How do I handle grieving for a stranger?

Dear s.e.,

When I was a teenager (nine years ago), I had a heart transplant. This affects every day of my life; it's kind of a core part of my experience. And with that comes the grief: There was a person who I'll never know, whom I literally carry with me. They died, and they or (if their wishes were unclear) their family chose to save my life. And... they have no idea who I am, and vice versa. My feelings about surviving a disease that would have killed me in a few weeks are tied to this grief.

I know about heart donors in general: most of their deaths are sudden and unexpected, and they tend to be younger adults. But I don't know this person's story. Who were they? Am I older now than they ever got to be?

It hits hard around anniversaries: the day they died/the day I survived a normally-terminal illness. Or when I'm struggling with depression and feel like I "shouldn't" be, for their sake. I might be able to contact their family (there's a process for anonymized letters, if we consent to being contacted; I haven't heard anything from them). From a grief perspective, it feels even more selfish to contact them. They are mourning someone they knew and loved. What would I even say?

— Sincerely, Heavy Heart

Hey there, Heavy Heart,

I'm glad you're here with us because of a stranger's generosity. Having been on the other side of this question making decisions about end-of-life and anatomical gifts (and as an organ and tissue donor myself) I can tell you that your donor's family probably loves to think about their heart being carried out into the world. This isn't just anecdata: A 2025 study in The American Journal of Transplantation found that donor familes "endorsed the personal benefits of donation, including the feeling that a part of their loved one lived on in the recipient and that donation aligned with the donor's altruistic nature."

I sometimes like to imagine that I'm passing some part of a loved one when I walk down a busy city street, wait in line to board an airplane, or read a really good book by an author who received someone's cornea, or kidney, or heart. And I would be genuinely so delighted to hear from a recipient.

I believe that we don't truly die until no one speaks our names, and while you don't know your donor's name, you clearly carry their memory with you. As long as people speak your name, your donor, too, will be honored. And know that you should be alive. Yes, you're here because a terrible thing happened, but the people who experienced that terrible thing wanted something powerful to come out of it. You are an oak rising from a fallen acorn, even if it fell out of time, too soon, when so many acorns just crumble away into dust.

It's okay to feel grateful and joyful and sad all at once about this stranger and their family. We don't make enough space for mixed emotions in grief, and how it's possible to grieve something wonderful and experience proxy grief on behalf of someone else. And you don't need me to tell you this, but I'll say it anyway: It's okay to carry this grief with you as you move through life. It's a huge part of you.

I think it's worth writing your donor's family a letter. You don't have to send it right away, you might write a couple of different letters, but putting your feelings and experiences into concrete form can be really meaningful, as silly as it sounds. Sometimes just the process of writing is really cathartic, and you can decide to just save that letter or set it on fire or, yes, go ahead and forward it to the intermediary who facilitates communication between donor families and recipients.

They might be on the other end of this wondering about reaching out to you but not wanting to disturb you, and as the ten-year anniversary comes up, that could be a really lovely moment. It might be a bittersweet one, too, but it's worth the risk. They may have declined contact, in which case the organization will hang on to the letter in case they change their minds, and that's okay. It's okay if they get it and sit with it for a while before opening it, and it's okay if they never respond: Just sending that letter is a profound recognition and a gesture they will appreciate.

What I would love to hear is that you're doing okay and living a great life because of their kindness. If you're an artist or a writer or another creator, I'd love to see your work or know where I could find it. If you're chasing things that make you happy — a really cool job, travel, starting a family, whatever that looks like for you — I would want to know that too. If you've built an amazing relationship with someone, that would be lovely to hear too. And if you've done, or are doing, something specifically because of this gift, talk about that too — whether you decided to go to medical school or volunteer at the animal shelter or plant a tree or shrub in their honor.

At an event recently someone asked me about ring theory — the idea that we should "comfort in, dump out" — lending support to people closer to the deceased, rather than putting our feelings on them. There's a lot to recommend in ring theory, but sometimes people interpret it a little simplistically. Sharing your feelings with people close to the deceased doesn't necessarily mean you're grief hijacking or making them comfort you: You are carrying big feelings together. In this case, you are also close to the deceased in a very intimate way, and you can share that too, and talk about how you think of them and their family on the anniversary of your surgery, and feel grief for them as you mark another year of life.

Contacting them definitely isn't selfish. Making yourself a little vulnerable with that letter and putting yourself out there is actually a form of generosity. I also want to note that you are not alone in your feelings; a 2018 literature review in Health Psychology Open found that a lot of recipients had complicated emotions about their donors, but it also found that donor families overwhelmingly want to hear from recipients.

Tell your donor's family (when you're ready) that I said...

Thank you. It's a privilege and an honor to be able to carry your loved one's legacy, and your kindness at a time of incredible sadness truly changed the world.