ‘amazing’ kindness from
others tended to perceive the kindness as being undeserved, which was
in turn linked with reports of shame/weakness and mistrust. Shame
has been associated with intense anger, hostility and the blaming of
others for one’s plight (Tangney et al. 2007 ) and can lead to unfavour-
able evaluations of the donor and the help received (Fisher et al. 1982 ).
The narratives of many of the male liver recipients indicated that, for
them, transplantation was a highly self-threatening experience and this
elicited defensive reactions that included some negative evaluations of
their experience. Attempts were made to discursively redefine the situa-
tion, lessening the value of the help received. For example, when asked
whether he thought of his donated liver as ‘the gift-of-life’, Anthony
responded: ‘I think I was already alive before. I’ve been given an exten-
sion ... Yes, so I just see it, that I’ve been kind of let off the hook for
a while’. He referred to the gift-of-life as ‘a good selling point. Yeah, a
marketing thing’, but ‘it doesn’t cross my mind to view [my liver] like
that’.
As noted previously, gift-of-life rhetoric serves to emphasise the mag-
nitude of the donated organ. That is, it underscores the ‘amazing’ kind-
ness of the donor, and ‘amazing’ nature of the gift given and received
in transplantation. With their status as good, moral, citizens of society
already challenged through the lens of healthism, the ‘amazing’ nature
of the gift might serve to exacerbate liver recipients’ feelings of shame
and inhibit the experience of gratitude in this context. In sharp contrast