Posted on 02/22/2002 5:20:15 AM PST by independentmind
The Global Economy and Brute Life
In a recent issue of Atlantic Monthly (January 1998 ) George Soros , best known as a world-class billionaire financier, analyzed some of the deficiencies of the global capitalist economy. It is a fairly elementary exercise, but coming from a person in his position, one tends to sit up and take notice. The benefits of world capitalism, Mr. Soros notes , are unevenly distributed. Capital is in a better position than labor. And, surely it is better to be situated at the center of the global economy than at the peripheries. Given the inherent instability of the global financial system, busts will inevitably follow booms, like night the day, and capital tends to return to its centers leaving the minor players in faraway places high and dry. Meanwhile, the rapid growth of global monopolies have compromised the authority of states and weakened their regulatory functions.
But what bothers Mr. Soros most is the erosion of social values and social cohesion in the face of the increasing dominance of anti-social market values. Not that markets are to be blamed, of course. By their very nature markets are indiscriminate, promiscuous and inclined to reduce everything, including human beings, their labor and even their reproductive capacity to the status of commodities, to things that can be bought, sold, traded, and stolen. So, while, according to Mr. Soros, a Market Economy is generally a good thing, we cannot live by markets alone. "Open" and democratic societies require strong social institutions to serve such vital goals as social justice, political freedom, bodily integrity and other human rights. The real dilemma, as Mr. Soros sees it, is one of uneven development. The evolution of the global market has outstripped the development of a mediating global society.
Indeed, amidst the neo-liberal readjustments of virtually all contemporary societies, North and South, we are experiencing today a rapid depletion, an ‘emptying out’ even, of the traditional modernist, humanist, and pastoral ideologies and practices. But meanwhile, new mediations between capital and work, between bodies and the state, belonging and extra-territoriality, and even between , social exclusion and medical- technological inclusion are taking shape. So, rather than a conventional story of the sad decline of humanistic social values and social relations , our discussion is tethered to a frank recognition that the conventional grounds on which those modernist values and practices were based have shifted beyond recognition.
Nowhere, perhaps, are these processes more transparent than in the rapid dissemination in the past decade of organ transplantation technologies and practices which under the ideal conditions of an "open", neo-liberal , global Market Economy has allowed for an unprecedented movement of , among other "things", mortally sick bodies moving in one direction and detached "healthy" organs (transported by commercial airlines in ordinary plastic beer coolers stored in the overhead luggage compartment of the economy section ) in another direction, creating a bizarre "kula ring" of international trade. This essay critically explores -- with particular reference to recent organ transplantation "developments" in Brazil, South Africa, India, the United States, and China -- the new forms of bio-economics and bio-sociality (Rabinow 1996) that are now emerging in the wake of the internationalization of this immensely powerful , if crude, medical technology.
What is needed, then, is something akin to Donna Haraway’s (1985 ) radical "manifesto" for the cyborg bodies and cyborg selves that we have, in fact, already become through the appearance of these strange markets, excess capital, advanced bio-technology, ‘surplus bodies’ and human ‘spare parts’. Together, these have allowed for a spectacularly lucrative world trade in organ transplantation which promises to certain, select individuals of reasonable economic "means" living almost anywhere in the world -- from the Kalahari Desert in Botswana to the deserts of the Arab Emirate of Oman -- a "miraculous" extension in what Giorgio Agamben (1998) refers to as "brute" or "bare" life, the elementary form of biological "species life". This, in turn, is made possible by the internal and domestic reorganization of neo-liberal , democratic states and their successful capture of the "cadaver" now redefined as the "state’s body" and the concomitant politicization of death. By this we mean the increasing capacity of the post-transplantation State to define and determine the hour of death and to claim, unashamedly, the ‘first rights’ ( and first rites ) to the disposal of the body’s parts.
Until very recently, only highly deviant authoritarian and police states -- Nazi Germany, Argentina in the late 1970s, Brazil in the 1960s and 1970s, and South Africa under apartheid -- had assumed this capacity in the 20th century, this final word, as it were, over brute life, politicized death, and the creation and maintenance of a surplus population of "living dead", whether Black industrial workers kept in barbaric worker hostels in apartheid South Africa, (see Ramphele 1994), the "disappeared" in Argentina, or those walking cadavers kept hostage in Nazi concentration camps. The "democratization" of practices bearing at least some family resemblances to these (i.e., the "living dead" maintained in intensive care units for the purpose of organ retrieval ) in neo-liberal states has generally occurred in the absence of public outrage or resistance, with the possible exception of public unrest following democratic Brazil’ passage of its authoritarian law of "presumed consent" to organ donation in 1997, which we shall discuss below.
In the face of this ultimate, late modern dilemma -- this "end of the body" as we see it -- the task of anthropology is relatively clear and straight forward: the recovery of our discipline’s unrealized radical epistemological promise and a commitment to the "primacy of the ethical" (Scheper-Hughes 1994) while daring to risk practical , even political, involvement in the dangerous topic 1 under consideration. The need to define new ethical standards for the international practice of organ donation -- especially in light of the abuses that undermine the bodily integrity of socially disadvantaged members of society and the public trust that is necessary for voluntary organ donation to continue, brought together a small international task force. The "Bellagio Task Force on Transplantation, Bodily Integrity, and the International Traffic in Organs", lead by social historian, David Rothman, is comprised of a dozen international transplant surgeons, organ procurement specialists, human rights activists, and a medical anthropologist (myself, NS-H) meeting in 1995 and again in 1996 in the Rockerfeller Conference Center in Bellagio, Italy. The task force is examining the ethical, social, and medical ramifications of these problems and is considering various strategies to impact them, including the creation of an international human rights body -- a "Human Organs Watch" , if you like -- to monitor reports of any gross violations in the procurement and distribution of human organs in transplant surgery. An initial report of the Task Force was published in Transplantation Proceedings (Rothman et al., 1997). At the 1996 meeting, I was "delegated" by the Task Force to launch a very exploratory, ethnographic, comparative study of the social and economic context of organ transplantation, including the global and domestic traffic in organs.
The field research on which this discussion is based, therefore, derives from this "mission". It represents the preliminary findings from the early stages of the collaborative "Selling Life" project. My Berkeley colleague, Lawrence Cohen, is currently conducting research in India on the emerging "black market" in human organs resulting from new laws prohibiting the previously legal trade in live kidney donors. In my on-going research in Brazil and South Africa I am being assisted by a small "team" of local researchers and field assistants (see acknowledgments). At home in Berkeley, I am collaborating with Joao Biehl who has assisted both in the analysis of the emerging Brazilian data and in thinking through many of the arguments made in this paper.
The focus on the "commodification" of the body and body parts within the new global economy owes a particular debt to the writings and thought of Sidney Mintz, particularly his magisterial book, Sweetness and Power. This article is offered as a "transplanted" surrogate for the 1996 Sidney Mintz lecture which I was extremely honored to present at Johns Hopkins University 2 .
The Organs Ring and The Commodified Body
Indeed, as Arjun Appadurai has noted (1986) there is nothing fixed, stable, or sacrosanct about the 'commodity candidacy' of things. Nowhere is this more dramatically illustrated than in the "booming" global and domestic markets in human organs and tissues from both living and deceased donors to supply the transplant industry, a medical business driven by the simple market calculus of "supply and demand". The very idea of organ 'scarcity' is what Ivan Illich would call an artificially created need, invented by transplant technicians and dangled before the eyes of an ever expanding sick, aging, and dying population. This market is part of an impressive development and refinement of transplant technologies. These developments were facilitated historically through the medical definition of irreversible coma ( at the end of the 1950s) and the new legal status of "brain death" ( at the end of the 1960s) in which, as Giorgio Agamben (1998:163) notes, death became an epiphenomenon of transplant technologies. These transformations reveal the extent to which the sovereign power of postmodern states, both "democratic" and authoritarian, is operationalized through the life sciences and medical practices. These apparatuses, sciences, and technologies are globally integrated in markets which, in turn, increasingly reconfigure local states and local "cultures".
Lawrence Cohen, for example, who has worked in rural towns in various regions of India, from north to south, now reports that in a very brief period of time the idea of trading "a kidney for a dowry" has caught on and become one strategy for poor parents desperate to arrange a comfortable marriage for an "extra" daughter. In other words, a spare kidney for a spare daughter. Cohen notes that ten years ago when villagers and townspeople first heard through newspaper reports of kidney sales occurring in the cities of Bombay and Madras they responded with predictable alarm and revulsion. Today, some of these same villagers speak matter of factly about just when in the course of a family cycle it might be necessary to sell a "spare" organ. Some village parents say they can no longer complain about the fate of a dowry-less daughter. "Haven't you got a spare kidney?", one or another unsympathetic neighbor is likely to respond.
And in rural Brazil , over a similarly short period and in response to demands to ‘donate’ a kidney to a family member , working class people have begun to view their bodies and body parts as comprised on unessential redundancies. "Nanci, " I was challenged by a forty year old woman who had ‘given’ a kidney (for a small compensation) to a distant relation. "Wouldn’t you feel compelled to give an organ of which you yourself had two and the other ‘fellow’ had none?" I pointed out, rather lamely, that the Good Lord had given us two of quite a few organs and I hated to think of myself as selfish ( egoista ) for wanting to hang on to as many of the pairs as I could! It was not so long ago -- 1986, in fact -- and in this same community when I had been invited to accompany a small procession to the graveyard where we ceremoniously buried a ‘fellow’s’ amputated foot! The folk Catholic ideology of the sacredness of the body -- and the integrity of its component parts-- was still then the commanding ethos. And though I felt a bit silly giving that gangrenous foot the benefit of a decade of the rosary as a ‘send off’, Rosalva’s reconceptualization in the late 1990s of her body as a mere reservoir of spare parts struck me as a troublesome turn’ of events.
The particular and well documented case of organ selling and , more recently , of organ stealing ( see New York Times, May 12, 1998) in Indian villages is but one small, if well documented, link in a 'booming' world market in organs and human tissues (not to mention blood, semen, ova , and babies) that links east and west, north and south. Over the past 30 years, organ transplantation has been transformed from a rare and experimental procedure performed in a few advanced medical centers in the first world to a fairly common therapeutic procedure carried out in hospitals and clinics, not all of them certified and legitimate, throughout the world. Kidney transplantation, which is the most universal form of organ transplant, is now conducted in the US, in most European and Asian countries, in several South American and Middle Eastern countries, and in a few African counties ( in North Africa and South Africa). Survival rates for kidney transplant have increased markedly over the past decade, although these still vary by country and by quality and type of organ (living or cadaveric).
Until recently the "best" medical option for kidney transplantation was using a genetically closely related living donor (Fischel 1991). Today, however, morbidity rates from infection and hepatitis are higher in countries like Brazil, India, and China , which still rely heavily on living kidney donors than in the U.S., Canada, and the countries of Western Europe which rely more on cadaveric donation. But within some poorer countries to the South, like Brazil, survival rates for kidney transplant are still better with a matched living donor than with an 'anonymous' cadaveric organ which stands a good chance of not having been adequately tested or screened.
Organ transplantation now takes place in a trans-national space with both donors and recipients following the paths of capital and technology in the global economy. In general, the movement of donor organs follows modern routes of capital: from South to North, from third world to first world, from poor to rich bodies, from black and brown to white bodies, from young to old bodies, productive to less productive, and female to male bodies. Residents of the Gulf States (Kuwait, Saudi Arabia, Oman, United Arab Emirates) travel primarily to India to obtain kidneys, while residents of Taiwan, Hong Kong, Korea and Singapore travel to mainland China for transplant surgery, allegedly with organs removed from executed prisoners. Japanese patients travel to North America as well as to Taiwan and Singapore for organs retrieved from brain dead donors, a definition of death only very recently and reluctantly accepted in Japan.
And, a great many people -- and by no means are all of them wealthy -- have shown their willingness to travel great distances to secure a transplant using both legal and illegal channels. This is so even when the survival rates in some of the more commercialized contexts is quite poor. Between 1983-1988, 131 patients from just three renal units in the United Arab Emirates and Oman traveled to Bombay, India where they purchased, through local brokers, kidneys from living donors. The donors, from urban shantytowns outside Bombay, were compensated between $2,000 and $3,000 for a kidney. News of the "organs bazaars" operating in the slums of Bombay, Calcutta and Madras appeared in Indian weeklies and in special reports by ABC and the BBC. Meanwhile, prestigious medical journals, (including The Lancet and Transplant Proceedings ) published dozens of articles analyzing the medical risks and poor outcomes resulting from transplantation using "poor quality" kidneys from medically compromised "donors" 3
A medically invented, artificial scarcity in human organs for transplantation has generated a kind of panic and a desperate international search them and for new surgical possibilities. Bearing many similarities to the international market in adoption, those looking for transplant organs are so single minded in their quest that they are sometimes willing to put aside questions about how the organ [or ‘the baby’ in the case of adoption] was obtained. In both instances the language of "gifts" , "donations", " heroic rescues" and "saving lives" masks the extent to which ethically dubious and even illegal practices are used to obtain the desired " scarce" commodity, infant or kidney, for which foreigners (or "better off" nationals) are willing to pay what to ordinary people seems a king’s ransom. With desperation built in on both sides of the equation -- deathly ill "buyers" and desperately needy "sellers" -- once seemingly "timeless" religious beliefs in the sanctity of the body and proscriptions against body mutilation have collapsed over night in some parts of the third world under the weight of these new market's demands. These new demands are driven by the rapid dissemination of the medical technology and expertise of transplant surgery and a new global social imaginary about the possibilities of bodily rejuvenation and 'repair' through organ replacement.
The gap between supply and demand that drives the new global trade in organs is exacerbated by religious sanctions and/or cultural inhibitions with respect to "brain death" and the proper handling of the dead body. Prohibitions in one country or region can stimulate an "organs market" in more secular or culturally pluralistic neighboring countries or regions. Meanwhile, the " scarcity " of organs produced in the wake of centralized "waiting lists" for transplantation has provided many incentives to physicians, hospital administrators, government officials, and blatantly commercial intermediaries to engage in ethically questionable tactics for obtaining organs. For example, heart transplantation is hardly performed at all in Japan due to deep reservations about the social definition of brain death, while most kidney transplants are gotten with living, related donors (see Lock 1996, 1997; Ohnuki-Tierney 1994).
For many years desperate Japanese nationals have resorted to intermediaries with connections to the underworld of organized crime ( the so called "body mafia") to locate donor hearts or (when lacking related donors), paid unrelated kidney donors in other countries, including the United States. According to Lock (personal communication, 1997) who is engaged in a comparative study of transplant surgery in Japan and Canada (1996, 1997), a ring of Japanese yakuza gangsters, working on behalf of desperate Japanese transplant candidates through connections at a major medical center in Boston was uncovered by journalists and broken up by police there a decade ago. And, until recently, Japanese kidney patients also traveled to Taiwan and Singapore to purchase organs obtained (without consent) from executed prisoners, until this practice was roundly condemned by the World Medical Association in 1994 and was prohibited by new regulations.
The ban on the use of organs from executed prisoners in one part of "capitalist" Asia, opened up the possibilities for a similar practice in another part of "communist" Asia. The demand for hard currency by strapped governments recognizes no fixed ideological or political boundaries. Recently, the New York Times (February 24, 1998) reported on an FBI operation which led to the arrest of two Chinese citizens charged with conspiring to sell human organs of executed prisoners. The undercover "sting" operation was set up by the human rights activist, Harry Wu , who has been alerting the world since the 1980s to this alleged, covert practice in China . This particular case is still pending investigations, but its outcome may determine once and for the veracity of Harry Wu ( and other human right activists) contested claims about the organs trade in China today , which we will discuss at greater length below.
Despite the publicity and attention to the more spectacular international traffic in human organs , an equally important though far less explored dimension of the organs trade is domestic, following the usual routes of social and economic cleavages and obeying domestic rules of class, race, gender, and geography. Dr. X, an elderly Brazilian surgeon and nephrologist, admitted during an interview in Sao Paulo in 1997 that "the commerce in organs has always been a reality in Brazil and among and between Brazilians.
" Those who suffer most, he said, are the usual ‘nobodies’ ", mostly poor and uneducated, who are tricked into "donation" through illegal and unethical bodily transactions. The elderly doctor cited a transplantation scandal that occurred in Brazil in the late 1980s one of several such cases exposed by local journalists and human rights activists. This particular one concerned a young accident victim, a mere girl of 12 years, from the interior town of Taubate, who while undergoing surgery on her broken leg, had a "spare" kidney removed by unscrupulous surgeons. Following a complain lodged by her family who noticed a scar where none should have been, the local Public Defender began an investigation but it was interrupted by the Federal Police. Consequently, the Federal Board of Medicine was "compelled" to pass a verdict of "not guilty" due to lack of evidence.
But the poor and socially disadvantaged populations of Brazil and elsewhere in the world have not remained silent in the face of these threats and assaults to their health and to their bodily integrity, security, and dignity. For many years these marginal populations, living in urban shantytowns and hillside favelas, possessing little or no "symbolic capital" have announced their fears and their outrage through the idiom of seemingly "wild" rumors and urban legends , to be discussed below, that warn of the existence and the dangerous proximity of markets in bodies and body parts ( Scheper-Hughes 1996). The circulation of the rumors and "urban legends" of organ theft have produced in their wake a climate of hostile "civil" resistance toward even legitimate and altruistic organ donation and organ transplantation in some countries to the South (such as Brazil and Argentina) where voluntary donations began to drop precipitously in the 1980s. Medical associations and governments have tried, without success, to correct the "disinformation" being disseminated by the persistent organ stealing rumors.
And, in a curious reversal, these ‘ illiterate’ rumors originating in the periphery have migrated to the comfortable and affluent "core", the comfortable middle class communities of the U.S. Despite the appointment of a full-time USIA disinformtion specialist, Todd Leventhal (see USIA 1994) who has lead a long and expensive U.S. government campaign to kill the "body parts" rumor, as recently as the late fall of 1997 a variant of the organ stealing rumor carrying dire warnings about the existence of seductive female ( or, less often, male) medical "agents" involved in the body parts trade was circulated among thousands of Americans via an electronic mail "chain letter" . One strand of the chain was passed among a network of progressive academics, and to my amusement I was one of the recipients. Thre warning was followed a few days later by an apology stating that the story may have been "just a rumor".
Indeed, it would seem from this that a great many people in the world, both North and South, are uneasy. Something seems amiss or profoundly wrong about the nature of the beast that medical technology has released in the name of transplant surgery. But why now, why so many years later? Has transplant surgery opened a Pandora’s Box that has resulted in a long overdue, popular backlash? Or, is there something new about the current organization of transplant surgery that has turned a once proud and altruistic moment in medical history into something unseemly and grotesque?
Dr.B., a heart transplant surgeon in Cape Town, South Africa whom I interviewed in February 1998, said he has become very "disheartened" about his profession’s recent decline in prestige, trust, and value : " Organ transplantation has moved from an era back in 1967 when the atmosphere and public attitude was very different ...You know, people then still spoke about organ donation as that fantastic gift. Our first organ donor, Denise Dawer, and her family, were very much hallowed here. They were given a lot of credit for what they did and their photos are displayed in our hospital’s new Transplant Museum. Society at that stage was still very positive. Now that there have been hundreds of thousands of donors throughout the world , the idea of organ donation has lost some of its luster. And, donor’s families throughout the world have been put under a lot more pressure. And there have been some incidents that were unfortunate... So we’ve begun to all of a sudden to experience a sea of backlash . In Europe there has been a strong backlash because of the state’s demand, the moral requirement even , to donate. Europeans have generally had a good social conscience, they tend to believe in the better good of society, and so up until now they supported organ transplantation as a social good. But , now, suddenly objections are beginning to be raised. The Lutheran Church in Germany, for example, has started to question the idea of brain death, long after it had been generally accepted there. And so we have seen a drop of about 20% in organ donations in Europe, but especially in Germany. This is entirely new. So we are experiencing a real backlash, and what happens in Germany, unfortunately, has repercussions for South Africa".
The New Cannibalism: Artificial Needs and Invented Scarcities
The keywords in organ transplantation that require at the outset a radical deconstruction are "scarcity" , "need", "donation", "life", "death " , " supply," and "demand," terms which hide their medical, economic, and technological mediations.
The idea of organ 'scarcity' , for example, is an unexamined premise in the vast literature, ideology, rationale, and practice of transplant surgery and its self-generated institutions, networks, and practices and organ procurement. Organ scarcity is like a mantra and it is invoked, without question, in reference to the long "waiting lists" of expectant "candidates" for various transplant surgeries (see Randall 1991). In the U.S. alone, for example, despite a well organized national distribution system and a law that requires hospitals to request donated organs from next of kin, there are close to 50,000 people currently on various active organ waiting lists. But this 'scarcity' , created by transplant technicians, represents an " artificial" need that can never be satisfied, for underlying it is the quintessentially human denial and refusal of aging and death now facilitated by unprecedented possibilities of extending "brute life " with the organs of the other.
We are using the terms " brute life" or "bare life" -- terms resembling what the Greeks called "zoe", the " simple" fact of living that is common to all organic things -- advisedly . We introduce "brute life" as a parallel concept to "brain stem death", in order to make the point that life and death -- as we once knew them -- have been replaced in the time of transplant surgery with surrogates, facsimiles, and holograms. Death, for example. The determination of the hour (or moment) of has become the province of the State alone, because ordinary mortals are simply incapable of recognizing death in its newly legislated form. In the chilling words of one proponent of brain stem death: " We [experts] must therefore define the moment of the end and not rely on the rigidification of the corpse...or even less, on signs of putrefaction, but rather simply keep to brain death...What follows from this is the possibility of intervening on the false live person. Only the State can and must do this...Organisms belong to the public power: the body is nationalized" (Agambem 1998:165, citing Dagognet).
Meanwhile, the once so called "gift of life" that is extended to terminal heart , lung, and liver patients is , in fact, something other than the commonsense notion of a lived life. For example, the "survival" rates ( recorded in hospital statistics) of a great many liver transplant patients conceals the living-in-death, the weeks and months of extended suffering, a suffering sometimes to the death in hospital of these "successfully" transplanted patients. It is enough to make one well-informed bio-ethicist (M.Rorty, personal communication) state that she has stipulated in her own living will that all her ‘usable’ organs minus her liver may be taken and used by medical science . " But I draw the line", she said, "when it comes to liver transplantation. I have observed too much suffering in those post-operative patients to which I have no desire or intention to contribute."
Every well informed transplant patient today is warned that they are not exchanging a death sentence for a new life, but that they are exchanging one mortal, chronic disease for another. " I tell all my heart transplant patients", said the irrepressible South African heart transplant coordinator, Nursing Sister B.," that after the transplant they must accept that they now have AIDS and that in all probability they will die of an opportunistic infection resulting from the artificial suppression of their immune systems". While Sr. B’s statement is an exaggeration, most transplant surgeons accepted the kernel of truth being presented to the transplant candidate by Sister B.
"Transplant surgery is certainly not for everyone", said Dr. DN , a well known and respected South African heart transplant surgeon. "I myself would rather die than have a heart transplant and be made to live the kind of circumscribed, limited lives of my own patients". And for every romantic story of imagined affections between heart recipients and their altruistic, sacrificial "donors" that appear in tabloid feature stories, Dr. DN could match stories of major, unremitting depressions and of suicides in his personal sample of post- operative heart transplant patients. The surgeon told of a young patient with a brilliant career who jumped out of his hospital room window following the painfully slow recovery from an "excellent" transplant , and another and more recent story of a great concert pianist, who six months after receiving her new heart took a fatal dose of sleeping pills, leaving a note telling of her inability to endure life with a transplanted heart. In fact, Dr. DN admitted that in recent years he had given up transplant surgery in preference for other more positive cardiac surgical alternatives and procedures.
The arguments about 'scarcity of organs' has produced what Margaret Lock (1996, 1997 ) has called rapacious needs, and what Japanese sociologist Tsuyoshi Awaya (1994) unabashedly calls social ( or 'friendly') cannibalism. "We are now eyeing each other's bodies greedily", he says, " as a potential source of detachable spare parts with which to extend our own lives". While unwilling to condemn this newly emerging social contract, Awaya does want organ donors and recipients to face squarely just what kind of social exchange they are engaged in. In fact, in this context the "biosociality" (Rabinow 1996) of a few is made possible through the literal and unilateral incorporation of parts of bodies who, quite often, have no other social destiny than death ( Scheper-Hughes 1992; Castel 1991; Biehl n.d.).
Most importantly, the discourse on organ "scarcity" hides the phenomenal over-production of excess, wasted, and low quality organs that end up daily in hospital dumpsters throughout the world, due to the lack of technical training and social -technical infrastructure in addition to the simple indolence and ill-will of some hospital workers and medical professionals. A great many transplant surgeons, transplant coordinators, and other medical workers whom I interviewed in both South Africa and Brazil during 1997-1998 scoffed at the notion of "organ scarcity" given the appalling rates of youth mortality, accidental deaths, homicides, and transport deaths that produce a super-abundance of young, healthy "cadavers" and potentially usable organs. But these "precious commodities" are lost due to the lack of basic infrastructure: appropriately trained teams in hospital emergency rooms, rapid mobilization of transportation, the basic equipment to preserve "heart-beating" cadavers and their organs. But organ " scarcity" is also reproduced willfully and intentionally due to the increasing competition between public and private hospitals and among "competing" teams of even academic, university-based transplant surgeons who sometimes order their assistants to "dispose" of perfectly good and usable organs rather than allow "the competition" to get their hands on them.
And, while it may be said that "high quality" organs are always in scarce supply, there are plenty of what Dr. S., the director of a Brazilian Eye Bank, referred to as "left-over" organs and tissues floating around the world. Latin America, especially Brazil, has long been a favorite "dumping ground" for rejected products and surplus inventories produced in the first world , including "surplus" or "damaged" organs. In an interview with Dr. S. in 1997 , he complained bitterly about a U.S. based program, The International Cornea Project, which sends surplus tissues to his center. "Obviously," he said, "they aren't the best cornea. The Americans only send us what they have already rejected for themselves." 4
In South Africa, Mrs. R., the director of her country’s major Eye Bank, an independent foundation, generally kept about a dozen "damaged" or "post dated" cadaver eyes ( and not a blue eye among them) in her decidedly informal agency’s refrigerator for purposes that remained unclear. All I was told was that these "poor quality" "cornea" ( but , in fact, they were eyes ) would not be used for transplantation anywhere in South Africa. Meanwhile, the fax machine in Mrs. R’s office continued to spill forth messages and requests from North Africa. And, in his office not far away from the Eye Bank, Dr.B., the aforementioned Cape Town heart transplant surgeon , tried to retrieve an e-mail message from a physician in Southern California who was, according to Dr. B, "hawking his wares" over the Internet: guaranteed, "high quality" human organs, "fresh" airborne delivery promised to surgeons anywhere in the world within 30 days of placing an electronic mail order. "That ‘ colleague of yours’ should be investigated", suggested Dr. B. "Indeed", I agreed, " but hopefully not by me!"
Such questionable and often highly commercialized global exchanges have contributed to the transfer of transplantation knowledge and capacities to previously "under served" areas. And so these trans-national marketing practices are both criticized and defended by transplant specialists. A few years ago, for example, transplant surgeons, under the leadership of Dr. Thomas Starzl, from the University of Pittsburgh Medical School tried to establish an agreement with the Brazilian Association of Organ Transplantation whereby the Americans would exchange 'state of art' medical technology and specialized training in exchange for a supply of human livers. Starzl defended the proposal to Brazilians as an important step toward the development of an "international exchange in organs" guided by laws of supply and demand. Since Brazil had not yet developed the technology and expertise to perform liver transplantation the country had an "abundant supply" of usable livers that could help meet the needs of American patients. Eventually, Brazil would develop, as it now has, its own national liver transplant program and the excess "supply" of Brazilian livers would be kept for domestic "consumption". This controversy over this ‘deal’ was widely discussed and crticised in the Brazilian news media (see Isto E Senhor, 11 de dezembro, 1991; Folha de Sao Paulo , 1 dezembro, 1991,4:1). Above all there was a concern over the State’s loss of control of "national" bodies and body parts, similar to the national furor that accompanied revelations of an active and semi-covert market in Brazilian babies.
The inherent social justice issues and dilemmas in organ transplantation have long made human rights activists, physicians of conscience, bio-ethicts and other concerned intellectuals uneasy and, on occasion, indignant. Today, earlier concerns over the inequitable distribution of the benefits of transplantation and the organ trade -- whether international or domestic -- are being replaced by nationalist sentiments and passions. Indeed, as Agamben, citing Dagognet, noted the donor body , dead or alive, is becoming nationalized. The very idea of "Brazilian livers" going to American transplant patients gives Dr. O., a Brazilian surgeon , "an attack of spleen". Organs, he maintained, are and they should be treated as a " a national treasure", a statement I frequently encountered in Brazil and the New (democratic) South Africa. In commenting on the frequent requests by wealthy foreigners , but especially German, English, and Israeli "ex-colonials" living in Botswana and Nimibia to come to South Africa in search of organs and transplant surgery, Nursing Sister B., a soon to retire transplant coordinator for a large private hospital in Cape Town said: " I can’t stop them, of course, from coming to South Africa or to this hospital, but I tell them in words of one syllable that as far as I am concerned South African organs belong to South African citizens. And that before I see a white person from Nimibia getting their hands on a heart or a kidney that belongs to a little Black South African child , I myself will see to it that the bloody organ gets tossed into a bucket".
At that moment we passed by the private room of Mrs. T. , a "European" woman from Nimibia who had become virtually resident in the hospital where she had been waiting for over a year for a lung transplant. "And she can continue to wait till hell freezes over, as far as I am concerned", said the outspoken transplant coordinator. Nursing Sister B. explained that she was only following the directives of Dr. Zuma, South Africa’s controversial Minister of Health: " Dr. Zuma has said that all organs must go to South Africans first. Absolutely. So, as far as I am concerned, the organs will only go to a foreigner if there are no South Africans who are able to take it. All my foreign patients are told that. We still get quite a few Israeli patients in our hospitals looking for transplant surgery which they say they simply cannot get in Israel because it is against their religious codes, which isn’t true. I have a major problem with this. In Israel they have first world medicine. They don’t need to come to us....But they think that our private hospitals are better equipped and more comfortable. And they think that if they pay out of pocket they can get to the top of the list. It burns me up. So I just tell them to pack up and go home, that I will not give them an organ unless it is an extra organ that is just going to waste and will end up in a bucket. And I have said as much to old Mrs. T. lying in there : ‘No way will you get a lung transplant over and above any South African child’ .....And, the day I find out that they are doing her over and above a South African, I will be out there swinging. I don’t care about my position or my salary. I will go right down there to the ANC office and I will report it directly. I back Dr. Zuma on this one hundred percent."
But Nursing Sister B’s nationalist sentiments are not universally shared by transplant specialists in South Africa , for whom other considerations -- especially the ability of foreigners and "over-border" patients to pay double or more what the State or private insurance companies in South Africa allow for the surgery -- are often uppermost. In one public hospital’s kidney transplant unit, that I visited, for example, a steady stream of paying foreigners from Mauritius was partly responsible for keeping the unit solvent, during a time of severe budget cuts under Dr. Zuma’s policy transferring public funds to primary care.
Meanwhile, the arguments and concerns about social justice , nationalized organs, and the inalianability of body parts are countered by equally passionate arguments on behalf of individual autonomy, including the "right to sell" one's organs (see Daar 1992; Kervorkian 1992; Marshall, Thomas and Daar 1996; Richards n.d.). In all, the current amalgam of positions and discourses points to the constitution of new social ties, conceptions of justice, and social contracts around the mercantile "ends " and uses of the body.
Rest of article here.
Seems to me that everybody in the industry makes a handsome profit out of organ transplant EXCEPT the source of the organs itself.
It would certainly increase supply dramatically.
I could discuss the inherent dignity and worth of every human being, but I doubt you would grasp what I was trying to say. I could say that every person should be treated as an end and never as a means. Again, I doubt that anyone so immersed in such utilitarian calculations would think the claim has any merit.
So I will refer to the article, which I am guessing you didn't read.
The idea of organ 'scarcity' , for example, is an unexamined premise in the vast literature, ideology, rationale, and practice of transplant surgery and its self-generated institutions, networks, and practices and organ procurement. Organ scarcity is like a mantra and it is invoked, without question, in reference to the long "waiting lists" of expectant "candidates" for various transplant surgeries (see Randall 1991). In the U.S. alone, for example, despite a well organized national distribution system and a law that requires hospitals to request donated organs from next of kin, there are close to 50,000 people currently on various active organ waiting lists. But this 'scarcity' , created by transplant technicians, represents an " artificial" need that can never be satisfied, for underlying it is the quintessentially human denial and refusal of aging and death now facilitated by unprecedented possibilities of extending "brute life " with the organs of the other.
And you think that the pressuring, cajoling and weaseling will improve with offers of consideration?
An organ donation is precisely that-- a gift of life from one person to another. Where I come from, it's rude to offer to compensate someone for his or her generosity.
Actually, I think that with current proposals to TAKE organs unless told otherwise (shifting the burden from the hospitals to the donor's family) means that things will get far worse for people. Allowing the family to receive some sort of consideration for their assets will not (IMHO) make this bad situation any worse off then it is now. Alternatives seem to make it worse
And I have nothing wrong with a gift. if you want to give me a car, or any other asset, then you should be free to do so. you should not be EXPECTED to do so, however, and you certainly would be well within your rights to expect a fair value for your asset. My "need" for your asset is not a "Claim" upon your asset
if a human ogran is so much more valuable than another type of asset, say a car, then why should they be prohibited from receiving money for the more valuable asset?
And it is not a gift to the recipient - they're paying through the nose for transplants. All I'm asking (for discussion) is that if you want people to fork over something so valuable, give them some incentive.
Of course it will. Many more people take perfectly good organs to the grave each year than there are recipients on the waiting list. If even a small fraction of them choose to sell their organs for money, it will be a buyer's market. When supply outstrips demand, who needs pressure?
An organ donation is precisely that-- a gift of life from one person to another. Where I come from, it's rude to offer to compensate someone for his or her generosity.
LOL! For the sake of politeness, you would consign 50,000 to death row.
And those organs belong to the dead person. No sick person has the "right" to those organs. Every person should have the ability to make the choice, free of any monetary consideration, as to whether he wants to donate his organs to help save the life of another.
Why do you think that if someone is not willing to donate his organs, he would, free of duress, be willing to sell them?
Exactly! That's the reason for the compensation.
Every person should have the ability to make the choice, free of any monetary consideration, as to whether he wants to donate his organs to help save the life of another.
Everyone has that ability now, but somehow they aren't donating. Furthermore, everyone would still have that ability, even if organs could be sold legally. They are perfectly within their rights to refuse compensation.
Why do you think that if someone is not willing to donate his organs, he would, free of duress, be willing to sell them?
For the same reason that so much more food, clothing and sporting equipment is sold than is ever donated.
(Just curious: do you have an organ donor card?)
I believe that I have checked off that option on my driver's license, but I don't have an "organ donation" card, whatever that is. I wouldn't feel morally compromised by not volunteering my organs, either.
And as long as we're talking about personal details, I have a father who died of end stage renal disease and a 3 1/2 nephew who died of an incurable heart defect, so I know a little about organ failure. How about you? How much do you know about the hell that patients with organ transplants often endure?
Nor should one (or one's soon-to-be survivors) feel morally compromised at insisting on payment for one.
That will do, but please check. It will say "ORGAN DONOR" in prominent letters on your driver's license.
How much do you know about the hell that patients with organ transplants often endure?
Perhaps not as much as you, so I can't help wondering why you'd be so strongly against a measure that would reduce that suffering so dramatically.
Some of the other items on my peeve list were touched on:
1) the sanctity of the dead (you can tell a lot about a culture by how they treat their dead),
2) using persons as a means to an end and the buying and selling of human remains as commodities,
3) cultural taboos on cannibalism and some of the biological implications of the practice (I mean, why not donate your stripped carcass to the hospital cafeteria afterwards? There's plenty of good tissue left)
Indeed, and even more by how they treat their sick and infirm.
The point is that nobody should get on his high horse about how donated organs are good enough, without being willing to donate his own. (Good for you that you are willing.)
I don't expect my survivors to profit from my death,
You do have insurance, don't you? Isn't that in the same category?
I am listed as an organ donor, and I don't expect my family to make any money from it. But I'd feel pretty good about it if I knew they would.
I can't really disagree with that.
I don't consider insurance profiting. I still have income that would be lost. Not to mention it is the insurance company that profits, at least if they're competently managed.
Well, arcane, glad to see you back. (But you are wrong on this one!)
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