Lucille Hubbard is a tiny woman. Lucille, not her real name, is poor, black, and dependent on Medicaid and public assistance. After leaving the West Indies for New York as a young adult, Lucille made her living caring for people in need. Before turning 25, however, she learned that she suffered from untreated hypertension and kidney disease. Her physician at a large public hospital told her that her end-stage renal disease was dire. She would need dialysis while waiting for a transplant, or she would die. "I went through so much in my life," Lucille said. "This seemed like the last straw."
After a long struggle over her resident status, Lucille obtained her green card and was put on dialysis while waiting for a donor kidney. After several frustrating years waiting for the United Network of Organs Sharing (UNOS) to offer Lucille what she needed--a dead man or woman's kidney--she finally received a transplant from a brain-dead donor. But the transplant failed after a few years when she rejected the kidney. A serious heart condition and severe anemia made it impossible for Lucille to endure regular dialysis treatments. She tried to find a living donor among friends and relatives, but those who agreed were bad matches.
Her health rapidly deteriorating, Lucille considered an illegal transplant abroad from a paid living kidney donor. Lucille was put in touch with an Israeli-led syndicate of organ brokers, part of a worldwide network of transplant traffickers. The brokers suggested a "transplant tour" to Turkey or Romania, but the price of the prearranged package deal to Turkey was an astronomical US$180,000, and the cheaper option of rural Transylvania was frightening. Lucille feared that she might reject a kidney from a Romanian or Turkish peasant. She needed a cheaper alternative and an organ from a person who was, she felt, biogenetically "closer" to herself, preferably a kidney from a black person. "I am not a racist," she told me. "But I was afraid of going all that distance and facing another organ rejection."
Then Lucille got the call she was hoping for. A broker arranged a bargain transplant tour package: US$65,000, including the US$6,000 fee to pay a poor donor to forfeit a spare part. A kidney seller had been found in a slum of Recife, Brazil: a strong, healthy, Afro-Brazilian man with an O (universal donor) blood type. But Lucille and her donor would have to travel halfway around the world to a private transplant clinic in a prestigious hospital in Durban, South Africa.
The New Medical Ethics
The neo-liberal adjustments of societies to meet the demands of economic globalization have been accompanied by depletion of traditional modernist, humanist, and pastoral ideologies, values, and practices. New relations between capital and labor, bodies and the state, inclusion and exclusion, belonging and extraterritoriality, have taken shape. Some of these realignments have resulted in surprising new outcomes: for example, the demands for "medical" and "sexual" citizenship in countries such as Brazil and India, which have challenged international patent laws and trade restrictions to make lifesaving drugs available. Others--for example, the spread of paid surrogacy in assisted reproduction--have reproduced existing inequalities.
These trends are starkly crystallized in the global markets in bodies, organs, and tissues, which supply the needs of transplant patients willing to travel great distances to procure them. But rather than lament the decline of humanistic social values, I recognize that the material grounds on which they were based have been altered almost beyond recognition.
The entry of market incentives into organs procurement has thrown into question the transplant rhetoric on "organs scarcity." There is obviously no shortage of desperate individuals willing to sell a kidney, a portion of their liver, a lung, or a cornea for a pittance. …