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Shadi Norouzali1 
, Bahman Bahmani2 , Manouchehr Azkhosh1 , Mohammad Saeed Khanjani1 , Kianoush Abdi1 , Katayoun Najafizadeh3 , Omid Ghobadi3
, Bahman Bahmani2 , Manouchehr Azkhosh1 , Mohammad Saeed Khanjani1 , Kianoush Abdi1 , Katayoun Najafizadeh3 , Omid Ghobadi3
1- University of Social Welfare and Rehabilitation Sciences
2- University of Social Welfare and Rehabilitation Sciences ,bbahmani43@yahoo.com
3- 5. Iranian Research Center of Organ Donation
2- University of Social Welfare and Rehabilitation Sciences ,
3- 5. Iranian Research Center of Organ Donation
Abstract: (63 Views)
Introduction:
Organ donation is a life-saving medical intervention performed to preserve life or improve a patient’s physical condition. In this procedure, a healthy organ is removed from the body of a living person, a person with brain death or heart death and transplanted to the body of a sick person who has a defective organ(1-6). In cases where transplantation follows death, organ donation requires the consent of the deceased individual’s family(5, 7-9). Evidence suggests that organ donation may be associated with psychological consequences for donor families, recipients, or both(10-13). Following donation, donor families may wish to obtain information about the fate of the donated organ(14-20), while recipients may seek contact with donor families to express gratitude(14, 17, 21). However, the process of communication between donor families and recipients remains unclear and poorly defined in most parts of the world(14, 15, 17, 21, 22). Moreover, donation teams, hold divergent views regarding whether and how such contact should occur(10-12). This study aimed to systematically review the psychological consequences of meeting between organ donor families and recipients.
Methods: Following PRISMA guidelines, we searched English (Scopus, PubMed, Web of Science) and Persian (Magiran, SID) databases for studies published between 1980 and December 2022 to examine the psychological consequences of contact between donor families and organ recipients.
Two independent reviewers screened the identified studies based on predefined inclusion and exclusion criteria. Studies lacking either a “meeting” component or “psychological consequences” were excluded. Inter-rater agreement was assessed using Cohen’s kappa coefficient, yielding κ = 0.82 at the title/abstract screening stage and κ = 0.87 at the full-text review stage, indicating excellent agreement. Discrepancies were resolved through discussion, and when necessary, a third reviewer adjudicated.
Following screening, seven studies were included in the content analysis, and findings related to psychological consequences of Meeting between donor families and recipients were extracted. Study quality was assessed using the CASP tool for qualitative studies, and the Newcastle–Ottawa Scale for quantitative studies. Overall, the included studies were of acceptable quality ( Table1).
Results:
According to the duration between the initial awareness of potential contact and the actual meeting, the findings were classified into two primary domains(Table 1).
Conclusion:
This systematic review conceptualizes meeting between donor families and organ recipients as a complex, multifaceted phenomenon encompassing both beneficial and adverse psychological consequences. On the positive side, such contact may facilitate meaning-making, emotional closure, and expressions of gratitude. Conversely, it may give rise to emotional dependency,feelings of ownership, and the reactivation of grief, highlighting its potential psychological risks.
The findings are predominantly derived from Western societies, individualistic contexts, thereby limiting cross-cultural generalizability. In contrast, Eastern and religious societies, such as Iran, are shaped by collectivist norms and belief systems that may significantly influence how such meeting is perceived and experienced. In these settings, implicit or explicit social expectations to initiate or maintain communication may emerge, potentially leading to psychological consequences that differ from those observed in Western contexts. These considerations underscore the necessity of culturally sensitive research and the development of context-specific, supplementary guidelines.
A key limitation in the literature is the predominance of cross-sectional and short-term studies. The psychological impact of meeting is inherently dynamic, as grief processing, adaptation to organ donation, and interpersonal relationships evolve over time. However, longitudinal data remain scarce, indicating a critical gap in understanding long-term trajectories and delayed effects. Therefore, future studies should prioritize longitudinal designs to better capture these long-term effects.
Methodologically, both qualitative and quantitative approaches have been employed. While qualitative studies provide in-depth insights, and quantitative studies enhance generalizability, mixed-methods designs with larger samples are needed. Overall, contact should not be universally recommended, and evidence-based, culturally adapted guidelines are essential.
Accordingly, the following considerations should be incorporated into guideline development:
Ultimately, the decision to facilitate contact should not be universally mandated but rather guided by evidence-based, culturally adapted protocols that prioritize the psychological well-being of all stakeholders.
Ethical Considerations:
This study is part of a doctoral dissertation approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics Code: IR.USWR.REC.1401.174).
Funding:
This research was funded by the Social Welfare Management Research Center of the University of Social Welfare and Rehabilitation Sciences.
Conflict of Interest:
The authors declare no conflict of interest.
Acknowledgments:
The authors express their sincere gratitude to all contributors to this research project.
Organ donation is a life-saving medical intervention performed to preserve life or improve a patient’s physical condition. In this procedure, a healthy organ is removed from the body of a living person, a person with brain death or heart death and transplanted to the body of a sick person who has a defective organ(1-6). In cases where transplantation follows death, organ donation requires the consent of the deceased individual’s family(5, 7-9). Evidence suggests that organ donation may be associated with psychological consequences for donor families, recipients, or both(10-13). Following donation, donor families may wish to obtain information about the fate of the donated organ(14-20), while recipients may seek contact with donor families to express gratitude(14, 17, 21). However, the process of communication between donor families and recipients remains unclear and poorly defined in most parts of the world(14, 15, 17, 21, 22). Moreover, donation teams, hold divergent views regarding whether and how such contact should occur(10-12). This study aimed to systematically review the psychological consequences of meeting between organ donor families and recipients.
Methods: Following PRISMA guidelines, we searched English (Scopus, PubMed, Web of Science) and Persian (Magiran, SID) databases for studies published between 1980 and December 2022 to examine the psychological consequences of contact between donor families and organ recipients.
Two independent reviewers screened the identified studies based on predefined inclusion and exclusion criteria. Studies lacking either a “meeting” component or “psychological consequences” were excluded. Inter-rater agreement was assessed using Cohen’s kappa coefficient, yielding κ = 0.82 at the title/abstract screening stage and κ = 0.87 at the full-text review stage, indicating excellent agreement. Discrepancies were resolved through discussion, and when necessary, a third reviewer adjudicated.
Following screening, seven studies were included in the content analysis, and findings related to psychological consequences of Meeting between donor families and recipients were extracted. Study quality was assessed using the CASP tool for qualitative studies, and the Newcastle–Ottawa Scale for quantitative studies. Overall, the included studies were of acceptable quality ( Table1).
Results:
According to the duration between the initial awareness of potential contact and the actual meeting, the findings were classified into two primary domains(Table 1).
- The pre- contact phase(from awareness to meeting):
- Negative consequences experienced by donor families
- Negative consequences experienced by recipients
- The Post- meeting phase:
- Consequences for donor families
- Positive consequences (e.g., reduced ambiguity, facilitated grieving, enhanced meaning-making, and more positive attitudes toward donation)
- Negative consequences (e.g., reactivation of grief, emotional dependency)
- Consequences for recipients
- Positive consequences (e.g., gratitude, psychological relief)
- Negative consequences (e.g., guilt, anxiety about graft survival, symbolic identification with the deceased)
Conclusion:
This systematic review conceptualizes meeting between donor families and organ recipients as a complex, multifaceted phenomenon encompassing both beneficial and adverse psychological consequences. On the positive side, such contact may facilitate meaning-making, emotional closure, and expressions of gratitude. Conversely, it may give rise to emotional dependency,feelings of ownership, and the reactivation of grief, highlighting its potential psychological risks.
The findings are predominantly derived from Western societies, individualistic contexts, thereby limiting cross-cultural generalizability. In contrast, Eastern and religious societies, such as Iran, are shaped by collectivist norms and belief systems that may significantly influence how such meeting is perceived and experienced. In these settings, implicit or explicit social expectations to initiate or maintain communication may emerge, potentially leading to psychological consequences that differ from those observed in Western contexts. These considerations underscore the necessity of culturally sensitive research and the development of context-specific, supplementary guidelines.
A key limitation in the literature is the predominance of cross-sectional and short-term studies. The psychological impact of meeting is inherently dynamic, as grief processing, adaptation to organ donation, and interpersonal relationships evolve over time. However, longitudinal data remain scarce, indicating a critical gap in understanding long-term trajectories and delayed effects. Therefore, future studies should prioritize longitudinal designs to better capture these long-term effects.
Methodologically, both qualitative and quantitative approaches have been employed. While qualitative studies provide in-depth insights, and quantitative studies enhance generalizability, mixed-methods designs with larger samples are needed. Overall, contact should not be universally recommended, and evidence-based, culturally adapted guidelines are essential.
Accordingly, the following considerations should be incorporated into guideline development:
- Organ donation regulations vary across countries. For example, in some jurisdictions, cross-border organ donation is permitted, which may influence the process of contact.
- Contact guidelines should be grounded in principles of protection, confidentiality, autonomy, and informed choice for both donor families and recipients.
- In light of cultural differences and their impact on psychological outcomes, each country should develop culturally adapted, context-specific protocols alongside adherence to general international principles.
- Prior to initiating meeting, a comprehensive assessment of both parties (donor families and recipients) should be conducted, including evaluation of grief status, mental health, and expectations regarding contact. In cases of significant psychological vulnerability, meeting should be postponed or conducted with appropriate professional support.
- Specialized training for donation and transplant teams, along with the involvement of rehabilitation counseling professionals, may improve mediation processes and reduce negative outcomes.
- Individuals seeking meeting, should receive education regarding potential positive and negative outcomes, relational boundaries, privacy considerations, realistic expectation management, and the importance of preserving the recipient’s independent identity.
Ultimately, the decision to facilitate contact should not be universally mandated but rather guided by evidence-based, culturally adapted protocols that prioritize the psychological well-being of all stakeholders.
Ethical Considerations:
This study is part of a doctoral dissertation approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics Code: IR.USWR.REC.1401.174).
Funding:
This research was funded by the Social Welfare Management Research Center of the University of Social Welfare and Rehabilitation Sciences.
Conflict of Interest:
The authors declare no conflict of interest.
Acknowledgments:
The authors express their sincere gratitude to all contributors to this research project.
Keywords: organ recipient, recipient, donor, donor family, organ transplantation, organ donation, meeting, communication, contact, relationship, psychological consequences, emotional experience, brain death.
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