Bioethics Beyond Altruism Donating and Transforming Human Biological Materials

(Wang) #1

266 C. Kierans


Organs-for-transplant are things of a different kind. They are at
once “natural” and “technical”—biotic components whose capacity to
perform a function stems from the matrix of technologies and techni-
cal skills they are embedded within. Moreover, that they come bound
up with a whole range of social practices of exchange; that is, gifting,
selling, coercing, stealing and so on, means they are no less “thick with
politics” and, as such, are no less bound up with systems of value—
the conceptual focus of this chapter. Value provides a rich ground for
understanding transplant medicine, particularly the ways it is made
to work in different social and cultural sites and settings. It provides a
critical way of thinking about the costs and benefits associated with the
technological capacities of biomedicine, as well as to whom, when and
under what conditions these costs and benefits are (unevenly) appor-
tioned. Approaching things in this way, as Bijker implies, helps us see
the politics in transplantation in a new light.
Understanding value and how it is both produced by and attributed
to organ transplantation is, however, far from straightforward. To aid
its explication, anthropological scholarship provides two main ways of
thinking about the concept. First, there are those who work with value
in plural form, treating it as synonymous with or stemming from a
world view. Approached in this way, the anthropologist will see what is
valued and valuable as grounded in distinctive orientations to the world;
in the way the world appears as real or meaningful to any group or soci-
ety and, from there, what is of value within it (Dumont 1986 ; Viveiros
de Castro 2004 ). Second, it is possible to treat value in terms of valu-
ation, as a function of economy, as something produced in the course
of various types of exchange, as a form as well as part of wider prac-
tices (Levi-Strauss 1969 [1949]; Mauss 1967 ; Sahlins 1972 ; Strathern
1974 ).^1
In the context of transplant medicine, both conceptions of value play
important roles and can be said in many significant ways to overlap: the
former resonates with various social, cultural and bioethical perspec-
tives invoked to explain the ways in which the transplant project has
been accepted, rejected or specifically indigenised or the ways in which
it might be said to be working for or against the human good (Crowley-
Matoka 2005 ; Hamdy 2012 ; Lock 2001 ). The latter approach includes

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