*Purpose: The Gift of Life metaphor is prevalent in pro-donation dialogue, aiming to promote transplant programs and conceptualize the act of organ donation. To obtain a better understanding of living donor perceptions on the term “Gift of Life”, we analyzed thematic views presented by anonymous living liver donors.

*Methods: 26 anonymous living liver donors completed a semi-structured qualitative interview consisting of questions regarding their motivations, experiences, and perceptions on donation. Views given specifically on the Gift of Life were prompted by the interviewer, while other instances of gift terminology may have been brought up spontaneously by the patient. Interviews were conducted over the telephone or in person by an experienced qualitative researcher. Interviews were audio-recorded, transcribed, quality-checked, and analyzed for common themes pertaining to gift discourse.

*Results: Five major themes relating to the Gift of Life terminology were elucidated: (1) complete agreement with the term and its relevance to donation, (2) their donation did not represent a Gift of Life, (3) the term was too grandiose, (4) a belief that the term has more meaning for the recipient rather than donor, and (5) that the “gift” goes both ways, with the donor also benefiting from the experience. In addition, directed donors tended to view the Gift of Life term as one that was more applicable to non-directed donors. This was based on the perception that the act of giving an organ to a complete stranger represented a greater “gift” than donating to a known recipient.

*Conclusions: In summary, our findings suggest that the term Gift of Life should generally be avoided in describing the donation act with anonymous living liver donors. A more subtle and individually tailored approach outlining both medical and psychosocial aspects of the donation process may resonate more with anonymous donors.

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