Bodies, Commodities, and Biotechnologies

by Sharp, Lesley A.

• ISBN13: 9780231138383
• ISBN10: 0231138385
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-10-01
• Publisher: COLUMBIA UNIV PRESS

Summary

In the United States today, the human body defines a lucrative site of reusable parts, ranging from whole organs to minuscule and even microscopic tissues. Although the medical practices that enable the transfer of parts from one body to another most certainly relieve suffering and extend lives, they have also irrevocably altered perceptions of the cultural values assigned to the body.Organ transfer is rich terrain to investigate& -especially in the American context, where sophisticated technological interventions have significantly shaped understandings of health and well-being, suffering, and death. In Bodies, Commodities, and Biotechnologies, Lesley Sharp probes the ideological assumptions underlying the transfer of body parts, the social significance of donors' deaths, and the medico-scientific desires surrounding complex forms of body repair. Sharp also considers the experimental realm, in which nonhuman species and artificial devices present further opportunities for recovery and for controversy.A compelling scientific investigation and social critique, Bodies, Commodities, and Biotechnologiesexplores the pervasive, and at times pernicious, practices shaping American biomedicine in the twenty-first century.

Table of Contents

List of Illustrations	ix
Acknowledgments	xi
INTRODUCTION	1	(6)
1. THE GOOD DEATH
Managing and Memorializing the Dead	7	(40)
2. BODY COMMODITIES
The Medical Value of the Human Body and Its Parts	47	(30)
3. HUMAN, MONKEY, MACHINE
The Brave New World of Human Hybridity	77	(30)
EPILOGUE
The Future of the Body Transformed	107	(6)
Notes	113	(4)
References Cited	117	(8)
Index	125

Excerpts

Copyright information

Chapter Two, "Body Commodities: The Medical Value of the Human Body and Its Parts" (excerpt)

Marketing the Human Body

A prominent debate within the contemporary realms of ethics and the law concerns the biomedical use of human bodies. Discussions focus regularly on themes of individual ownership as well as more widespread notions of community stewardship. The former concern -- that is, our individual rights to our own bodies -- emerges as inherently American. In contrast, in nations with a strong socialist bent, such as Sweden, for example, attempts to assert individual rights to corpses seem absurd, for as the state cares for its citizens when alive, the citizen's body parts are offered willingly to others in need at the time of death. (Some experts argue that this accounts in part for why Sweden's rate of donation answers its current demand for transplantable organs.)

In American discourse on the body, however, we regularly pose questions that attest to our sense that our bodies belong to us. If we can will our bodies to science, can we -- or can our heirs -- then claim that we own our bodies, or at the very least, assert rights to how they will be used? Does this mean that our bodies are our own property? If reusable parts can be extracted from our bodies, who holds rightful claims to these? Can or should we hold sway over the body's parts if they are of value on the open market? Should we be able to exert direct control over how these might be bought, sold, or used? And what are the dominant social sentiments regarding the willingness to be transformed into -- or reduced to -- a wide assortment of reusable parts? Furthermore, what about those miniscule bits of us whose value hinges on the encoded genetic information embedded within? Who are the rightful shareholders? Should it be us, individually and alone, or should we share ownership with others who are deemed genetically similar?

As this line of questioning illustrates, commodification is ultimately a transformative process. When Marx wrote of the strangeness of commodities, he was especially troubled by the inevitable mystification of a commodity's "origins," meaning specifically the exploitative labor processes that engendered its production. I, too, am deeply interested in the question of origins, although my intent here is to go well beyond an interrogation of labor practices. Of particular concern to me, on the one hand, are the medicalized processes that transform human body parts into objects of intense desire and, on the other, the subversive social responses that ultimately challenge the mystification of commodified organs' origins. More precisely, when body parts are given anonymously, culled from the dead, and then transplanted into ailing patients, involved lay parties may experience an intense longing to trace their exchange and, thus, track down one another. As I will illustrate below, the heavy medical reliance on the donor body as a source of transplantable parts may mean that involved lay parties, whose members began as strangers, may long to establish bonds of intimacy. Encounters between these parties circumvent professional and medicalized practices that commodify body parts and relegate patients to the generic category of "organ donor."

This second chapter, "Body Commodities," builds on the material discussed in the first, so I wish to revisit, very briefly, a few key points to underscore the linkages at work. The realm of organ transfer offers interesting examples of how we think about the human body and its reusable parts in this society. My comments here concern professional versus broader social responses to the culling of parts from dead bodies, or what I refer to as cadaveric donors. Organ transfer is particularly well suited to discussions of body commodification because standardized clinical practices, policy guidelines, and legislation concerning rights of body ownership and access were set in place forty to fifty years ago, specifically in response to the growing success of organ transplantation.

A factor of great significance is that cadaveric organs are almost always given anonymously in the United States. That is, details of donors' identities are not disclosed to patients when they receive transplanted parts. An important theme that will emerge later is that mandated anonymity encourages intriguing -- yet unintended -- consequences, engendering new forms of sociality between the surviving kin of organ donors and organ recipients. When organs are transferred from an anonymous, dead stranger, transplant recipients must ultimately imagine who their donors had been. All involved lay parties -- including organ recipients and the surviving kin of deceased donors -- are both moved and perplexed by the overwhelming evidence that death can beget life.

There is also an assortment of professionals whose work typically overlaps with the experiences of organ recipients or donor kin. At one end are transplant surgeons, nurses, and social workers; at the other are procurement specialists, who promote organ donation, acquire consent from the kin of dying patients, and might also sometimes assist surgeons in extracting usable parts from donors' bodies. Organ transfer's success is understood by this array of professionals as hinging on strict rules of decorum, where dominant ideological principles guide language, thought, and behavior.

As I noted earlier, in the United States transplantable human organs are understood as rare and precious goods, acquired through the generosity of donor kin to assist strangers whose very lives depend on their receipt. Perhaps the most important principle at work is that organ transfer relies exclusively on the "donation" and not the sale or forcible taking of human body parts. Donation is so intrinsic to organ transfer in this country that it is regularly referred to as "giving the gift of life," an act that is understood as helping others who might otherwise die from organ failure. All involved parties also emphasize that transplantable organs are in scarce supply, and this is asserted regularly and convincingly in the statistics quoted in transplant literature, by the media, and during transplant-related events. As noted in chapter 1, less than one third of those awaiting transplants actually receive matching organs each year, and, as UNOS and other organizations now estimate, approximately sixteen patients die each day waiting. These grim figures lie at the heart, so to speak, of anxieties over organ scarcity in America. As also noted in the previous chapter, transplantable organs are at times even described as precious national resources.

When we speak of organ transfer as "donating life," or of organs as "precious national resources," we rapidly transform parts of ourselves into commodified objects of desire. But why -- and how -- do we allow such transformations to occur? One factor is our aversion to speaking openly about death. When we refer to the heart, lungs, liver, kidneys, and intestines as "gifts of life," we avoid dwelling on the horrors of massive head traumas and brain death; the deep sadness of sudden tragedy; the frustrations of hospital-based deaths; and the surgical realities involved in removing organs from the torsos of donors. As such, the language of the gift economy mystifies key aspects of organ transfer.

Among the most difficult topics to broach with those intimately involved in this realm is whether in commodifying bodies, we commercialize them, too. Clinical medicine is rife with specialized language, ranging from technical jargon for tools and techniques to slang that debases human patients to euphemisms designed to soften the emotional blow of devastating news (Coombs et al. 1993). Organ transfer professionals likewise draw on distinctive terms and turns of phrase in describing aspects of their own work. In the interest of exploring the paired themes of commodification and commercialization, I will focus briefly on euphemistic ways of talking about how transplantable body parts are procured in America.

Powerful forms of rhetorical policing (or what Richardson has dubbed "semantic massage" (Richardson 1996) simultaneously underscore the life-affirming aspects of organ transfer while silencing discussions of body commodification. Consider this: if organs are donated as "gifts of life," how can we speak of a commerce of the body? Are not such objects in fact offered willingly by kin with the understanding that this might save several lives at once? As we shall see, the language of the gift economy is bolstered by national legislation, because the marketability of the body is highly dependent on how parts are categorized medically, socially, and legally in this country. Let us then consider aspects of the human body trade as a means to understand specifically what happens with transplantable human organs.

Legal Aspects of the Human Body Trade in America

The commerce in parts reaped from human bodies has expanded in extraordinary ways in recent years. Whereas half a century ago blood products figured prominently, our reproductive capacities are now marketable, too, such that financial compensation may be offered for sperm or eggs or surrogacy services. The reasons driving the legal commodification of these and other body parts over others are somewhat obscure and contradictory. One common argument is that it is permissible to market replenishable parts of ourselves because we incur no harm in doing so. Further, these replenishable products are in endless supply. As a result, laws permit us to sell our hair, blood, plasma, and sperm to various agencies around the country.

Ova, on the other hand, are always described as "donated," rather than bought, sold, or marketed. They stand in contrast to other body products in part because of their finite quantity. A woman's egg supply is understood as limited to the number with which she was born and, further, is regularly described as deteriorating in quality as she ages. Also, unlike sperm or blood harvesting, the procedures necessary for egg extraction are potentially dangerous. Egg "donors" are nevertheless understood as being "compensated," but never paid, for their time, commitment, and effort. To pay a woman for such "labor" would debase the assumed Samaritan act of assisting an infertile woman in need (Ragoné 1994, 1999). Such rationalizing nevertheless raises questions about the customary practice of compensating men financially for their reproductive capacities, whereas women are exempt (beneath the guise of protectionist rhetoric, at least) from the open marketing of their bodies (and their parts).

Similar restrictions apply to whole organs. Although organ donors are sources of great medical worth, the value of their donations is clouded in a highly specialized language that privileges the gift economy and obscures references to commodification. This is especially evident where reusable human organs of cadaveric origin are concerned. Nevertheless, those who work for OPOs regularly quantify the worth of individual bodies, speaking of the "seven" or even "nine organ donor" as the quintessential success case. The donor body's value is similarly quantified by UNOS and other organizations, who regularly report that a single dead body may generate fifty or more reusable parts. This figure has climbed steadily over the last few decades as clinical medicine finds even more ways to reuse the dead (Feher 1989; Flye 1995; Hogshire 1992; Kimbrell 1993; Machado 1998; Murray 1996).

Transplantable organs define a special focus in legislative initiatives that carefully restrict the human body trade in America. Most importantly, it is illegal to buy and sell transplantable organs. In response to an enterprising broker's attempts to offer kidneys on the open market, the Uniform Anatomical Gift Act of 1968 criminalized the selling of human organs for profit. (For a systematic review of amendments and drafted revisions, consult CUSL 1980; 1988.) As a result, all firms involved in the oversight, procurement, and redistribution of human organs are nonprofit groups, and these include the nation's OPOs as well as UNOS, which directs, on a daily basis, all OPOs' activities. The charges associated with organ transfer are understood as covering donor management, organ removal and processing, transportation, and administrative costs. They are not for individual organs themselves.

There is no denying, however, that organ transplantation is among the more lucrative medical professions in the United States and the accomplishments of a transplant unit ensure much local prestige for any hospital. Transplant surgery is also exorbitantly expensive, with an individual patient's costs ranging from tens to hundreds of thousands of dollars, depending on the organs involved and potential clinical complications. Yet transplant patients often link the range of costs incurred directly to certain kinds of organs over others. Professionals may even willingly do the same: in one instance from my research, patients based in a particular transplant ward were handed price sheets that detailed the differential costs for kidneys versus livers or hearts as part of the informed consent process (Sharp 1994). At least at the transplant end of organ transfer, it is well known that "donated" organs bear heavy price tags.

Other contradictions emerge when we consider human tissues -- a category that includes corneas, skin, bone, and ligaments. In such contexts, the question of whether the body is commercialized is even more complex. Tissues are retrieved in tandem with organs and they, too, are donated by kin, who give their consent for both categories of body parts at the same time and often on the same release forms. Legal loopholes play a large part in exempting tissues from the restrictions imposed on whole organs, and thus they are just as likely to be handled by for-profit as by nonprofit groups. In fact, we readily acknowledge that tissues are commercial artifacts because we refer to involved agencies as bone, skin, and eye "banks." Economic survival as a nonprofit tissue firm is proving increasingly difficult: as the staff of one agency explained to me during a recent on-site visit, they are now considering shifting to for-profit status so that they can survive financially in a market now dominated by commercial firms.

Regardless of which body parts are acquired from the dead, charges that easily range between five and six figures are passed on to the consumer (that is, to the transplant recipient) or to their insurance provider. A dominant premise asserted in all quarters, however, is that issuing direct payments to surviving kin for the deceased's body parts threatens an already precarious realm of medicine that relies so heavily on selfless acts of human kindness. It also debases the sanctity of the body. The thought that financial compensation for body parts would quickly degenerate into sanctioned forms of blood payment, engendering exploitative practices that would prey primarily on the desperately poor, is also deeply abhorrent.

Nevertheless, anxieties over organ scarcity regularly spark debates on whether surviving donor kin should be compensated somehow. When I first entered this field of research in 1991, innovative reward proposals were generally dismissed immediately because they defied dominant assertions that linked body integrity to a respect for the dead. Professionals collectively expressed open disgust for blatant forms of body commodification, a stance guided in large part by the medical imperative to do no harm. Today, all involved parties embrace the need for ever more diligent public education campaigns, yet within the last six years financial incentives have surfaced as the most popular proposed solutions. The momentum of this approach is evident in recent policy statements issued by the American Medical Association, which, in partnership with UNOS, advocates investigating the viability of financial rewards (AMA 2003; Delmonico et al. 2002). Proposals now discussed frequently and openly at transplant events include offering donor kin a maximum $10,000 tax credit, a funeral expense supplement, a charitable donation credit, or a direct payment.

A dominant assumption driving these proposals is that Americans will commit more willingly and eagerly to organ donation when offered financial rewards. Proponents insist that such an approach is ethical because it will save more lives by alleviating the organ scarcity crisis. All realize, however, that such proposals require delicate public handling: the fear is that such policies will be interpreted as attempts to purchase human organs directly from the living or from surviving kin of the deceased. Such efforts risk being interpreted as nothing less than offers of blood money, especially when economically disenfranchised parties are involved.

Some of these recent policy initiatives nevertheless have shaped new state laws, and Pennsylvania (which houses several of the nation's most prestigious transplant centers) provides a case in point. State Act 102, which became effective in March 1995, was instigated by the late Governor Robert Casey, who was himself a liver and heart recipient. Act 102 offers a comprehensive approach to public outreach and donor motivation, strategies that other states and federal agencies have since duplicated. Yet another earlier and more controversial component involved offering partial financial assistance to donor kin for funeral costs (Nathan 2000). Although this section of the act failed to win full support in the legislature, at one point it generated a serious proposal for a three-year pilot project designed to test the effectiveness of $3,000 in funeral assistance to donor kin. If implemented, it would have been the first instance in this country of providing direct and legalized financial compensation to surviving family members. Enthusiastic consideration of this experimental strategy in some quarters marks an important watershed in proposals generated in response to anxieties over organ scarcity. Recently, Wisconsin passed legislation that reimburses living donors for travel expenses and lost wages, an example other states are certain to follow.

When I ask donor kin if financial incentives would have eased their decisions, they readily fall back on the language of the gift economy as a means to frame their responses. They assert regularly in interviews that financial rewards would debase organ donation and its associations with Samaritan acts of kindness. Such sentiments are especially pronounced among parents who have consented to organ donation when faced with their children's tragic deaths. In short, donor kin are far less concerned with reimbursement than they are with forms of remembrance.

Donor kin are also (sometimes painfully) aware of the ways organ transfer commodifies human bodies, and especially how it redefines known individuals as sources of reusable parts. This form of depersonalization is an unfortunate yet inevitable part of cadaveric donation, largely because organs are donated anonymously. Both procurement and transplant professionals regularly stress that anonymity is central to organ transfer's success. It allows donor kin to mourn their losses privately, without complications that might arise from exuberant or nosey recipients. Furthermore, too much knowledge of the donor might initiate pathological behavior in a recipient who is already deeply troubled by what some label "survivor guilt," or else by the sense that part of a dead person now resides within them. Transplanted organs should be viewed simply as replacement parts; also, the donor is dead and thus is no longer there. As such, the transplanted organ can harbor no trace or memory of its origins.

As a result of these professional understandings, it has long been considered taboo within the realm of organ transfer for donor kin and the recipients of their loved one's organs to be in direct contact with one another. In order to comprehend this longstanding policy we must look back -- albeit briefly -- at earlier cases of surgical experimentation that eventually gave rise to this successful realm of medical practice.

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