Last Best Gifts: Altruism and the Market for Human Blood and Organs

208 Pages·2006·1 MB·English

by  Kieran Healy

Last Best Gifts

Last Best Gifts
Altruism and the Market for
Human Blood and Organs
KIERAN HEALY
The University of Chicago Press Chicago and London
KIERAN HEALYis assistant professor of sociology at the University of Arizona.
The University of Chicago Press, Chicago 60637
The University of Chicago Press, Ltd., London
© 2006 by The University of Chicago
All rights reserved. Published 2006
Printed in the United States of America
15 14 13 12 11 10 09 08 07 06 1 2 3 4 5
ISBN: 0-226-32235-1 (cloth)
ISBN: 0-226-32237-8 (paper)
Library of Congress Cataloging-in-Publication Data
Healy, Kieran Joseph, 1973–
Last best gifts : altruism and the market for human blood and organs / Kieran Healy.
p. cm.
ISBN 0-226-32235-1 (cloth : alk. paper)—ISBN 0-226-32237-8 (pbk. : alk. paper)
1. Procurement of organs, tissues, etc. 2. Procurement of organs, tissues, etc.—Economic
aspects—United States. 3.Transplantation of organs, tissues, etc.—Economic aspects—United
States. 4. Tissue banks—United States. I.Title.
RD129.5.H43 2006
362.17'84—dc22 2005030538
oThe paper used in this publication meets the minimum requirements
of the American National Standard for Information Sciences—
Permanence of Paper for Printed Library Materials, ANSIZ39.48-1992.
For my parents,
DERRY AND MARY HEALY

Contents
List of Illustrations ix
Acknowledgments xi
1 Exchange in Human Goods 1
Procurement rates for blood and organs vary strikingly. This varia-
tion has its roots not in individual dispositions to give but in insti-
tutional differences between procurement systems. Organizations
responsible for procuring blood and organs create and sustain al-
truism by providing opportunities to give and by producing and
popularizing accounts of what giving means.
2 Making a Gift 23
Advocates of organ transplantation have, over the past thirty years,
articulated and refined a cultural account that has changed public
understanding of organ procurement and exchange. This account
has described and motivated donation, in part by addressing two
problems: harvesting organs both introduces a utilitarian calcula-
tion at the time of death and threatens to place a cash value on
human life. As structural pressure on the transplant system has in-
creased, so has the possibility of commodification. Recent changes
in discourse should be understood in the context of organizational
efforts to produce viable accounts of caring and altruism and to
manage the expressive dimensions of money.
3 The Logistics of Altruism 43
There is no donation without a procurement organization, but some
organizations are more successful than others at finding donors.
Structural and organizational characteristics of organ procurement
organizations explain much of the variation in procurement rates
within the United States. Small changes in organizational strategy
can have large effects on procurement. These findings are in sharp contrast to the
emphasis on individual motives for giving found in both public accounts of dona-
tion and much of the research on donation.
4 Collection Regimes and Donor Populations 70
Procurement systems also vary cross-nationally. Data on blood collection in Eu-
rope shows that variations in national collection regimes affect both donation
rates and the composition of the donor pool. Some systems attract many once-
off donors, others have smaller populations of regular donors. Blood collection
regimes produce their donor populations by providing differing opportunities
togive to different sorts of people. For example, Red Cross systems take greater
advantage of personal ties to transfusion recipients than do state-run systems or
those based on blood banks.
5 Organizations and Obligations 87
Procurement organizations do not stand outside the exchange system or manage
donors in a purely strategic way. Like individual donors, decision makers within
these organizations may be affected by the moral economy of exchange. When
HIV appeared in the U.S. blood supply, there was a crucial period of uncertainty
about the nature of the disease and its presence in the blood supply. The struc-
ture of institutionalized exchange relations shaped how organizations that collect
blood from unpaid donors and those that buy plasma from sellers perceived their
environments and helps to explain why they reacted differently.
6 Managing Gifts, Making Markets 110
A complex technical infrastructure determines a great deal about howsystems of
exchange in human goods work, irrespective of whether the core exchange is for-
profit or voluntary. In many ways, whether exchange is commodified matters less
than whether it is industrialized—that is, administered by rationalized organi-
zations that try to collect goods like blood and organs as efficiently as possible.
The proliferation of secondary markets in human goods exposes a tension between
the short-run logistical demands faced by procurement organizations and the
long-run development of ideas about the “gift of life” that legitimate the exchange
system. Treating human goods either as ordinary commodities or presents given
without obligation results in similar problems.
Appendix: Data and Methods 133
Notes 143 Bibliography 169 Index 185
Illustrations
Figures
2.1 The organ donor shortage, 1988–2004 25
2.2 Stories about organ donation mentioning infants or children 30
2.3 Stories mentioning financial incentives for organ donation 39
3.1 UNOS regions and OPO boundaries 49
3.2 “Balance of trade” in kidneys, 1997 53
3.3 Changes in procurement rates and road fatalities, 1989–1996 55
3.4 Procurement rates by OPO, 1997 57
3.5 Predicted effects on procurement rates 64
4.1 Percent of population that has ever given blood, by country 74
4.2 Three measures of the donor population 81
4.3 Effect of collection regimes on blood donation 83
5.1 Reported cases of AIDS in the United States, 1981–1985 101
Tables
A.1 Models predicting donor procurement rates 137
A.2 Individual-level variables predicting blood donation 138
A.3 Country-level models of donation 139
A.4 Mixed-effects (model) model of donation 140
ix