{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:07:21Z","timestamp":1788880041150,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Heart transplantation (HTX), a treatment for end-stage heart failure, is accompanied by substantial psychological and physical strain for recipients. Many individuals develop Donor and Donation Images (DDI), referring to the thoughts and emotions directed toward the donor and\/or the transplanted organ. The present study aims to systematically quantify the content dimensions of DDI and to explore their associations with psychological well-being and perceived organ acceptance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 407 adult post-HTX patients participated in the survey. A self-developed questionnaire assessed 12 content categories of DDI, together with their perceived consequences. Descriptive analysis, gender comparisons, and exploratory factor analysis (EFA) were conducted to examine the underlying structure of DDI. Linear regressions and Spearman correlations were used in an exploratory manner to investigate statistical associations between DDI factors and psychological and emotional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis of 402 complete datasets yielded three content factors: Social, Sex\/Age, and Identity, capturing different facets of DDI. Women were more likely than men to contemplate the donor\u2019s gender, age, and personality traits. Regression analysis showed small but statistically significant associations between the Social factor and perceived changes in personality and behavior, as well as between the Social and Sex\/Age factors and positive emotional consequences. Across all models, the explained variance was low. No meaningful associations were observed with organ acceptance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study represents the first quantitative attempt to structure the contents of DDI and to examine their psychological correlates in a large cohort of HTX recipients. While the observed associations were modest, the findings contribute to a more nuanced understanding of how recipients engage cognitively and emotionally with their donor. The results underscore the need for further research, including instrument refinement and longitudinal designs, to better capture the complexity of DDI and their potential relevance for psychosocial care in transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1813966","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:20:57Z","timestamp":1788877257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["My heart will go on \u2013 quantitative content analysis of donor and donation images in patients after heart transplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Leoni","family":"Wahlers","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora M.","family":"Laskowski","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Halbeisen","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Tigges-Limmer","sequence":"additional","affiliation":[{"name":"Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum","place":["Bad Oeynhausen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Paslakis","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1080\/21674086.1973.11926639","article-title":"The intrapsychic integration of a new organ. A clinical study of kidney transplantation","volume":"42","author":"Basch","year":"1973","journal-title":"Psychoanal. Q."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1177\/13591053221149780","article-title":"The psychosocial adjustment of kidney recipients across donation contexts","volume":"28","author":"Bourkas","year":"2023","journal-title":"J. Health Psychol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1007\/BF00435634","article-title":"Does changing the heart mean changing personality? A retrospective inquiry on 47 heart transplant patients","volume":"1","author":"Bunzel","year":"1992","journal-title":"Qual. Life Res."},{"key":"ref4","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.hrtlng.2013.08.003","article-title":"The psychological experiences of adult heart transplant recipients: a systematic review and meta-summary of qualitative findings","volume":"42","author":"Conway","year":"2013","journal-title":"Heart Lung"},{"key":"ref6","volume-title":"Jahresbericht Organspende und Transplantation in Deutschland 2024","year":"2025"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1037\/h0036316","article-title":"When is a correlation matrix appropriate for factor analysis? Some decision rules","volume":"81","author":"Dziuban","year":"1974","journal-title":"Psychol. Bull."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"455","DOI":"10.3390\/healthcare9040455","article-title":"The actualization of the transplantation complex on the Axis of psychosomatic totality\u2014results of a qualitative study","volume":"9","author":"Eichenlaub","year":"2021","journal-title":"Healthcare"},{"key":"ref9","article-title":"Exploratory factor analysis: a users\u2019 guide","volume":"1","author":"Ferguson","year":"1988","journal-title":"Int. J. Sel. Assess."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/S0033-3182(87)72508-0","article-title":"Heart transplant candidates rejected on psychiatric indications","volume":"28","author":"Frierson","year":"1987","journal-title":"Psychosomatics"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1023\/B:TAJP.0000041262.36839.fd","article-title":"\u201cIs it me, or isn\u2019t it?\u201d\u2014transplanted organs and their donors as transitional objects","volume":"64","author":"Goetzmann","year":"2004","journal-title":"Am. J. Psychoanal."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1348\/135910708X399447","article-title":"Psychological processing of transplantation in lung recipients: a quantitative study of organ integration and the relationship to the donor","volume":"14","author":"Goetzmann","year":"2009","journal-title":"Br. J. Health Psychol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"110464","DOI":"10.1016\/j.jpsychores.2021.110464","article-title":"Organ integration in kidney transplant patients \u2013 results of a KTx360\u00b0 substudy","volume":"145","author":"Hennemann","year":"2021","journal-title":"J. Psychosom. Res."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1109\/MCSE.2007.55","article-title":"Matplotlib: a 2D graphics environment","volume":"9","author":"Hunter","year":"2007","journal-title":"Comput. Sci. Eng."},{"key":"ref15","volume-title":"IBM SPSS statistics","year":"2022"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1177\/1474515112466155","article-title":"Patients\u2019 experiences of information and support during the first six months after heart or lung transplantation","volume":"12","author":"Ivarsson","year":"2013","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1080\/01612840590959452","article-title":"Somebody else\u2019s heart inside me: a descriptive study of psychological problems after a heart transplantation","volume":"26","author":"Kaba","year":"2005","journal-title":"Issues Ment. Health Nurs."},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.3205\/000194","article-title":"Position paper on the importance of psychosocial factors in cardiology: update 2013","volume":"12","author":"Ladwig","year":"2014","journal-title":"GMS Ger. Med. Sci."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"952","DOI":"10.3390\/jcm12030952","article-title":"Donor and donation images (DDI)\u2014a scoping review of what we know and what we Don\u2019t","volume":"12","author":"Laskowski","year":"2023","journal-title":"J. Clin. Med."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"21174","DOI":"10.1038\/s41598-025-07317-7","article-title":"A large cross-sectional study on the prevalence and predictors of donor and donation images in patients after heart transplantation","volume":"15","author":"Laskowski","year":"2025","journal-title":"Sci. Rep."},{"key":"ref21","article-title":"LiverTox: clinical and research information on drug-induced liver injury","year":"2021"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/j.1745-8315.2011.00496.x","article-title":"Fantasized recipient\u2013donor relationships following lung transplantations: a qualitative case analysis based on patient narratives","volume":"93","author":"Neukom","year":"2012","journal-title":"Int. J. Psychoanal."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"M33","DOI":"10.1530\/EJE-15-0464","article-title":"Cushing\u2019s syndrome: update on signs, symptoms and biochemical screening","volume":"173","author":"Nieman","year":"2015","journal-title":"Eur. J. Endocrinol."},{"key":"ref24","article-title":"Transplants in the U.S. by state performed: January 1, 1988 - October 31, 2025 for organ = heart, National Data","year":"2025"},{"key":"ref25","article-title":"Python","year":"2024"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1111\/j.1365-2702.2007.02206.x","article-title":"Heart transplantation experiences: a phenomenological approach","volume":"17","author":"Sadala","year":"2008","journal-title":"J. Clin. Nurs."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1034\/j.1399-0012.2003.00065.x","article-title":"Transplant recipients\u2019 conceptions of three key phenomena in transplantation: the organ donation, the organ donor, and the organ transplant","volume":"17","author":"Sanner","year":"2003","journal-title":"Clin. Transpl."},{"key":"ref28","volume-title":"pandas-dev\/pandas: Pandas","year":"2020"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/s00398-017-0157-y","article-title":"Psychologie in der Herzchirurgie","volume":"31","author":"Tigges-Limmer","year":"2017","journal-title":"Zeitschrift f\u00fcr Herz-,Thorax- und Gef\u00e4\u00dfchirurgie"},{"key":"ref30","first-page":"179","article-title":"Hypnotherapeutische Interventionen in der Herztransplantation","volume":"5","author":"Tigges-Limmer","year":"2010","journal-title":"Hypnose - Zeitschrift F\u00fcr Hypnose Und Hypnotherapie"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1007\/s00278-004-0409-7","article-title":"Hypnotherapie in der Herztransplantation","volume":"50","author":"Tigges-Limmer","year":"2005","journal-title":"Psychother. (Berl)."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s40264-024-01398-5","article-title":"Tacrolimus-induced neurotoxicity after transplant: a literature review","volume":"47","author":"Verona","year":"2024","journal-title":"Drug Saf."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"3021","DOI":"10.21105\/joss.03021","article-title":"Seaborn: statistical data visualization","volume":"6","author":"Waskom","year":"2021","journal-title":"J. Open Source Softw."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1813966\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:21:00Z","timestamp":1788877260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1813966\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":33,"alternative-id":["10.3389\/fpsyg.2026.1813966"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1813966","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]},"article-number":"1813966"}}