The Extra Layer of Intensity (The Complexity of Being A Transplant Participant)

The transplant experience is ripe with intensity. The nature-defying movement from near-death to a full life. A story containing both tragedy and redemption; with transplant donor and recipient alike being sustained beyond the expected trajectory of a passing. The separation of wholeness into parts and the reconfiguration of the half which has the potential of returning to health by the remaining shell of the departing ghost. Containing all the components of tales as old as time, transplantation is the 21st Century parable of resurrection and the crucifixion in one.

Wrapped in both the technologies of of science and the traditional tropes of spirituality, transplantation brings to all participants of the process of transformation complexity, for it is no mere singular event despite how the spectacle of the surgery may have us thinking otherwise.

This complexity of feeling and rich tapestry of intellectual history which maps the progression of humanity from victim of the elements to conqueror of the natural environment, the space age of chartering and mastering the interior space of the human body, can be summarised by one phrase.

This phrase, which I coined when validating the experience of overwhelm of a fellow transplant participant, is “the extra layer of intensity”.

To be strictly accurate, the complexity of being a transplant participant contains layers of intensity, not just a single layer, however the core idea of there being an additive aspect of transplantation which goes beyond mere substitution but the rebirth into gestalt being, meaning greater than the sum of its constitutive parts, requires a definitive encapsulation of this multiplicity.

This encapsulation, or rather, these extra layers, for the transplant recipient are as follows:

Material- the pound of flesh and the scars.

Genetic- having another set of DNA intertwined; hybridity.

Pharmaceutical- immunosuppression, other medication to moderate co-morbidities, etc.

Comorbidities- relating to the rest of the body having been weakened by the previous organ failure; immunosuppression, immunosuppressive drug side effects (e.g. diabetes, cancer, etc).

Somatic-the trauma of the surgery; regardless of transplantation being a tool of survival and a fantastic feat, the opening of the body and the use of organ supporting machines keeping the body alive many leagues further than the body would usually be able to cope with; being able to survive the unsurvivable has created a new level of trauma for the body.

Psychological (emotional)- the weight of the new organ’s providence out of death;  the cultural imaginary surrounding transplantation, with all the echoes of the monstrous and the miraculous; the charting of the waters of simultaneous trauma and celebration with no elder guides to point the wisest path, within a culture which only wants to hear the story of victory and return to normalcy. Survivor’s guilt and the burden of being aware of the transience of life, the contingency which has allowed a continuance of survival, as well as the obligation beyond oneself (and to the donor as well as all those who do not receive transplants in time) to live a good life. High incidences of distress post-transplant in relation to one’s new existence.

Intellectual- the weight of philosophies which go into making transplantation feasible: such as the cartesian mind-body split where one dis-identifies from the body and elevates the mind-brain as what determines ones human and vitality; the Western allopathic approach that sees everything as interchangeable and ultimately separable, reducing all parts to the singular; the valuing of technological advancement above the impact on the participants, who are all secondary to the advancement of human knowledge and ingenuity.

Spiritual- mostly fables and myths within the transplant imaginary, but there nonetheless. Echoes of mystical ideas such as carrying the karma of the donor, of carrying the burden along with the overall spirit of transplantation, including its shadows, such as the red market and the brutal experimentation in the 1900s-1980s, the rivers of blood which paved the way to the seemingly everyday continuation of existence.  

For the donor family the extra layers are as follows:

Material- parts of the body of the once living child or parent or sibling have now been removed and scattered like to the winds to strangers.

Genetic- their dead child/parent/sibling’s DNA continues on and is kept alive by the recipient’s body.

Comorbidities- the stress of losing their child/parent/sibling will have made them more susceptible to physical illness as well as psychiatric conditions; previously existing conflicts with surviving family members may be magnified; divorce is more likely amongst parents whose children die (and so the loss of a spouse, in relational terms, frequently follows the loss of a child).

Somatic- the trauma of the loss will have kept into all their cells; when the anniversary approaches PTSD may be triggered and shaking, and other bodily convulsions and movements may be a way that the body tries to work through the trauma.

Psychological- the expected condition of depression following the loss of a family member is uniquely accompanied in transplantation with a grief which can never end. This mourning cannot end because a part of the donor literally, physically, “lives on” and there is no resolution through the anonymisation of the process and not knowing what socio-cultural home the organs reside in.

Spiritual- the cognitive dissonance of believing that the organs that are donated are only the physical remains of the extinguished consciousness of the loved one, whilst continually longing to know the recipient to see if there are any echoes of the individuality of the family member living on.

For the medical transplant team (and associated scientists) the extra layers are as follows:

Material- in addition to the physicality of the transplanted organ, there are layers in the internal scarring.

Genetic- the discovery of Microchimerism within the recipient, how the DNA of the donated organ does remain in situ but also in many instances circulates to other locations in the body.

Comorbidities- a multitude of various potentially dangerous medical conditions are to be expected with transplant recipients on account of the transplant medication which recipient must take lifelong post transplant. 50% of recipients will experience cancer, if not more; many with face acute organ rejection- all face chronic.

Somatic- dissociating from their own bodies in parallel with the dissociation from the bodies of the donor cadavers, the recipients on the operating table, etc.  

Psychological- having the bear the burden of operating, of treating medical crises, of seeing patients die, of seeing recipients survive and then die after 1 year, 5 years, 10 years, of having to tell them to live a normal life whilst either knowing that this can never really happen; or, whilst believing the story and living in cognitive dissonance with another reality in the Clinic.

Spiritual- having to tell the story that the transplanted organ is just a tool to the recipient whilst simultaneously telling the story that the transplanted organ is a “gift of life”.

As summarised here, the extra layers to the substitutive operation are numerous. It is almost as if transplantation follows a law of multiplicity whereby there is an exponential amount of complexity that arises. The various layers are a lot to take in. And, given the intensity of the topic it can be challenging to hold space for these many layers from a space of openness and curiosity.

Transplantation transforms life by bringing an extra layer of intensity to existence. Everything is amplified: highs and lows are forever anchored to the acute awareness of both the precariousness of living and the importance of living one’s best life. This is the case for recipients as may be expected. Yet, this process of amplification also runs parallel in both the donor families, who are the proxy of the donors, as well as the team of scientists and medics who coordinate the transplant process. The formal study of the impact of transplantation on the donor families and transplant teams psychologically (and other layers) is still in its infancy.

The force of this intensity ought not be underestimated. It creates a bind to the process which draws one so deeply within the spectacle of the surgery that it blinds one to being able to look at the bigger picture. This blindness is perpetuated by a fear of a reaction by the prodding of a tensely drawn web of feelings, convictions, and ideas about what it means to be human which are acutely interdependent. If the thread is gathered up and pulled in, the stitching may unravel completely (which would be too much for anyone to bear) or it may become even more securely interwoven. However which way the pulling of the currently tensed threads will go cannot yet be ascertained. What can be, is that the pulling of the inwardly tensed knots of an intricately crafted piece, guarantees that another societal change will ripple out from within the web to all the many interconnected layers of society.    

Bibliography

https://www.jhltonline.org/article/S1053-2498(10)00290-1/pdf

https://mh.bmj.com/content/44/1/46

https://www.tandfonline.com/doi/full/10.1080/08164649.2019.1611527