11 Valued Matter: Anthropological Insights ... 277from the routines of economic life, it paradoxically suggests a “pure”
form of capitalism, because those who labour to produce organs-for-
transplant do so in the absence of any capacity (or requirement) to
reproduce their own efforts. In this case, the production of value is
vampiric; because it works in the space where labour is directed to
maintaining life, by staving off its end, it extracts without restoration.
The profound struggle by living-related organ donors and recipients
to stay alive is, therefore, the very basis for the production of profit.
All that flows from this only serves to diminish the capacity of those
affected—not just the patient but their extended families—to ensure
that their health is protected and their everyday lives reproduced. In
the absence of adequate social protections, and where an emphasis on
rights and entitlements is little more than rhetorical, those with the
least resources to expend on their health must to do so to the point of
utter depletion.
Arendt suggests that “the human capacity for life in the world always
implies an ability to transcend and to be alienated from the processes
of life itself, while vitality and liveliness can be conserved only to the
extent that men are willing to take the burden, the toil and trouble
of life, upon themselves” (Arendt 1958 : 120). In a context of radical
responsibilisation for health and for life, it is important to ask what
value transplant medicine has when efforts to extend life come at such
a profound cost, when families like Carlos’s are systematically stripped
of their assets and so have little capacity to maintain themselves in the
process. Even in the event of successful organ transplant, many families
are unable to support the costs of immunosuppression and the further
medical care required to protect and ensure the longer-term survival of
their transplanted kidney.
That they must enter relations of economic bondage and sacrifice
their finances, property and security is made more destabilising still in a
context where CKD is far from a rare occurrence, but in fact, is rapidly
increasing, multiplying its effects within households and across the frag-
ile constituency of already poor families. The sacrifices that CKD entails
could as Michael Lambek ( 2008 : 146) contends “be the most profound
of ritual acts, serving as the ultimate ground of value”. The creation of
(surplus) value out of the very struggle to stay alive surely stands as a
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