8 R.M. Shaw
economies of moral behaviour deriving from the writing of feminist
theorists such as Carol Gilligan ( 1982 ) as influential.
One of the most significant applications of gift terminology to think-
ing about the transfer of bodily tissue and fragments has been Richard
Titmuss’ ([1970] 1997 ) comparative research on blood donation in the
USA and UK. Titmuss expounded the virtues of a gift system for man-
aging blood donation that was voluntary and without remuneration,
where blood was distributed according to medical need rather than abil-
ity to pay. His argument was based on the idea that public models of
service provision were superior to market models because they stimu-
lated ethical behaviours motivated by altruism and social duty, which
was essential for social cohesion and a sense of community. In con-
trast, Titmuss claimed that commodity systems produced temporary,
non-binding relations between vendors and purchasers, and encouraged
people to act in instrumental ways that debased and devalued human
relationships and undermined the dignity of the human body. Since the
initial publication of Titmuss’ book in 1970 , debates about the manage-
ment and distribution of blood and other bodily tissues have remained
largely polarised around the dichotomy of gift and commodity,^3 despite
transformations in political economy, the shift to post-Fordism and the
rise of neoliberal ideology, and biomedical and technological innova-
tions in tissue exchange.
Although the gift-giving model is still the reigning organisational
framework for the promotion and provision of tissue donation in
many countries across the globe, and is conceptualised in opposition to
a market model of exchange based on commodification, transactional
behaviours involving human biological materials are highly diverse.
People who donate bodily materials and services may have mixed
motivations for donation. Those motivations, as researchers increas-
ingly point out, may include financial and altruistic reasons (Pennings
2015 ). Additionally, what altruism is taken to mean in different loca-
tions, contexts and times is not absolute. Like Titmuss, Kieran Healy
( 2006 ) posits a social-organisational account of altruism, arguing that
perceptions of altruism depend very much on the extent to which a par-
ticular act is institutionalised and the incidence (rate or frequency of
occurrence) of that act.^4 The meaning of altruism thus tends to shift in
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