Abstract
BackgroundIn their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant.MethodsUsing the PubMed database, we retrieved 1,120 articles from the top ten internal medicine journals and 4,644 articles from the two main transplantation journals (Transplantation and American Journal of Transplantation). Out of the internal medicine journal articles, we analyzed those in which organ transplantation was the main topic (349 articles). A total of 349 articles were randomly selected from the transplantation journals for content analysis.ResultsIn our sample, organ transplantation was described in positive terms and was presented as a routine treatment. Few articles addressed ethical issues, patients’ experiences and uncertainties related to organ transplantation. The internal medicine journals reported on more ethical issues than the transplantation journals. The most important ethical issues discussed were related to the justice principle: organ allocation, differential access to transplantation, and the organ shortage.ConclusionOur study provides insight into representations of organ transplantation in the transplant and general medical communities, as reflected in medical journals. The various portrayals of organ transplantation in our sample of articles suggest that Fox and Swazey’s critiques of the procedure are still relevant.
Highlights
In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals
Among the 349 articles retrieved from the two transplantation journals, 77.4% were from Transplantation
There was some variation between the internal medicine and transplantation journals in terms of the distribution of types of organ transplantation (p < 0.001)
Summary
In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. . .” [4], p.197 They eventually decided to leave the field for reasons stated in the last chapter of their seminal work Spare Parts (1992): the routinization of the practice; the overidealization of its potential results; the triumphalist attitude of professionals who believe “death is our enemy”; nonchalant attitudes regarding the complexities of gift exchange; the massive financial investment in transplantation as opposed to other types of health care; and a general reluctance to consider the inherent uncertainties in this area of medicine [4]. Medical and scientific advances do not rule out uncertainty, but modify its content and create new areas of uncertainty that were not previously known [5,6]
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