Abstract
One must technologize bodies to conceive of organ transplantation. Organs must be envisioned as replaceable parts, serving mechanical functions for the workings of the body. In this way, it becomes possible to imagine exchanging someone’s organs without changing anything essential about the selfhood of the person. But to envision organs as mechanical parts is phenomenologically uncomfortable; thus, the terminology used to describe the practice of organ retrieval seems to attempt other, less technological ways of viewing the human body. In this paper, I analyze three common metaphors that currently contextualize the process of organ retrieval in English-speaking communities: harvesting the agrarian body, procuring the commodified body, and receiving the gifted body. These powerful images constrain the gaze toward the body in important ways. Every gaze both obscures and reveals. While each of these three metaphors makes sense of some aspects of organ retrieval, each of them is ultimately subject to being overtaken by what Jeffrey Bishop calls the technological imaginary. This imaginary deploys a gaze that obscures important elements of what it means to be human and does violence to parts of the phenomenological experience of transplantation and bodily existence. I argue that no matter how hard one tries to avoid the technological aspect of transplantation practices by embracing nonviolent metaphors—even the metaphor of gifting, which seems the most promising—it will never be possible to fully resist organ transplantation’s violence toward our phenomenological sense of embodiment.
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Notes
Per Lesley Sharp, the general term “organ transplantation” typically refers to three distinct domains: the relinquishing of organs by dead or dying persons or their families, the surgical removal of organs from the deceased, and the surgical placement of organs into a patient whose own organ(s) are failing [1]. In this paper, I use “organ transplantation” in reference to all three domains and “organ retrieval” or “removal” in reference to the surgical removal of organs from a deceased body. Retrieval and removal are not neutral terms, and they too both enable and constrain the gaze in certain ways. However, I am choosing to use them because they seem to be the least morally charged of the available options, and because using them allows me to focus on what is gained and lost by the three dominant metaphors/terms at hand.
The way organs are allocated is complex. While slightly different for each organ type, allocation decisions are based off of algorithms weighing medical need, likelihood of success, wait time, age, survival probability (taking into account comorbidities), prior successful receipt of different organs, prior failed receipt of the same organ, prior living donation of organs, and geographical distance from “donor” (see [4, 5]). This apparently objective utilitarian calculus is aimed at equitability and seeks “to achieve the best use of donated organs” and “avoid wasting organs” [6]. However, there is evidence that “these apparently scientific criteria have measurable effects on access to organs for specific populations (minority, ethnic, age)” [7].
Donation is now the most common metaphor; in the United States, the “Donate Life” slogan and logo is described as “the national symbol of the cause of donation” [8]. Throughout this paper I will occasionally use the word “donor” to refer to those whose organs are retrieved, but I will put it in quotes to reflect the fact that while this is the most common language, it is still a metaphor.
Fredrik Svenaeus recognized three broad metaphors for transplantable organs: gift, resource, and commodity [9]. These would roughly correspond to the three metaphors of receiving/gifting/donation, harvesting, and procurement, respectively. The emphasis of his work is different than mine, but is indeed compatible.
The concept of the gaze has been used by philosophers and critical theorists since the middle of the twentieth century to refer to the act of seeing and perceiving. Notable developers of this concept include Jean-Paul Sartre, in Being and Nothingness (1943), Michel Foucault, in The Birth of the Clinic (1963) and Discipline and Punish: The Birth of the Prison (1975), and Jacques Derrida, in The Animal that Therefore I Am (1997) [10,11,12,13]. In The Birth of the Clinic, Foucault adapts the concept of the gaze to medicine, referring to the act of looking diagnostically at a patient in light of the unequal power dynamics involved in the doctor–patient relationship [11]. Post-colonial, feminist, and womanist scholars have continued to apply this concept in new ways since then. For one example, see Stacey M. Floyd-Thomas’ “Oh Say Can You See?: Womanist Ethics, Sub-rosa Morality, and the Normative Gaze in a Trumped Era” [14].
I will briefly defend my use of the term “violence” with regard to transplantation’s effect on the phenomenological experience of embodiment in a later section. While I do not intend to use the term uncritically, I fully recognize that what is gained and lost in using the term violence deserves to be more fully articulated in future projects.
These paradoxical premises are as follows: “(1) the concept of transplantation as a medical miracle; (2) the denial of transplantation as a form of body commodification; (3) the perception of transplantable organs as precious things; (4) the dependence on brain death criteria for generating transplantable parts; (5) the assertion that organs of human origin are becoming increasingly scarce in our society and require radical solutions; (6) an insistence that the melding of disparate bodies is part of a natural progression in a medical realm predicated on technological expertise; and, finally, (7) the imperative that compassion and trust remain central to the care of dying patients, even when a new corporate style of medicine demands an increasing number of transplantable organs” [1, p. 8].
Space does not permit a thorough explanation of enframing here, but for more on the idea, see [20].
I chose to use the term “agrarian body” (instead of other options such as the agricultural, farmed, or cultivated body) because it denotes both something related to the cultivation of land and someone who advocates a redistribution of landed property, especially as part of a social movement. This has obvious resonance with the project of organ transplantation today.
Some academic journals, such as the American Journal of Transplantation, have banned overt use of harvest terminology [22]. Many organ procurement organizations are also now rejecting harvest language in favor of the term “recovery.” I do not have space to address this latest turn here, but it is interesting to note, particularly because it is evidence that a metaphor that is satisfactory to all parties has not yet been settled on.
This discomfort is evident in more recent popular literature, where “organ harvesting” seems to be a pejorative term reserved for organ retrieval gone awry, seen in headlines and titles such as the following: “Independent Tribunal Finds that China Harvests Organs from Prisoners,” “Bitter Harvest: China’s ‘Organ Donation’ Nightmare,” “Organ Harvests from the Legally Incompetent: An Argument Against Compelled Altruism,” “Israel Harvests Palestinian Martyrs’ Organs,” and “Mexican Cartel Henchman Arrested for Killing Children to Harvest Their Organs ” [24,25,26,27,28]. It is also common to see both harvest language (used pejoratively) and donation language (indicating “good” transplantation practices) in the same article, which I take as evidence that the donation metaphor is being leaned on to fix the problems inherent in the harvesting metaphor. For an example, see “Death Row Organ Harvesting: China to Implement New Donation Programme” [29]. This article uses both harvest language, mainly in reference to the organs taken without consent from executed prisoners, and donation language, in reference to the new program attempting to address ethical concerns. There is an underlying assumption that “organ harvesting” is associated with unethical practices of taking organs from a vulnerable population, while “organ donation” is associated with an opt-in, consent-based, non-commodified system.
Gaylin is quite clear that he would oppose the creation of neomort farms. He ends the article saying: “And yet, after all the benefits are outlined, with the lifesaving potential clear, the humanitarian purposes obvious, the technology ready, the motives pure, and the material costs justified—how are we to reconcile our emotions? Where in this debit-credit ledger of limbs and livers and kidneys and costs are we to weigh and enter the repugnance generated by the entire philanthropic endeavor? … This is the kind of weighing of values for which the computer offers little help. Is the revulsion to the new technology simply the fear and horror of the ignorant in the face of the new, or is it one of those components of humanness that barely sustain us at the limited level of civility and decency that now exists, and whose removal is one more step in erasing the distinction between man and the lesser creatures—beyond that, the distinction between man and matter?” [30, p. 30].
It has since changed its name to the American Foundation for Donation and Transplantation, which I attribute to the inevitable failure of the procurement metaphor and the search for a successful one in donation.
For the rest of these estimates, an infographic, and more information, see [35].
Stiegler argues, against Heidegger, that our deaths are not the horizon toward which we live, but rather, there is no horizon because we cannot adjust to technics (see [39, 40]). This may be part of the reason we are able to conceive of the transhumanist ideal of living forever, leaving behind our biology and entering into a technological eternity. Is this thinking also at work in the transplantation ideology, which idealizes and heroizes the idea of living on after our deaths?
Quote is from a male patient.
I should also acknowledge that the terms “giving/gifting,” and “donating” have different connotations and are often used differently in different contexts. However, I will use both here, because concept of organ donation has been built using tropes of gift-giving.
Contemporary philosophy has seen a resurgence of the theme of gift, particularly in the work of Jacques Derrida and Jean-Luc Marion, owing partly to disagreement over whether Mauss was correct [47; 49, p. 6]. It is important to note that Mauss’s work, while seminal, is not a comprehensive theory of gift and was intended only as a collection of initial observations with suggestions for further study. Additionally, gift ideology arising from other cultures than the ones studied by Mauss may have different and fruitful directions for scholarship in this area. I use him here because he remains the most complete and widely cited sociological scholar of gift-giving behavior.
In fact, some DMVs are operated by OPOs, presumably so that they can get as many drivers to become organ “donors” as possible. Organ donation promotional materials are often displayed on the walls of these DMVs.
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Mason, J. To harvest, procure, or receive? Organ transplantation metaphors and the technological imaginary. Theor Med Bioeth 43, 29–45 (2022). https://doi.org/10.1007/s11017-022-09563-6
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DOI: https://doi.org/10.1007/s11017-022-09563-6