Understanding donors' motivations: a study of unrelated bone marrow donors.

Medical advances in bone marrow transplantation techniques and immunosuppressive medications have dramatically increased the number of such transplants performed each year, and consequently, the demand for bone marrow from unrelated donors. Although physiological aspects of bone marrow donation have been thoroughly investigated, very few studies have examined psychosocial factors that may impact individuals' donation decisions and outcomes. To examine one particular set of donor psychosocial issues, this study investigated motives for bone marrow donation among 343 unrelated bone marrow donors who donated through the National Marrow Donor Program. Six distinct types of donor motives were identified from open-ended questionnaire responses. Donors most frequently reported motives reflecting some awareness of both the costs (to themselves) and potential benefits (to themselves and the recipient) of donation. A desire to act in accordance with social or religious precepts, expected positive feelings about donating, empathy for the recipient, and the simple desire to help another person were also commonly cited reasons for donating. Among a series of donor background characteristics, donors' gender was the variable most strongly associated with motive type; women were most likely to cite expected positive feelings, empathy, and the desire to help someone. Central study findings indicated that donor motives predicted donors reactions to donation even after the effects of donor background characteristics (including gender) were controlled. Donors who reported exchange motives (weighing costs and benefits) and donors who reported simple (or idealized) helping motives experienced the donation as less positive in terms of higher predonation ambivalence and negative postdonation psychological reactions than did remaining donors. Donors who reported positive feeling and empathy motives had the most positive donation reactions in terms of lower ambivalence, and feeling like better persons postdonation. These finding add substantially to the body of work concerning medical volunteerism generally, and also have important practical implications for the recruitment and education of potential bone marrow donors.

Letting go: family willingness to forgo life support.

OBJECTIVE: To describe the process of family decision making about life support in the critical care setting. DESIGN: Descriptive, exploratory. SETTING: A northeastern United States university-affiliated medical intensive care unit. SAMPLE: Thirty family members of 16 critically ill patients. RESULTS: Letting go or becoming willing to forgo life support involved three interrelated and complex processes: (1) family members sought out, obtained, and tried to understand information about the critical illness; (2) they reviewed the life story of the patient, seeking meaning in the patient's life and the critical illness; and (3) they struggled to maintain family roles and relationships. For most families, interpersonal and intrapsychic work during each process created a reframing of the issues related to the critical illness: (1) they came to believe that they had done all that could be done and were able then to relinquish the goal of recovery for acceptance of a peaceful death; (2) they reviewed the patients's life, finding some meaning and a sense that, given the situation, the patient would not want to continue on life support, and then they moved toward closure; and (3) they were able to bring about (at least within a small group of the closest family members) a sense of doing the "right thing", and they were able to develop some sense that forgoing life support for the ill relative would not destroy important family relationships. For a few other families this movement toward resolution did not occur, and although family members attempted to deal with the issues of life support, their efforts were fraught with conflict and prolongation of the end-of-life period. CONCLUSIONS: Little is known about the actual experience of family members as they are involved in life-support decision making. Identification of the needs of family members to work through the decision-making experience cognitively, emotionally, and morally is essential to communicating effectively about the ill relative's condition and to providing understanding and support to families involved in life-support decision making in the critical care unit.

The self-image of unrelated bone marrow donors.

This study investigated the self-image of individuals who donate bone marrow to strangers as part of the National Marrow Donor Program. Quantitative surveys were administered to donors before donating (N = 849), shortly after donating (N = 754), and a year after donating (N = 370). In addition, 52 donors were interviewed in-depth by telephone at the same three points in time. Many of these donors felt that by donating bone marrow they were actualizing a central trait in their identity. Thus, many donors believed that they were distinct from others in the centrality of the traits of helpfulness and generosity to their identities. This belief often stemmed from a strong emphasis on helping in their families of origin. Other qualities activated by donation included religious identity, being a helping professional, and desire to be a role model. Self-evaluation appeared to have been enhanced for some donors due to the donation.

Psychosocial effects of unrelated bone marrow donation: experiences of the National Marrow Donor Program.

In this study, we investigated the psychosocial effects of unrelated marrow donation. Survey questionnaires were administered pre-donation, shortly post-donation, and 1 year post-donation to all donors through the National Marrow Donor Program over a 3-year period. Univariate, bivariate, and multivariate analyses were then performed. Donors were generally quite positive about the donation 1 year post-donation: 87% felt it was "very worthwhile" and 91% would be willing to donate again in the future. Marrow donors were more likely than kidney donors to feel better about themselves as a result of the donation (P < .001). Donors with longer collection times, in general, had less positive psychosocial outcomes from the donation. Donors who experienced lower back pain or difficulty walking as a result of the donation were more likely to experience the donation as more stressful and painful than expected, but no more likely to experience it as less positive emotionally than donors who did not experience these side effects.

When altruism fails: reactions of unrelated bone marrow donors when the recipient dies.

This article examines the responses of bone marrow donors to the death of the unrelated person to whom they donated. Data analyzed were 330 questionnaires and fifty in-depth interviews collected from donors in the National Marrow Donor Program at one year post-donation. Death of the recipient produced feelings of guilt and responsibility in the donors in only a few cases (2% of donors from questionnaire data and 2 of the 23 donors interviewed). Grief occurred often (22 of 23 donors interviewed) and was often surprisingly intense, given the fact that the recipient was a stranger. Intensity of grief varied depending on the perceived relationship with the recipient. Our data indicate that limiting contact and/or information about the recipient to the donor would be unlikely to result in more positive psychosocial outcomes. However, several strategies which might be useful in relieving donor guilt and/or grief are suggested.