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Marie-Andrée Jacob - Matching Organs with Donors: Legality and Kinship in Transplants

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Book:
Matching Organs with Donors: Legality and Kinship in Transplants
Author:
MarieAndre Jacob
Publisher:
University of Pennsylvania Press
Genre:
Books / Politics
Year:
2012
City:
Philadelphia
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3 / 5
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While the traffic in human organs stirs outrage and condemnation, donations of such material are perceived as highly ethical. In reality, the line between illicit trafficking and admirable donation is not so sharply drawn. Those entangled in the legal, social, and commercial dimensions of transplanting organs must reconcile motives, bureaucracy, and medical desperation. Matching Organs with Donors: Legality and Kinship in Transplants examines the tensions between law and practice in the world of organ transplantsand the inventive routes patients may take around the law while going through legal processes.
In this sensitive ethnography, Marie-Andre Jacob reveals the methods and mindsets of doctors, administrators, gray-sector workers, patients, donors, and sellers in Israels living kidney transplant bureaus. Matching Organs with Donors describes how suitable matches are identified between donor and recipient using terms borrowed from definitions of kinship. Jacob presents a subtle portrait of the shifting relationships between organ donors/sellers, patients, their brokers, and hospital officials who often accept questionably obtained organs.
Jacobs incisive look at the cultural landscapes of transplantation in Israel has wider implications. Matching Organs with Donors deepens our understanding of the law and management of informed consent, decision-making among hospital professionals, and the shadowy borders between altruism and commerce.

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Matching Organs with Donors

CONTEMPORARY ETHNOGRAPHY

Series Editor

Kirin Narayan

A complete list of books in the series is available from the publisher.

MATCHING ORGANS WITH DONORS

Legality and Kinship in Transplants

Marie-Andre Jacob

UNIVERSITY OF PENNSYLVANIA PRESS
PHILADELPHIA

All rights reserved. Except for brief quotations used for purposes of review or scholarly citation, none of this book may be reproduced in any form by any means without written permission from the publisher.

Published by

University of Pennsylvania Press

Philadelphia, Pennsylvania 19104-4112

www.upenn.edu/pennpress

Printed in the United States of America on acid-free paper

10 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

ISBN 978-0-8122-4432-8

CONTENTS

Introduction: Matching

Friends to Death on the Front Page

In autumn 2005, at HaMagen Hospital, a kidney donor, about thirteen hours after a transplant, died following severe internal bleeding in his stomach. The donor was a thirty-eight-year-old man. His family did not know about the donation; he had not informed them. To explain his absence, he had told members of his family that he was on a trip to Barcelona with his secretary. At the request of the family, his body was taken to a forensic institute for an autopsy: a plastic clip that served to close the blood vessels had slipped after removal of the kidney, causing a leak and massive bleeding. The leak could also have been caused by an increase in blood pressure that dislodged the clip. The kidney was supposed to have been removed from the donor three weeks before the donation, but the operation had been postponed because the donors blood pressure had suddenly fallen.

Although I eventually learned about this tragic case from the reflections of people in the HaMagen hospital transplant unit, I became aware of it mostly through newspaper articles, just like everyone else. The media coverage questioned whether this transplant had been a donation or a sale. The front page article from the Maariv newspaper was titled Friends to Death. By putting quotation marks around the words healthy and altruistic, another article played not only on sensationalism, but on ambivalence about whether the donor was healthy enough to donate to begin with, and whether the donation was genuinely altruistic or a sale. The profound confusion about the legality or illegality of purchasing and selling kidneys was highlighted, as this excerpt shows:

police said Wednesday that they would not open a criminal inquiry into whether a man who died Monday after a kidney operation in hospital had actually sold, rather than donated this organ.

Police said that even if it turned out that the man had sold his kidney, it had no authority to investigate the matter, since it is not illegal in Israel to sell one of the bodys organs.

Things dont last long in Israel, a transplant coordinator told me. The day after the death of this donor, when I visited the HaMagen pretransplant unit I saw potential donors sitting in the waiting room before their meetings with doctors, as usual. A group of four people in their thirtiesa patient with his sister, and the patients would-be-donor with her husbandwere talking and commenting about the coverage of the story. They did not seem to find it important or troubling, and they did not particularly question why they had come here today or what might happen to them. A few days after the incident, when I still felt shaken by it, I realized that things seemed to have gotten back to routine in the hospital and that it was business as usual. Noa, an intermediary who was making a business of matching unrelated donors and patients, and who had seemed so distressed by the case, was busy and had several meetings with clients that week.

At that moment, and often during my time in the organ transplant milieu, I felt as though I was lagging behind the people I was hanging out with. I was not in synch with them, delayed. That I wrote reports, papers, and this book several months after I gathered the data that inform it gives me some semblance of distance, but it also confers a feeling of being after, or behind the field.

In telling this opening story as I have, I do not wish to use distance to make a freak-show, to use Kitty Calavitas expression,China, they have death penalty why should I be bothered with what is going on in China perhaps there. Here with donors, it is becoming too complicated.

Noas partner Michal was also increasingly concerned about their business. There are no donors, she said. When I asked her why she thought things slowed down, she told me in a tone of confession: I think it is black magic. You wont believe me, but I believe in it. It is, you know, charming thats my feeling. When pressed to explain, she said: Its jealousy yes, the competitors. We are the biggest in the country, nine donors in four months, its a lot. We have donors, we respect people, and there are people who are jealous.

Perhaps things dont last long in Israel, but the atmosphere was in fact beginning to change in the transplant unit. A couple of weeks after the dead donor incident, I started hearing more and more disheartened comments by people working in the unit. The transplant coordinator lamented that there are no cases, there is nothing. Others simply said that today everyone goes abroad. Others, including the head of the unit, told me they do not think the system as it exists now is sustainable. When I told a senior surgeon that according to my findings living transplants were on the rise, he replied: Yes, but with time, it will go down. You cannot do medicine if it is not moral.

Matching

This book tells the tale of the activities of matchmaking persons for organ transplant purposes in Israel. It interprets the legalistic, technocratic, and bureaucratic dimensions of this matching process in terms of biological compatibility, but also in terms of social compatibility. Matching, as we will see, is directly linked to relatedness in kinship terms, which itself is predicated on a complex nexus of acceptability, legitimacy, proximity, and arms length negotiations. The book uses the adjudication of matching donors and recipients in order to travel back and forth between scenarios of the legal and the illegal, and to question the significance of the thin, at times invisible, line that allegedly divides the two.

Deeply intrigued by the conditions under which contemporary living organ transplants often take place, I wrote this book to show various aspects of creativity in a field where people usually see pure interest or pure altruism, desperate need, market forces, and bureaucracy. The book thus documents the field not by showing what is right or wrong, or true or false, in it, but by evoking the creative, inventive toiling of some its actors.

In order to show the particularity of the Israeli case, the book makes use of vignettes drawn from ethnographic fieldwork conducted in the United States. Not a comparative study per se, the book makes use of comparison at those junctures where Israeli and American practices have explicitly modeled one other, or where a specific aesthetic or normative dissimilarity resonated to broader theoretical and policy debates in transplants.

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