Tue Mar 9, 2004

The Sociology of Blood and Guts

The director of UCLA’s Willed Body Program, Henry Reid, has been arrested for illegally selling human body parts from perhaps as many as 800 cadavers. A second man, Ernest Nelson, has also been arrested and charged with receiving stolen goods. Nelson claims that he routinely showed up hacksaw-in-hand at UCLA, with the full knowledge of the Program, and left with knee joints, hands and other body parts. UCLA officials describe Nelson and Reid as a pair of criminals operating without the knowledge of the University. The practice came to the attention of other administrators when Nelson wrote a letter to UCLA demanding $241,000 compensation for body parts he had been forced to return after UCLA banned transfers of cadavers to people or organizations unaffiliated with the University.

Exchange in human goods is a topic near and dear to all my major organs. At the moment, I’m trying to write the conclusion to a book about some aspects of it. Over the past twenty years or so in the United States, a very large and complex system of tissue procurement and distribution has grown up, mostly to service the demand created by new medical technologies. Some of these, like heart and kidney transplants, enjoy broad public support. Others, like the use of processed cadaveric skin for lip enhancement and penis enlargement, bone screws for orthopedic surgery or cadavers in automobile crash tests are less well known.[1] With the exception of the plasma market in the U.S., almost all solid organs and human tissues come from voluntary donors. The increasing demand for body parts has led to a lively debate (going back to the 1970s) on whether some kind of market in human body parts is a good idea. Although this is a very important question, in my view debate about it misses a lot of what’s really interesting about actually-existing systems of exchange. The wide range of empirical variation in rates of blood and organ donation across countries, and within the U.S., for example, complicates the simple contrast between giving and selling that underpins arguments about markets for organs. So does the terrific amount of cultural work that goes into maintaining the viability of organ donation, on the one hand, and real markets for things like human eggs, on the other.

Demand for organ transplants now outruns the supply of organs by a factor of about ten, and bioethicists and many medical professionals have come around to the view that some kind of financial reimbursement might increase the supply of organs. The main thing standing in the way is the terrific success of their own efforts, since the 1970s, to convince people that organ donation was a morally worthwhile practice rather than a ghoulish reprocessing of the dead. Central to this effort was the idea that organ donation is the “gift of life,” a way for a person to go on doing good after their own death and a means for grieving families to see their loved ones live on in a quite literal way.

Now, it is important not to romanticize gift-giving. The obligation to return a gift with something of equal or greater value can keep power relations ticking along nicely. There is nothing like an exchange of gifts for insulting someone to their face. But gifts do tend to be very particular. They are for someone special. They are not given at random. Even anonymous gifts, such as the gift of a human heart or liver, tend to take on this character. Both donor families and recipients tend to have an ideal picture of the other partner in the exchange. Much of the early media coverage of organ transplants encouraged this tendency, focusing as it did on particular people—often children—desperately in need of a transplant. The wrinkle in this idea is that, as Viviana Zelizer has shown, similar processes can be found at work within market exchange. Egg donors are really egg sellers, for instance, but much of the exchange in this market takes place in an atmosphere of gift-giving. The money is still there at the center of it all, of course, but it won’t do to say that the associated gifts and other features of the transaction are simply window-dressing for a simple sale.

The key interface is not the individual-to-individual transaction (largely a myth anyway, in this area) but the transition into the secondary exchange of human goods—the world where donated hearts go, where donated skin is rendered, and where knee joints and heart valves and tendons are processed. This organizational layer does not have the (even fictively) particularized quality that individual decisions to donate or sell may possess. It is concerned with maintaining a reliable supply of homogenous products to cope with a generalized demand. It shouldn’t be a surprise that UCLA’s program has been in trouble before for mixing donated bodies with medical waste and animal remains and dumping them in a landfill. That sort of tendency is built into complex organizations, and it persists whether or not the raw materials are sourced via markets or gifts. It’s a consequence of the industrialization of exchange in human goods, not its commodification.

fn1. I hope that link won’t get us banned by filtering software.