Matching Organs with Donors: Legality and Kinship in Organ Transplants

Matching Organs with Donors: Legality and Kinship in Organ Transplants

Matching Organs with Donors: Legality and Kinship in Organ Transplants

Matching Organs with Donors: Legality and Kinship in Organ Transplants

Synopsis

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 transplants--and the inventive routes patients may take around the law while going through legal processes.

In this sensitive ethnography, Marie-Andrée Jacob reveals the methods and mindsets of doctors, administrators, gray-sector workers, patients, donors, and sellers in Israel's 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.

Jacob's 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.

Excerpt

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 technique used for removal of the kidney was laparoscopy or “keyhole surgery,” less invasive than open surgery; the media mentioned that it “is used in 80 percent of all such procedures in the U.S. and has been successful in more than two dozen live donor kidney removals so far this year.” 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 donor’s 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 Ma’ariv 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:

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