Bone marrow transplantation is an increasingly preferred method of treatment for patients with aplastic anemia, some forms of leukemia, and certain tumors, such as lymphoma and breast cancer. When the patient's only alternative is death, psychosocial and cultural aspects of the relationship between the donor and the recipient become of paramount importance. In relation to organ transplantation, the gift has a special emotional meaning because it signifies life and creates a spiritual bond between the donor and the recipient. The article explores the theme of gift exchange and its psychosocial implications in bone marrow transplant donors and recipients. The impact of the relationship of the donor to the recipient is of particular interest because a live donor is indicated for all bone marrow transplants. The influence of cultural and religious attitudes also is investigated.