Incongruence and tensions in complex organizations: The case of an organ transplantation system*

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This paper conceptualizes complex organizations consisting of heterogeneous types of social relations and identifies the incongruences, cleavages, and tensions inherent in such systems. Social relationships, making up markets, hierarchies and networks are constituted and regulated on the basis of social rule systems. Each operates with its own rationality or logic. When these are combined or integrated into larger systems, the complex structure involves zones of incongruence and tensions at the interfaces between different types of relations. A key principle formulated in the paper is that in any complex system of heterogeneous social relationships, there are zones of incongruence and tension at the junctures or interfaces of different types of relations. A complex medical organization, the organ transplantation system of Sweden, is used to illustrate the conceptualization. The organization of an organ transplantation system entails a high degree of complexity, not only because of its particular medical and non-medical technologies (including transport and communication systems), but also because the system consists of heterogeneous types of social relationships: administrative, professional, market and network-exchange relationships. These coordinate different parts of the system: each individual hospital, sets of hospitals within and outside Sweden, international organ exchange arrangements, physicians and other professional groups, relatives of deceased potential donors, and potential recipients, and so forth. The paper identifies (1) key social relationships in the OTS; (2) the basic characteristics of the relationships and some of their underlying rules; and (3) several zones of structural incongruence and tension in the organ transplantation system.