Review of “The Political Economy of Organ Transplantation: Where do Organs Come from?”

Abstract

This thought-provoking work examines how the relationships of organs, tissues, and cells transferred from one body to another through donation, sale, or gift are mediated by the state, market, and family. The book is a thorough review of the sociological, anthropological, and ethical literature surrounding transplant organs but encased within the author’s own personal dilemmas and lived experience. His work skillfully underscores the negotiations and accommodations inherent in the use of these technologies and reveals the situatedness of decisions that belie any simplistic readings of the ethics of transplantations. Hagai Boas, himself a kidney transplantee, argues that the two main approaches in the social sciences to transplantation are driven largely by metaphors obscuring the difference between transplantation and trafficking: the first from critical medical anthropology that has focused primarily upon trafficking and equated transplantation with black market exchanges; and the other from transplantation medicine which has framed transplants primarily in terms of gift metaphors. Although I felt his characterizations of the anthropological literature failed to place it within its context (i.e. studies of subaltern donors in low income settings), he notes such discourses hide the situatedness of decisions about transplants, the realities of organ scarcity, the needs of patients who face eventual inevitable organ rejection, and the ability of organ transplantation to enhance the quality of life of transplantees and save lives. Rather, his path between these utopian and dystopic views of transplantation requires paying close attention to the political economy of transplanted organs as entities that are curated, prepared, and transferred from the bodies from which they are taken to the bodies in whom they are transplanted. He argues that organ transplantation is mediated by social institutions: the state (through regulations, donor registry schemes, and allocations); the market (in which organs are valued and may be sold and paid for); the family (who may offer organs to family members, or make decisions to finance transplants), or any combination of the three. This allows him to demonstrate how the mobility of organs and access to transplants is shaped by very specific social, cultural, legal, and political circumstances.