The Experience of Married Couples Who Both Donated a Kidney - A Psychoanalytic Perspective

This study explores the experiences of married couples who have donated a kidney to strangers. While extensive research has been conducted on the motivations and experiences of individual kidney donors, little attention has been given to cases where both members of a married couple chose to donate a kidney to strangers. Most existing studies focus on kidney donations to acquaintances or family members, and occasionally on cases where both spouses donated a kidney within their family, such as to a child. In such contexts, the motivation and experience are naturally tied to familial relationships and commitments.

In contrast, research on kidney donation to strangers typically examines the experiences of individual donors, without addressing instances where both spouses donated to strangers. This study aims to investigate the unique experiences of such couples. By delving into their experiences, the study seeks to understand the personal, relational, and faith-based significance of the donation for these couples.

At the personal level, the study examines the experiences of these couples in comparison to individual donors as reported in the literature. At the relational level, it explores the role of the marital relationship in the decision to donate. Through the lens of Kleinian theory on couple dynamics, the study seeks to identify patterns in the couples' interactions that may have influenced their joint decision to donate. This research thereby contributes new insights to the field, addressing a gap in the literature on spousal kidney donation.

Additionally, Boaz's (2022) research on the characteristics of kidney donors to strangers in Israel, which focused solely on individual donors, found that all donors via the Matnat Chaim organization were Jewish, with 90% identifying as religious. Furthermore, 57% of these donors lived in non-urban areas, 38% in small communities with fewer than 5,000 residents, and 76% in communities beyond the Green Line. These findings highlight the socio-religious context of kidney donation in Israel, raising questions about the role of religious faith, social dynamics, and the personal significance of the act. In this context, the current study examines the influence of the donors' religious beliefs on their donation experience, contributing to the broader discourse by linking faith to psychoanalytic thought and enhancing understanding of the role of faith in marital relationships.

Accordingly, the study focuses on analyzing the personal aspects of the donation experience, the relational dynamics that enabled it, and the religious-spiritual significance attributed to this act. The research question is: What are the experiences of married couples who have donated a kidney to strangers, and how do they perceive the significance of the donation on personal, relational, and faith-based levels? From these perceptions, what can be learned about the motivations and meanings of kidney donation?

The study employs a qualitative methodology, analyzing in-depth interviews with nine religious-national couples (a total of 18 interviews) who both donated a kidney to strangers. At the time of donation, participants were on average 40 years old, all were parents, and all led lives combining religious faith with social engagement. Donations occurred over varying time intervals, sometimes influenced by one spouse's prior decision to donate.

Findings reveal that kidney donation is a complex and multifaceted act, integrating personal motives for meaning and fulfillment, marital values of partnership and mutual support, and profound religious faith. For the participants, the donation reflected a commitment to values of kindness, mutual responsibility, and Tikkun Olam (repairing the world), fostering a sense of self-worth, personal significance, and strengthening their marital bond.

From a psychoanalytic perspective, the findings offer diverse interpretations. The concept of Tikkun Olam was understood on dual levels: as a Jewish religious notion emphasizing collective responsibility for societal and global improvement, and as a personal process of growth, development, and inner healing. Drawing on the theories of Freud, Klein, and Kohut, alongside Ruth Nezer’s interpretations, the study suggests that kidney donation represents:

• Sublimation (Freud): channeling instincts into moral and social actions that achieve "repair."
• Reparation (Klein): an effort to restore and compensate for perceived loss or guilt.
• Self-cohesion (Kohut): a means of achieving personal meaning and wholeness.
  Nezer highlights the integration of personal and universal dimensions, likening acts of kindness to striving toward divinity. The participants viewed their donation as a mission bridging personal, relational, social, and divine realms—an act that combines personal healing with social contribution and transcends individual needs for the benefit of others.

This study offers a unique contribution to understanding the interplay between giving, marital dynamics, and religious faith. It underscores the transformative power of kidney donation, both internally and socially, expanding the understanding of altruistic acts as integrative processes combining instincts, interpersonal relationships, values, and faith. The research enriches the discourse on donation by emphasizing its relational dimensions, deepens the conceptualization of Tikkun Olam, and proposes a broader understanding of this notion as an act intertwining morality, spirituality, and social practice, fostering profound change in both the donors' lives and society at large.