Medical Decision-making and Logics of Negotiation in Living Organ Donation

Natascha Sánchez Hövel

doi:10.13189/ujph.2016.040206

Abstract

End-stage renal disease requires replacement therapy including renal transplant. Far from being a matter of biomedical criteria or individual choice, the decision whether preferring a dead or a living donor depends on availability. In Spain, cadaveric donation has been the hegemonic practice with an only recent introduction of living donation. The present paper focuses on the logics in the process of decision-making and negotiation between medical professionals and living donors while shaping, developing and giving meaning to an emerging social practice. Concepts of blood, courage, legitimacy and nature are central in the discourse of decision-making inserted in traditional constructions of kinship.

Highlights

Spain has been holding a leading position in organ transplantation being the percentage of cadaveric donation the highest worldwide
Every universe operates with its own common sense and the transplantation universe is no exception
Whereas donor selection and acceptance is constructed as a biomedical criteria based process, the invisible and naturalized but shared social constructions on good and natural donors versus bad and unnatural ones are, the dominant criteria

Summary

Introduction

Spain has been holding a leading position in organ transplantation being the percentage of cadaveric donation the highest worldwide. Every universe operates with its own common sense and the transplantation universe is no exception This particular common sense is characterized, on the one hand, by clearly dichotomous logics of good and bad, health and disease, human and machine, life and death, global and local, giving and receiving; logics introduced by the subjects from their experiences prior to their entry in the transplantation universe. These logics coexist and cohabitate, on the other hand, with others that are ambiguous, provisional, uncertain, frightening and changing. Beck goes even further by pointing out that “the more de-limitation occur, the more decisions are to be taken; this will be characterized by an increase of boundary constructs of provisional morality...” [2]

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