284 C. Kierans
2016 ; Kierans 2015 ), where women’s roles have been culturalised into
the “burden of caregiving” more generally (DiGirolamao and Salgado
de Snyder 2008 ). It is, however, beyond the scope of this chapter to
discuss organ donation in purely gendered terms, given the complexi-
ties of social and familial relations that underpin both organ failure and
attempts to access transplant medicine.- This is rather different to what Richard Titmuss envisaged when writ-
ing about the provision of blood banks as a public service in 1970 in
The Gift Relationship. When explicating practices of bio-valuation ask-
ing who is involved, how they are involved, when, why and under what
conditions is critical. When we take into account these dimensions, the
sorts of practices being discussed here, which depend on complex links
across scientific, medical and governmental sites and at various levels
(e.g. “local”, “regional” and “national”—themselves bureaucratically con-
structed and stabilised administrative categories internal to the system),
contrast markedly with the picture Titmuss outlines. - In the UK, patients classified as African Caribbean and South Asian
heritage are described as three to four times more likely than the white
British population to develop End Stage Kidney Disease (ESRD).
According to official statistics, they constitute approximately 28% of the
kidney transplant list, but only 4% of deceased organ donors. This “sta-
tistical problem” has driven health policy, health promotion and health
education initiatives to foster greater ‘in-group’ responsibility among
potential donors for renal patients, and orientation to a problem predi-
cated on the assumption that inequalities of access are driven from with-
out and not within health care.
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