Little is known about the long-term bereavement of organ donor families. The present study sought to explicate this experience through examination of post-bereavement correspondence. One thousand six hundred and thirteen items of correspondence exchanged between donor families, recipients, four USA Organ Procurement Organisations (OPO), and the National Donor Family Council were reviewed. The pattern and content of correspondence over a seven-year period was examined. The letters were analysed using a thematic approach that looked for patterns within the data. A comparative dimension concerned with detecting and highlighting important similarities and differences across cases was also applied. Gift Exchange Theory and a number of bereavement frameworks were used to interpret the investigation. Recipients wrote more often than donor families and generally were the first to initiate contact. Male donors generated more correspondence from donor families, as did the under 20-age group, with 25% of families corresponding about children between the ages of three to nine years. The content of initial letters exchanged between donor and recipient families were found to mirror each other, but the main theme of donor families’ letters concerned the donor, while gratitude was the main theme of recipients’ letters. Donor families corresponded with their OPOs and the National Donor Family Council for four main reasons: to thank them, to seek help and advice, to forward letters to recipients, and to elicit follow-up information about recipients. This presentation offers interesting theoretical insights that in turn offer guidance to donor family and recipient post transplant contact.