270 C. Kierans
Servants). Private health insurers for highly paid workers constitute
around 2% of the whole (INEGI 2012 ). For those who are unin-
sured; that is, not in formal employment, services are generally pro-
vided at a subsidised rate by the clinics and hospitals of the Secretaria
de Salubridad y Asistencia (SSA)—the Ministry of Health and Welfare.
This system of health care is run with no premiums and no guaranteed
package of services. Services are limited and, though part state-subsi-
dised, are heavily reliant on out-of-pocket payments at the point of use.
It is, however, important to note, that the characterisation of these
social insurance systems as distinct, is to a large extent, rhetorical. In
practice, the Mexican population move between these different points
of access as jobs are both lost and gained or indeed as patients with
access to social insurance attempt to circumvent bottle necks and wait-
ing lists, particularly with regard to IMSS, the largest provider, choos-
ing to forgo their social entitlements in favour of paying out-of-pocket.
In a not dissimilar fashion, healthcare professionals, particular doctors,
also move between healthcare systems, many holding positions across
public and private organisations simultaneously. This, in turn, creates
a conduit for patients to move between providers. The ethnographic
grounds of this study, its sites, were then, by virtue of this mobility, gen-
erated in situ by following patients and their families as they themselves
knitted together “bespoke” regimes of care, and, in so doing, provided
a practical way of “seeing” how the infrastructure of transplantation
works in practice. To aid the discussion which follows, it is important
for the reader to understand that there is no given or prescribed plat-
form in Mexico from which transplant medicine can be said to work
or which could provide a vantage point for an authoritative overview
of the organisational processes of organ exchange—the donating and
receipt of organs. Formal structures and processes here are blurry to
the extreme, shading into each other in ways it is largely impossible to
discern from the outside. Most importantly, Mexico’s complex health-
care system largely militates against the building of a coherent national
system of deceased organ sharing, as the various healthcare systems do
not work easily together. As a result, Mexico’s kidney population relies
largely on organs procured from living donors, and for the most part
living-related organ donors.^2