Tourism DA
Markets leaves the poor worse off and results in less supply and lower quality
organs – iran proves
Arora, 12 (Ishika Arora, contributing writer, journal of international studies at UCSD, THE
HUMAN MEAT MARKET: AN ANALYSIS ON THE LEGALIZATION OF THE ORGAN
TRADE, March 14, 2012, http://prospectjournal.org/2012/03/14/the-human-meat-market-ananalysis-on-the-legalization-of-the-organ-trade/ )
Defenders of an organ market also reference Iran’s monopsony in which the government is the only legal
buyer of organs. In this model, all middlemen and medical professionals involved are not paid for
the transplant. The patients rely heavily on government-subsidized treatment and on the kindness
of the volunteers involved. This allows poor citizens to not only sell their organs but receive transplants when in need. It also
increases the umbrella of government healthcare by providing free care to those who donate organs. In addition, they claim that
sellers come from all socioeconomic classes and not disproportionately from the poor. Because of a lack of
data, however, it is unclear whether Iran’s method has truly eliminated organ waitlists or if
there are major loopholes. In an ideal environment, the Iran model would seem to be effective. However, it is
important to consider the economic culture and healthcare system of a nation before
implementing such a model. For example, could this system work in the U.S. where healthcare is not
universal and economists are major supporters of a free market system? In India, would the lack of funding for governmental
regulation organizations as well as for healthcare allow this model to be effective? The Iran model is worth consideration. Overall, it is
possible that governmental regulation could, to a certain extent help remove some of the social issues involved in organ trading.
Assuming an organ market was introduced, however, would it solve its initial goal of increasing a healthy supply of available organs
for ill patients? An analysis of its effectiveness as a market will show that it will not be able to solve this issue and will create
additional problems. The purpose of legalizing organ trading is to save the lives of thousands of patients on the transplant waiting lists.
It is possible, however, that introducing
this new market may not increase the number of organs for
transplantation. This idea can be understood by creating a parallel between the blood market and
organ trade. In Richard Titmuss’s study, The Gift Relationship, he reveals that altruistic donation is
more efficient. Titmuss claims that introducing blood markets “represses the expression of altruism
[and] erodes the sense of community.” Thus, those who would previously donate blood for purely
altruistic purposes may decline to give a part of their body for monetary compensation. If this occurred
in the organ market, it may not result in an increase of available organs. Altruistic donation is
clearly a better model. In addition, while it would seem that legalization of organ trading would create
national and international quality standards, in reality it might create an “unclean” supply. Because many of the
donors would be of lower economic status, their desperation in destitution could cause them to
lie about the health of their organs. In addition, these sellers may have little access to healthcare,
creating a situation in which they may truly endanger their lives by parting with an organ their body
cannot afford. Not only will an organ market be unable to increase a healthy supply of organs, it will also create other issues.
From a purely economic perspective, legalizing the organ trade may force more poor citizens into
selling their organs. In anthropologist Lawrence Cohen’s study of the organ belt in rural India, he found that most of the
money that sellers received was used to paying back loans they had previously taken to feed
their families. An increased prevalence in the organ trade will cause organs to be considered an
economic asset that everyone can part with. This will cause an increase in loan collaterals
and people who do not want to sell their organs will have access to fewer loans. Essentially,
poor people will have to “mortgage their organs” in order to find a reasonable loan. As Bhakta
already stated in her article, legalization will not eliminate the black market. However, the organ market will not be effective for
several reasons. Not only will it not solve the issue of low organ reserves, it will also contaminate the current supply and exploit
poorer citizens. The reason there are so many problems caused by organ trading is because it is not meant to be an international
market. Instead, Israel’s “no give, no take” policy could be implemented in which those who opt out of donating their organs would be
placed at the bottom of the transplant list should they ever need one. In addition, other actions should be taken to increase the number
of yearly altruistic donations. A more aggressive social campaign could be the solution, but a human meat market is clearly not the
answer.
Altruism
Giving financial compensation for organs crowds out altruism and reduces
supply of organs – US blood market proves
Rothman, 06 (S. M. Rothman and D. J. Rothman, Professor of Sociomedical Sciences (in the
Center for the Study of Society and Medicine) and: Deputy Director, Center for the Study of
Society Medicine “The Hidden Cost of Organ Sale” American Journal of Transplantation; 13
February 2006, http://www.societyandmedicine.columbia.edu/organs_challenge.shtml )
These expectations, however, may be disappointed. Since the 1970s, a group of economists
and social psychologists have been analyzing the tensions between ‘extrinsic incentives’—
financial compensation and monetary rewards, and ‘intrinsic incentives’—the moral
commitment to do one’s duty. They hypothesize that extrinsic incentives can ‘crowd out’
intrinsic incentives, that the introduction of cash payments will weaken moral obligations.
As Uri Gneezy, a professor of behavioral science at the University of Chicago School of
Business, observes: ‘Extrinsic motivation might change the perception of the activity and
destroy the intrinsic motivation to perform it when no apparent reward apart from the
activity itself is expected’ (7–12). Although the case for the ‘hidden costs of rewards’ is certainly
not indisputable, it does suggest that a market in organs might reduce altruistic donation and
overall supply. Perhaps the most celebrated analysis of the tension between intrinsic and
extrinsic incentives is Titmuss’ work in blood donation. His book, The Gift Relationship
(1971), argued that the ‘commercialization of blood represses the expression of altruism
(and) erodes the sense of community’. Payment undermined the altruistic motivations of
would-be blood donors. Titmuss supported his hypothesis by comparing blood donation in the
United States and the United Kingdom. Analyzing data from England and Wales over the period
1946–1968, where the sale of blood was prohibited, Titmuss found that the percentage of the
population who donated blood and the amount of blood donated steadily increased. By
comparison, in the United States, where the sale of blood was allowed, donations declined.
Because U.S. data were more fragmentary, Titmuss drew as best he could on a variety of
sources, including surveys, municipal statistics and comments by medical experts and blood
bank officials. Nevertheless, he confidently concluded: The data, ‘when analyzed in
microscopic fashion, blood bank by blood bank area by area, city by city, state by state’,
revealed ‘a generally worsening situation’ (12).
Markets harms the vendors, selling an organ provides no economic
improvement, worse health conditions, and social stigma – empirics prove
Budiani-Saberi, 08 (Debra. A. Budiani-Saberi, Center for Bioethics, University of
Pennsylvania, Philadelphia, PA, Organ Trafficking and Transplant Tourism: A Commentary on
the Global Realities, 14 APR 2008, http://onlinelibrary.wiley.com/doi/10.1111/j.16006143.2008.02200.x/pdf)
What then of this emerging worldwide population of live kidney vendors? In Pakistan, the SIUT group has carefully
detailed a sample cohort of (n = 239) vendors in a followup— the outcome all very troubling The
majority of these CLDs (93%) who sold a kidney to repay a debt and (85%) reported no economic
improvement in their lives, as they were either still in debt or were unable to achieve their
objective in selling the kidney. The disturbing report by the SIUT group becomes not only an accounting of the Pakistani
experience but an indictment of the international transplant community because it overlooks the plight of
the donor whose interests are just as valid as the recipients. Egypt is one of the few countries that prohibits
organ donation from deceased donors. In the absence of an entity to govern allocation or standards for transplants, the market has
become the distribution mechanism. Egypt is also one of the countries in which COFS has conducted extensive field research and
long-term outreach service programs for victims of the organ trade. In-depth
longitudinal interviews conducted by
Budiani reveal that 78% of the CLDs (n = 50) reported a deterioration in their health condition.
This is likely a result of factors such as insufficient donor medical screening for a donation, pre-existing
compromised health conditions of CLD groups and that the majority of employed CLDs
reported working in labor-intensive jobs. A kidney sale does not solve the most frequently given reason for being a
CLD, 81% spent the money within 5 months of the nephrectomy, mostly to pay off financial
debts rather than investing in quality of life enhancements. CLDs are not eager to reveal their identity;
91% expressed social isolation about their donation and 85% were unwilling to be known
publicly as an organ vendor. Ninety-four percent regretted their donation (13). The studies
in Pakistan and Egypt are consistent with findings in India (14), Iran (15) and the Philippines
(16) that revealed deterioration in the health condition of the CLDs. A long-term financial disadvantage is evident
following nephrectomy from a compromised ability to generate a prior income level. The
common experience also entails a social rejection and regret about their commercial donation. These reports are consistent with the
COFS experience in the CLD interviews; a cash payment does not solve the destitution of the vendor.
Organ Sales
A market would thrive off capitalist exploitation and commodification of the
poor, creating cycles of structural violence so the rich can live forever.
Moniruzzaman, 11 (MONIR MONIRUZZAMAN (Ph.D. U of Toronto; MA U of Western
Ontario) is an assistant professor jointly appointed in the Department of Anthropology and
Center for Ethics and Humanities in Life Sciences at Michigan State University. “Inhumanity
of Human Organ Trade” 2011,
http://archive.thedailystar.net/forum/2011/October/organ.htm )
The advancement
of transplant technology has created a thriving market of human
organs worldwide. In China, organs are harvested from executed prisoners, while in South Asia, “fresh” organs are
removed from the bodies of the poor populations. While poor people are at a high risk of organ
failure (due to their dire living conditions), they usually die without receiving an
organ transplant, let alone dialysis. At the same time, they serve as mere suppliers of
body parts to prolong the lives of the affluent few. The organ trade is gravely
exploitative, as Indian Dr. J. V. Thachil argues: “It is criminal to exploit the poor in order to keep
less than one percent of the population alive”. In this trade, few of us would choose to sell
our organs, yet the desperately poor are left with few prospects other than to sell
their body parts. Those who benefit from this trade are recipients, brokers, doctors,
and businessmen, while the poor are tricked and forced to sell their organs, and as a
result endure severe suffering. Selling a kidney has devastating economic, social, and
health impacts on kidney sellers. My research on 33 Bangladeshi kidney sellers
reveals that 94% of them could not improve their economic circumstances by selling
a kidney. Most sellers sold their kidneys to pay off their debt, but were back in debt within few years. In fact, 80% of these
sellers did not receive the entire payment that they were promised. When the money was spent, they engaged in organ
brokering to support their families. In addition, Bangladeshi sellers became
socially isolated, were
stigmatized, and experienced marital conflict due to selling their kidneys. Most of them not
only regretted selling an organ, but also decided not to recommend that anyone sell a kidney. Further, these sellers
experienced frequent illness, pain, weakness, and weight loss, as well as anxiety,
distress, and depression after selling their kidneys. While the medical community has put the risk of
death for kidney donors due to surgery at one in 3,000 (according to Bruzzone and Berloco, 2007), the death rate of
Bangladeshi sellers could be higher, due to their terrible living condition and the fact that none of them received the promised
post-operative care. What is more, the organ trade violates humanist, cultural, and religious principles, such as holism,
integrity, and sacredness of the body, along with human dignity. The Bangladeshi sellers I interviewed believed that Allah was
the owner of their body parts, and therefore they felt that selling His gift is intrinsically wrong. They
stated that they
could not preserve the wholeness of their body, and therefore were living in an
undignified state, which they described as “sub-human.” Furthermore, organ trade is a
slippery slope practice. We have already seen not only human kidneys, but also liver lobes,
increasingly become market commodities in Bangladesh. How far can we go with the organ trade? Can
we chop a leg and a hand from the poor, assuming that one of these body parts is
sufficient for them? An organ trade would have much wider negative impacts, as well. It would likely
impede the establishment of a cadaveric organ donation program. Also, it would create a
market where wealthy patients would buy organs from the poor, whose price is
lower. An organ trade would encourage moneylenders to force the poor, or husbands
to force their wives, to sell organs for economic profit.
Capitalism causes global wars, warming, environmental destruction, and
structural violence – Constant drive for accumulation makes global economic
collapse inevitable
Robinson 06 Professor of Sociology at the University of California, Santa Barbara
(William I., Critical Globalization Studies, Chapter 2, “Critical Globalization Studies”, ed by R
Richard P Appelbaum,
http://www.soc.ucsb.edu/faculty/robinson/Assets/pdf/crit_glob.pdf SW)
We are living in troubling times. The
system of global capitalism that now engulfs the entire planet is in crisis.
There is consensus among scientists that we are on the precipice of ecological holocaust,
including the mass extinction of species; the impending collapse of agriculture in major producing
areas; the meltdown of polar ice caps; global warming; and the contamination of the oceans, the
food stock, water supply, and air. Social inequalities have spiraled out of control and the gap
between the global rich and the global poor has never been as acute as it is in the early twenty-first century. While absolute
levels of poverty and misery expand around the world under a new global social apartheid,
the richest 20 percent of humanity received in 2000 more than 85 percent of the world’s wealth,
while the remaining 80 percent had to make do with less than 15 percent, according to the United Nation’s oft-cited annual
Human Development Report (UNDP, 2001). Driven by the
imperatives of overaccumulation and
transnational social control, global elites have increasingly turned to authoritarianism,
militarization, and war to sustain the system. Many political economists concur that a
global economic collapse is possible, even probable.
Our alternative is to vote negative to refuse to participate in rescue operations
for global capitalism, only a totalizing rejection can prevent extinction.
HEROD 2004 James Herod, Getting Free,
http://site.www.umb.edu/faculty/salzman_g/Strate/GetFre/06.htm
It is time to try to describe, at first abstractly and later concretely, a strategy for destroying capitalism. This strategy,
at its most basic, calls for pulling time, energy, and resources out of capitalist civilization and
putting them into building a new civilization. The image then is one of emptying out capitalist structures,
hollowing them out, by draining wealth, power, and meaning out of them until there is
nothing left but shells. This is definitely an aggressive strategy. It requires great militancy, and constitutes an attack
on the existing order. The strategy clearly recognizes that capitalism is the enemy and must be destroyed, but it is not a frontal
attack aimed at overthrowing the system, but an inside attack aimed at gutting it, while simultaneously replacing it with
Thus capitalist structures (corporations, governments, banks, schools, etc.)
are not seized so much as simply abandoned. Capitalist relations are not fought so much as
they are simply rejected. We stop participating in activities that support (finance, condone) the
capitalist world and start participating in activities that build a new world while simultaneously undermining the old.
something better, something we want.
We create a new pattern of social relations alongside capitalist relations and then we continually build and strengthen our new
pattern while doing every thing we can to weaken capitalist relations.
In this way our new democratic, nonhierarchical, non-commodified relations can eventually overwhelm the capitalist relations and
force them out of existence. This is how it has to be done. This is a plausible, realistic
strategy. To think that we could create a whole new world of decent social arrangements overnight, in the midst of a crisis,
during a so-called revolution, or during the collapse of capitalism, is foolhardy . Our new social world must grow
within the old, and in opposition to it, until it is strong enough to dismantle and abolish capitalist
relations. Such a revolution will never happen automatically, blindly, determinably, because of the inexorable, materialist
laws of history. It will happen, and only happen, because we want it to, and because we know what we’re doing
and know how we want to live, and know what obstacles have to be overcome before we can live that way, and know how to
distinguish between our social patterns and theirs. But we must not think that the capitalist world can simply be ignored, in a
live and let live attitude, while we try to build new lives elsewhere. (There is no elsewhere.) There is at least one thing, wageslavery, that we can’t simply stop participating in (but even here there are ways we can chip away at it). Capitalism must
be explicitly refused and replaced by something else. This constitutes War, but it is not a war in the traditional
sense of armies and tanks, but a war fought on a daily basis, on the level of everyday life, by millions of
people. It is a war nevertheless because the accumulators of capital will use coercion, brutality, and murder, as they have
always done in the past, to try to block any rejection of the system. They have always had to force compliance; they will not
hesitate to continue doing so. Nevertheless, there are many concrete ways that individuals, groups, and neighborhoods can gut
capitalism, which I will enumerate shortly. We must always keep in mind how we became slaves; then we can see more
clearly how we can cease being slaves. We were forced into wage-slavery because the ruling class slowly, systematically, and
brutally destroyed our ability to live autonomously. By driving us off the land, changing the property laws, destroying
community rights, destroying our tools, imposing taxes, destroying our local markets, and so forth, we were forced onto the
labor market in order to survive, our only remaining option being to sell, for a wage, our ability to work. It’s quite clear then
how we can overthrow slavery. We must reverse this process. We must begin to reacquire the ability to live without working
for a wage or buying the products made by wage-slaves (that is, we must get free from the labor market and the way of living
based on it), and embed ourselves instead in cooperative labor and cooperatively produced goods. Another clarification is
needed. This strategy does not
call for reforming capitalism, for changing capitalism into
something else. It calls for replacing capitalism, totally, with a new civilization. This is an important
distinction, because capitalism has proved impervious to reforms, as a system. We can sometimes
in some places win certain concessions from it (usually only temporary ones) and win some
(usually short-lived) improvements in our lives as its victims, but we cannot reform it
piecemeal, as a system. Thus our strategy of gutting and eventually destroying capitalism
requires at a minimum a totalizing image, an awareness that we are attacking an entire way
of life and replacing it with another, and not merely reforming one way of life into
something else. Many people may not be accustomed to thinking about entire systems and social orders, but everyone
knows what a lifestyle is, or a way of life, and that is the way we should approach it. The thing is this: in order for capitalism
to be destroyed millions and millions of people must be dissatisfied with their way of life. They must want something else and
see certain existing things as obstacles to getting what they want. It is not useful to think of this as a new ideology. It is not
merely a belief-system that is needed, like a religion, or like Marxism, or Anarchism. Rather it is a new prevailing vision, a
dominant desire, an overriding need. What must exist is a pressing desire to live a certain way, and not to live another way .
this pressing desire were a desire to live free, to be autonomous, to live in democratically
controlled communities, to participate in the self-regulating activities of a mature people, then capitalism
could be destroyed. Otherwise we are doomed to perpetual slavery and possibly even to
extinction.
If
Case
They have to win the aff resolves every barrier to solve – fear of selling,
commodification, and stopping altruistic donations
Andrew, 09 - University of Mississippi School of Law, Attorney (Hughes, “You Get What
You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models”, 42 Vand.
J. Transnat'l L. 351 (2009))
There are several ways in which people’s beliefs about organ transplantation hinder the
effectiveness of current U.S. organ procurement policy and could also hinder efforts to reform
that policy. The popular entertainment media, including books, movies, and television, tap into
fears of organ snatching and “distort both facts and the capabilities of science and physiology.”56
Urban myths promote fear of an open organ market with stories about travelers waking in tubs of
ice with their kidneys missing.57 Historical accounts of English medical schools during the nineteenth century purchasing
cadavers at high prices from body snatchers and murderers have also fueled this fear of an open organ market.58 Whether justified or
not, this fear inhibits people’s willingness to give real consideration to organ procurement methods
that involve incentives for providing transplantable organs.59 Among other common
misperceptions that also prevent people from embracing organ donation is the false perception
that wealthy and famous people receive priority in the allocation of organs.60 This perception is
likely based in part on the news coverage that occurs whenever a celebrity receives an organ
transplant.61 Arguably the most important sets of beliefs that affect organ transplant policy are deepseated moral and ethical beliefs about the transfer of human organs. Lawmakers have been persuaded by
these moral and ethical objections that “the risks of legalized markets [for organ sales] are too great to justify their benefits.”62 The
morality argument is based on the “fundamental concern that the dignity of man would be debased if life, health or body parts were
exchanged across a market.”63 Courts, legislatures, philosophers, and scholars have all argued that “the sanctity of
the body is essential to human dignity and autonomy” and, therefore, that treating the human
body “as a commodity to be bought and sold . . . would have a dangerous and dehumanizing
impact on society.”64 According to one commentator, this “concern about the debasement of humanity” that underlies
prohibitions on organ sales is “[t]he same concern . . . that has led to laws against selling one’s life, freedom, children, or sexual
services.”65 Another commentator describes the ban on human organ sales as one of “myriad examples in law where individual
autonomy gives way to the state’s morality interest,” such as laws against “[d]rug use, prostitution, bigamy, and incest.”66 Another
widespread concern about human organ sales is the fear that legalizing such transactions would
have a perverse impact on organ distribution—that “disproportionately poor people, often
minorities, would be persuaded or exploited into selling their kidneys simply to escape debt.”67 At
the same time, “[c]onversely, it would primarily be the wealthy who could afford to purchase them.”68 Poor people might be “priced
out of access to organs in compensation systems,” and “the organs to which they would have access might be of lesser quality.”69
Thus, by this argument, critics of legalized organ markets could be justified on distributive justice grounds, if banning organ sales is
necessary to “prevent poor people from becoming the only ‘sellers’ . . . [and to] provide both poor and wealthy individuals equal
access to those organs being supplied—regardless of their ability to pay.”70 Many critics allege that legalizing organ
sales would discourage purely altruistic organ donations, offsetting (if not entirely then at least to some degree)
the expected increase in organ supply produced by a compensation system.71 According to this theory, a compensation
system would deter voluntary donors who are ethically opposed to receiving payment for
transplantable organs.72 Moreover, altruistic organ donation may have a value independent of the organ procurement context
per se, based on the potential for selfless donation to help bind society together.73 By this argument, an organ procurement system
that involves compensation and discourages altruistic donation might have other harmful effects on society.
Other barriers to organ donations
Andrew, 09 - University of Mississippi School of Law, Attorney (Hughes, “You Get What
You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models”, 42 Vand.
J. Transnat'l L. 351 (2009))
Despite the attempts of the UAGA and NOTA to encourage organ donation, the numbers indicate that the
current organ procurement system in the United States has failed to keep up with demand. A large
majority of U.S. citizens – as many as 81% - profess to support organ donation, but only onequarter have actually registered as donors. 34 The myriad of reasons for this discrepancy include a lack of
immediate personal benefit to donors; fear of confronting one’s own or one’s loved ones’ mortality; the
difficulty of persuading the bereaved to donate their loved ones’ organs; a lack of public
awareness of organ shortage; and the failure of doctors, hospitals, and family members to
discover the deceased’s intent to donate.35 Some commentators have explicitly identified U.S. transplant law as the
culprit of this discrepancy and of the consequent problem of organ shortage.36 One legal failure is the lack of adequate incentives to
donate.37 Another legal failure concerns the fact that, despite U.S. citizens’ professed support for organ donation, “the law presumes
an unwillingness to donate,” and then, even when a donor has expressed intent to donate, it de facto permits the donor’s next of kin to
override that intent by refusing to consent to the donation.38
Organ sales dehumanizes and reduces individuals to a set of parts
Sharp 01 (Lesley A, Sharp is an Ann Whitney Olin Professor of Anthropology. Lesley Sharp is also a Senior Research Scientist
in Sociomedical Sciences in the Mailman School of Public Health, Columbia University. “Commodified Kin: Death, Mourning, and
Competing Claims on the Bodies of Organ Donors in the United States”, American Anthropologist, New Series, Vol. 103, No. 1
(Mar., 2001), pp. 112-133, http://www.Jstor.org/stable/683925.)
As I have argued in detail elsewhere, human
bodies, their parts, and processes are regularly
commodified in biomedical contexts (Sharp 2000). The United States (and, more generally, the West)
exhibits a rich history of body commodification, where cadavers and blood, for example, have
long been viewed as commercial goods that can be bought and sold for medical use (Hogle
1999:23, 35; Richardson 1996). Human reproduction defines yet an¬other realm of embodied social
worth, where examples range from the hiring of wet nurses and, now, surrogate mothers, and
the open marketing of placenta, sperm, and ova; further, genetic materials are now prime targets
for a host of parties who recognize their commercial value. Or¬gan transplantation occupies
a dominant position in this specialized arena of American commodities, since its his-tory has
consistently been characterized by open discussions of commodification and legislative
decisions that guide the potential sale and use of human organs. Such develop¬ments have
then shaped the legitimate use of other human body parts and processes. More specifically, midtwenti¬eth-century concerns focused on the legality of retrieving organs from comatose patients connected to respirators, generating
such responses as the Harvard Ad Hoc Com-mittee, a presidential commission, and congressional hear-ings spanning from the 1960s
and into the 1980s (Capron 1983; Cutler, ed. 1969; Gregory 1981; Harvard Medical School 1968; President’s Commission 1981). A
primary medical concern throughout has involved the desire for ac-cess to transplantable
organs drawn from patients with irre-versible brain damage. Although far from uniform, all states
have passed legislation that dictates localized stand-ards for brain death criteria and organ
procurement (Wood 1994). Today, scores of human parts may be retrieved from a single donor
to replace those in a multitude of recipients (Smith 1994; compare Leary 1997 on artificial organs). These
include the major organs as well as a host of tissues taken from fetal to septuagenarian
bodies. Under such leg-islation, organ transplantation has grown into a multimil- lion-dollar
industry in the United States. The success of organ transfer in this country rests upon a host of
medical technologies that assure a steady pool of potential organ recipients. Briefly, these technologies in-clude the invention
of the dialysis machine during World War II, the ventilator (or respirator), the heart-lung ma-chine, and the development of the
immunosuppressant cy- closporine in the 1970s. Such developments—and their re-finements—now insure the survival of many
recipients awaiting and following transplantation, rendering the tra-jectory of organ transfer a medical reality in this society (Caplan
brain-dead patients
become medicalized cyborgs sustained in temporary stasis by complex technologies in
1983:23; Fox and Swazey 1974,1992:3ff.; Wood 1994). Another result is that, as Hogle (1995) asserts,
anticipa¬tion of organ procurement (cf. Helman 1988; Kaufman 2000). Facilitated by technological
developments, the accom-panying process of body commodification rapidly objecti-fies and
thus dehumanizes the organ donor, who is reduced to a set of parts that may be removed
and placed in the bod-ies of the chronically ill. As such, their bodies and organs emerge as
fetishized objects. As Marx (1978) asserted, commodification is a transformative process. Further, the
enigmatic quality of commodities lies in the mystification of their origins—that is, the
socioeconomic processes that generate them. This transformative quality of commodification (cf. Appadurai 1986; Pietz 1985) is central to the realm of organ procurement, which relies on
elaborate forms of metaphorical thinking that ultimately obscure the origins of reusable
body parts, a process that also allows for multiple readings of their social, medical, and
personal significance by transplant and procurement specialists, as well as organ recipients
and donor kin (Sharp 2000:292, 305). In short, organ procurement transforms donor bodies into a set
of highly valued commodities whose socio-medi-cal value promptly transcends professional
concerns for their humanity (cf. Kopytoff 1986).
Do not let the affirmative force their scarcity hype on you. Their system is ever
demanding but never fulfills, and targets vulnerable
Sharp 01 (Lesley A, Sharp is an Ann Whitney Olin Professor of Anthropology. Lesley Sharp is also a Senior Research Scientist in
Sociomedical Sciences in the Mailman School of Public Health, Columbia University. “Commodified Kin: Death, Mourning, and Competing Claims on
the Bodies of Organ Donors in the United States”, American Anthropologist, New Series, Vol. 103, No. 1 (Mar., 2001), pp. 112-133,
http://www.Jstor.org/stable/683925.)
An anxiety that underlies body commodification and that drives procurement efforts insists
that there is a chronic shortage of organs that is rapidly growing worse (Clark 1993; Engelhardt
1984; Featherstone 1982; Fletcher 1969; Levenson and Olbrisch 1987). Interestingly, discus¬sions of how to alleviate
this scarcity rarely place blame squarely upon the transplant industry itself. There is little
mention of transplant surgery as a popular and lucrative medical specialization; the
enthusiasm among surgeons to place increasing numbers of patients on waiting lists; or retransplantation as yet another source of organ demand. Rather, the lay public remains
culpable: this is a nation of selfish individuals who withhold and thus waste precious
organs. Further, the reluctance to donate stems from en-trenched “social factors,” a vague
label that encompasses a wide array of responses, including religious views about body
integrity, beliefs about physical and psychic suffering after death, or a rejection of the
legitimacy of brain death criteria. Even hospital staff may succumb, denying OPO staff set
on procurement access to potential donors. In re-sponse, public or professional education is
posited as the great panacea that can erode resistance. A related professional assumption is that throughout
much of the 1990s cadaveric donation rates have leveled at just over 4,000 per annum. Yet close examination of data reported
by the United Network for Organ Sharing (UNOS), a federally funded agency that coordinates the placement of organs nationwide,
reveals that the number of donors identified each year has, in fact, slowly yet steadily risen
since at least the late 1980s. Interestingly, UNOS rarely hails such increases (yet see UNOS 1994 and 1995). A significant
exception appears in the 1998 annual report, which states that “overall number of organs recovered for transplant from cadaveric
donors in 1998 exceeded 20,000 for the first time,” jumping 5.6% from the previous year (UNOS 1999a: 1). More careful analysis of
these data shows that donation has in fact increased incrementally overall by approximately 40%
since 1994 (UNOS/OPTN 1987-1994). This downplaying of increased organ avail¬ability and, thus,
the potential massaging of data render carefully orchestrated professional knowledge a
reality.2 Regardless of the actual figures, the transplant industry is indeed faced with a
dilemma that in other contexts would be a capitalist’s dream: the demand for these precious
goods far exceeds the supply; given the growing nature of this industry and its ever
burgeoning capabilities, this sim¬ply will not change. Human organs thus inevitably remain
scarce and precious commodities that define an increas¬ingly competitive medical
marketplace, where the brain dead serve the needs of the chronically ill who are in
des¬perate need of repair. A host of responses has arisen in an effort to quell the current demand for organs; I will name
only a few. Hospi¬tal mergers enable once competing transplant teams to share in the limited spoils generated by the nation’s
inten¬sive care units; and recent attempts to introduce national reforms by D. Shalala, U.S. Secretary of Health and Hu¬man Services
under President Clinton, sought to alter liver distribution policies (Stolberg 1998). Numerous other new and thus radical techniques
and approaches are designed to increase the donor pool overall: for example, organs
are now taken increasingly
from non-heartbeating cadavers (UNOS 1994) and from donors age 60 and older (UNOS 1999a: 1);
kidneys are being donated by living strangers to patients in need (Grady 1999); sections of healthy donors’ livers are placed in the
bodies of others (UNOS 1999b:7); while experimental
cloning, organ regeneration, bioartifi¬cial
techniques, and xenotransplantation define future prospects that many hope will solve
chronic scarcity (Fish¬man et al., eds. 1998; Hunkeler et al., eds. 1999). Among the most controversial policies has been
Pennsylvania’s experimental decision to offer burial fees as a donation in¬centive. This is of
special interest here because it so un¬abashedly commodifies human organs. Yet other propos¬als include
presumed consent laws and tax exemptions for donor kin (Bowden and Hull, eds. 1993; DeJong et al. 1995; Keyserlingk 1990:1005;
Khanna 1992; Richardson 1996: 77; Sells 1990; Siminoff and Leonard 2000).
Procurement organizations pressure individuals into donating and prevent
resistance through biological control
Sharp 01 (Lesley A, Sharp is an Ann Whitney Olin Professor of Anthropology. Lesley Sharp is also a Senior Research Scientist in
Sociomedical Sciences in the Mailman School of Public Health, Columbia University. “Commodified Kin: Death, Mourning, and Competing Claims on
the Bodies of Organ Donors in the United States”, American Anthropologist, New Series, Vol. 103, No. 1 (Mar., 2001), pp. 112-133,
http://www.Jstor.org/stable/683925.)
In the face of this worrisome shortage of human body parts, employees
of the nation’s myriad OPOs are
increas-ingly driven by an intense spirit of competition. OPOs are currently organized into ten regions
scattered across the country, and UNOS, the primary umbrella organization that oversees the distribution
of transplantable organs, regularly pits regions against each other in its reporting on annual
procurement rates. For example, Midwestern Re¬gion 9 (which includes Michigan, Illinois, and Indiana) was praised in the
1998 annual report for exhibiting the largest increase in donors (UNOS 1999a:3). Organ com¬modification is central
to OPO operation procedures: each site must generate projected annual donor figures and
then submit these in budget form to UNOS, which then deter¬mines the annual operating
budgets for all OPOs. As a re¬sult, some procurement professionals endure intense
pres¬sure from superiors who try to impose monthly donor quotas. In order to understand the nature of
procurement work, throughout 1995 I attended the semimonthly meetings of one east coast, urban-based OPO, from which I draw examples below. These meetings in some ways typify OPO work nationwide; in others they are unique. Each OPO has developed its
own style for handling case reviews, deter-mined by its directorship, internal organizational structure, size, and its own mix of
personalities. Conversations with professionals employed elsewhere, however, reveal many similarities to the meetings I attended.
First, throughout the country case reviews occur in some form in all OPOs, where discussions are generally guided by information
re¬corded on standardized donor information sheets required by UNOS. Second, their general purpose is to present indi¬vidual cases
(in the meetings I attended, all donor cases for the previous two weeks were discussed) and to review rea¬sons for success or failure.
Again, at the OPO where I con¬ducted my research, supervisors were always careful to praise employees for successful cases,
especially in those where the donor (or kin) proved to be especially difficult to manage. Failed cases were handled as lessons for what
might be done in the future if confronted with similar prob¬lems. A third characteristic of these meetings is that they fostered
camaraderie among professionals who, on a daily basis, worked alone or, at most, in pairs for extended hours in urban intensive care
units. The tenor of the case review meetings I witnessed ranged from light-hearted discus¬sions to informal yet emotionally draining
peer support group meetings to occasional verbal thrashing sessions by supervisors, a spectrum of styles reported as typical by professionals at other OPOs as well. The
overall demands of the job, compounded by the trauma these
professionals witness regularly in hospital wards, account for high job burnout rates unmatched in other domains of
organ transfer.3 Approximately fifteen years ago, OPOs were, as the founding employee of one of the nation’s oldest agencies
explained, “shoebox operations” comprised of a few staff members often with backgrounds in grassroots organizing who shared all
administrative and clinical responsibilities (cf. Rhodes 1991 on mental health workers). In response to an ever-growing transplant
industry, procurement has be¬gun to assume a corporate aura, especially in the nation’s larger centers. OPO staff have grown from a
handful to fifty or more employees, and their roles have become in¬creasingly specialized. One role significant to this discus¬sion is
that of the family counselor, who approaches the next of kin in order to acquire consent for donation. An¬other relatively recent
innovation that has significantly in¬creased donor rates is the “decoupling” strategy, whereby brain death is explained to kin who are
only later asked to consider donation. As one counselor explained, “Some¬times I have to work on families for days before they give
consent.” Counselors remain available in the hospital around the clock, providing kin with emotional support; they may also serve as
targets for verbal and even physical abuse as kin struggle with the news of impending death, or react to subsequent requests for organ
employ, in their own words, “aggressive” strategies to encourage
reluctant kin to donate. Persuasion may hinge upon such messages as: through donation the lost
loved one may live on in others; once troubled indi¬viduals may be redeemed by saving innocent lives; or that donation
donation. Some¬times counselors
may stave off the medical examiner (a message that is effective
among those fearful of a criminal
investi¬gation). Informants from several agencies (located outside Pennsylvania) also reported that
clandestine offers have occasionally been made by co-workers to assist with burial or other
costs as strategies designed to persuade reluctant donor kin to grant consent.4 Today family
counselors are culled from a variety of backgrounds that are increasingly non-clinical: they may be ministers, rabbis or hospital
chaplains, social workers, or, most recently, thanatologists, all of whom are highly valued as specialists on grief and mourning. In a
number of the nation’s larger OPOs today, a family counselor typically works in tandem with another OPO staff member whom I shall
refer to as a clinical coordina¬tor. These are medical
technicians (and often experienced critical care nurses) who monitor
potential donors’ bodies, trying to keep them from “crashing” before procurement can
occur. Aided by specialized drugs and sophisticated technologies, they control blood
pressure, watch for signs of brain hernia, and stave off sepsis. The ideal donor is one who
suffers solely from irreversible brain trauma—from an automobile collision, a severe brain
hemorrhage, or a gunshot wound to the head. In such cases, one hopes that the body itself
remains relatively unblemished for organ retrieval. Placed on respirators (or, as labeled in any
other context, “life support”), these donors’ hearts continue to beat on as oxygenated blood is fed
from the lungs; this in turn sustains other vital organs, which can continue to function for
hours, days, or longer. In some hospitals, house staff may withdraw from patients whom they
per¬ceive as unsalvageable, allowing the coordinator free and full-time access even before
formal consent has been ac¬quired or brain death declared. If kin grant consent, and if the
donor is, in fact, viable, the coordinator or yet another surgical specialist will then orchestrate the actual
retrieval of the donor’s parts, working beside transplant surgeons who arrive and remove organs for their respective
patients. The now anesthetized (albeit previously declared dead) do¬nor is eventually
disconnected from the respirator, becom¬ing, in the end, a hollowed-out body ready for
delivery into the hands of the mortician.