Mandatory Organ Donation

Mandatory organ recovery when an individual is announced dead would increase the opportunity for other patients to receive organs more efficiently; "Research shows that there would be an increase of between 16 percent to 50 percent in the availability of organs (Carney)." Carneys article, "The Case for Mandatory Organ Donation" argues that by making organ donation mandatory it would curb the illegal trade of valuable organs and make it more accessible to receive an organ. The illegal organ market will continue as long as organs are a limited resource and the profits attainable are high (Carney). Current trends indicate that there is a growing consideration that "harvesting from cadavers should be a routine procedure just like autopsies in murder investigations (Carney)." Some ethicists and doctors argue that it would be more effective to have a routine organ procurement procedure, Carney presents Aaron Spital's, Mount Sinai School of Medicine, and James Stacey Taylor's paper on Routine Recovery of Cadaveric Organs for Transplantation, "Routine recovery would be much simpler and cheaper to implement than proposals designed to stimulate consent because there would be no need for donor registries, no need to train requesters, no need for stringent government regulation, no need to consider paying for organs, and no need for permanent public education campaigns." This approach obviously presents ethical problems, especially in the United States where autonomy over the body is an innate human right, however it would reduce the extensive waiting list for organs such as liver. According to Carney "Roughly half a million people around the world suffer from kidney failure and many are willing to pay any price for a donor organ. They have two options: wait on impossibly long donation lists or pay someone for a live donor transplant (Carney)." Even though there are an extensive amount of people who opt to donate their organs when their are brain dead "even willing donors often end up not donating because families raise objections or there is a question about consent (Carney)."In addition to this the "bureaucratic shuffle" and hoops to jump through cause organs to lose their vitality. According to Carney and other medical professionals and ethicists implementing routine procedures would dramatically increase the organ supply and may serve as a domino effect to prevent illegal procurement or reduce the need for kin to donate their organs as a means to live longer.


Kaufman, Russ and Shim's article "Aged Bodies and Kinship Matters: the ethical field of kidney transplant" discusses the relationship between life extension and kin obligation for organ donation. Procedures such as kidney transplants are now routine procedures because of their less invasive qualities, thus "when techniques become less invasive and associated with lower mortality risk, consumer demand for them and ethical pressure to make them available both increase (Kaufman, Russ, Shim 82)." The expectations for longer life expects medical to cure in for the means of life extension, thus organ transplantation offers a now morally acceptable procedure to be done in order to extend life. This expectation also leads to the expectation that family and friends will provide the means of life extension, thus "love is actualized often through the commitment to a longer life and by doing things to prolong life (Kaufman, Russ, Shim 83)." In relation to Carney's explanation for the need for more organs Kaufman, Russ and Shim also argue that the growing demand for organs "emerges from the broad expectation that end[stage kidney disesase need not be fatal and from acceptance of kidney transplantation as a standard medical treatment for end-stage disease (84). It is therefore evident that because of changing technologies in the medical field and ethical acceptance of body modification there comes a higher demand for kidneys and other organs. Technoligizing medicine has brought on new implications for doctors, patients and donors to participate in life-sustaining and extending technologies (84). However, it is also important to note that the affluent middle class and insured people have primary access to these legal kidney sources. In correlation, Carney presents Nancy Scheper Hughes argument that "the current system of organ donation breeds inequalities (Carney)." The inequality of organ donation and receival has encourage patients to ask kin members to offer their kidneys, for the elderly younger generations are expected to "unnaturally" offer the gift of a kidney (85). Kaufman, Russ and Shim argue that ultimately the moral implication is "a sacrifice of the wholeness of the body and a nonreciprocal bargain (85)." Carney argues that this wholeness of the body would also be sacrificed without question by medical practitioners that support routine recover of organs at death with or without consent. Furthermore, he argues that procuring organs as routine would eliminate "kin obligation" for the older generation (Kaufman, Russ and Shim 86). "The potentiality of offering, giving, accepting, and receiving a kidney puts pressure on parent-child, spousal, and other meaningful bonds. Within those bonds, offering is a sign of unconditional love, sacrifice, and the strength of the bond (Kaufman, Russ and Shim 87)." These social and familial obligations could potentially be eliminated if organ donations exceeded what was needed.


The commodification and increasing monetary value of organs in the market economy has increased the trade of organs and has given increased value to poorer populations. The exchange of goods between patients needing a new organ and poverty ridden populations who need money exemplifies the global market economy and supply and demand, "the uninhibited circulation of bought and sold kidneys exemplifies a neoliberal political discourse based on juridical concepts of the autonomous individual subject, equality, radical freedom, accumulation, and universalism, expressed in the expansion of medical rights and medical citizenship (Scheper-Hughes 148). The exploitation of the poor living bodies to supply organs to an affluent class creates a kin relationship between the buyer and seller, "new forms of 'social kinship' must be invented to link strangers, even at times political enemies from distant locations who are described by the operating surgeons as 'a perfect match--like brothers' (Scheper-Hughes 150)." The kin relationship is made evident by a seller who said, "the money I paid him was 'a gift of life' equal to what I received (Scheper-Hughes 151)." The necessity to seek the illegal organ trade is founded in the limited organ availability due to the "expansion of the organs waiting lists...to include patients from medical margins--those over 70 years, infants, those with hepatitis C and HIV seropositivity, and those proven to be immunologically prone to organ rejection (Scheper-Hughes 154)." If the medical field limited the expansion of the medical margins there may not be a need to require mandatory donation and consent that is presented by Carney. The organ trade and market illustrates a dyer need for more organs that are easily accessible by legal hospitals, however to do so would mean to initiate a mandatory organ donation that presents ethical problems for the dead, living and doctors.


The central issue that must be illustrated is the necessity to utilize kinship ties in "Aged Bodies and Kinship Matters" in order for the elderly generation to obtain organs from younger family and friends because of the extensive waitlist for organs from brain dead patients. "The Last Commodity" presents the give and take relationship between the seller of the organ and the person buying the organ for health purposes. In this situation a kin relationship is created in order to describe the give and take relationship and the "perfect match" described by the doctors regarding blood type and other factors. The kin relation and necessity for organs for the livelihood of patients is also illustrated in Carney's article on a possible transformation to mandatory organ donations, "curbing the illegal trade in humans just might mean scrapping the way we think about the rights of brain-dead donors (Carney)," for example. However the elimination of the illegal organ trade would have a profound effect on those selling their organs for monetary value in a global market economy.

Is mandatory organ donation feasible in the United States and what would this mean for the illegal trade of organs?




Portrait: A Land Ravaged by Tsunami and Kidney Brokers
This link will take you to Scott Carney's pictorial on kidney donors, and brokers in a poverty ridden area.


Organs for Sale: Where in the World Can I Buy a Heart?
This link shows the pricing and location options for buying organs.

Sources
Carney, Scott. "The Case for Mandatory Organ Donation." Wired, May 8, 2007. http://www.wired.com/medtech/health/news/2007/05/india_transplants_do`1norpolicy (accessed March 4, 2011).

Kaufman, Sharon R. , Ann J. Russ, and Janet K. Shim. "Age bodies and kinship matters: the ethical field of kidney transplant." American Ethnologist 33, no. 1 (2006): 81-99.
Scheper-Hughes, Nancy. "The Last Commodity: Post-Human Ethics and the Global Traffic in "Fresh" Organs." In Global assemblages: technology, politics, and ethics as anthropological problems. Malden, MA: Blackwell Pub., 2005. 145-167.

Driver's License and Organ Donation

At the age of 15 1/2, when most of us have just learned to drive correctly we are asked to make the decision whether we want to be an organ donor. If we choose yes it is indicated on our driver's license with a red heart (refer to the license to the left). The Washington State Department of Licensing includes organ donation as a part of "Getting Your License" on their government sponsored website. This portion of the website indicates why you should donate, what it means on your license, what organs can be donated, how to register and what happens if you change your mind. In addition to this, it also indicates where to register for organ donation besides at the department of licensing, what to include in registration, as well as sites for more information and donating money to the organ donation registration. This site also provides a brochure that promotes organ donation to the fullest extent, for instance one of the headlines is "You have the power to DONATE LIFE (WA DOL)." On the first page of the brochure the benefits of donating organs, eyes, and tissue is represented through a mans survival story, through statistics and the overarching theme that with becoming an organ donor and indicating it on your license you can contribute to saving someone's life, "it provides hope to thousands of people with organ failure (WA DOL)." The second page of the brochure presents everything that can be donated to help others. One of the section caught my attention in particular, "How the donation process works":

"Your commitment to donation will not interfere with your medical care. Organ, eye, and tissue donation becomes an option only after all lifesaving efforts have been made. Consent for donation is confirmed, and your family is asked to participate in the process by providing your medical history. Surgical procedures are use to recover donated organs, eyes and tissue. The body is always treated with great care, respect and dignity."

The brochure and website information provided by the Washington Department of Licensing tends to glorify the heroism of organ donation, but does not present the very real issues that doctors, patients, and family members are faced with the reality of deciding when personhood has passed and the person is considered dead.

"To Be Freed from the Infirmity of (the) Age" by Krakauer presents the new technologies of sustaining life and what it means for defining death in modern science. Because there is the opportunity to sustain life through artificial means it has presented the issue of trying to figure when sustaining life will bring suffering, More recently "patients, surrogates, and physicians have agreed that sometimes withholding or withdrawing life-sustaining treatments is best (382)." However, laws and government policies also play a role "for allowing life-sustaining technologies to be withheld or withdrawn under certain circumstance (Krakauer 382)." Organ donation and use also indicates how an individual can conquer death or contribute someone else's desire to live longer; "the body is composed of disposable and potentially replaceable parts," this indicates the replacement of organs to promote a longer life (388). Organ transplantation is thus performed to help achieve a optimal living standard, the goal of modern science is to master the human body so when disease effects organs they can be replaced, "the Cartesian dream is manifested in the organ-replacement and life-sustaining technologies applied to gravely ill people (Krakauer 388)."

The organ donation indication on a drivers license gets much more complicated after considering that the technologies that are in place are to sustain one's life rather than announce death and harvest the organs. Furthermore, the promotion of donating organs by the department of licensing in Washington also ignores belief systems that disagree with organ transplantation and removal of body parts. In relation, Krakauer states that "the fundamental technological goal of mastery displaces traditional cultural and religious values, meanings and goals (Krakauer 390)." Modern medicine prides itself on technology that presents knowledge and answers but it also presents several problems because "all mastery displaces and thereby conceals the unmasterable (Krakauer 392)."

In the brochure on the Washington State Department of Licensing they state that, "Your commitment to donation will not interfere with your medical care." Lock's article, "Living Cadavers and the Calculation of Death" indicates the complexities of medical care and organ donation when the calculation of death is required. She states, "Brain-dead patients remain betwist and between, both alive and dead, breathing with technological assistance but irreversibly unconscious (136). The patient is surviving because of technology and the person has left the body, the trouble here is though are they really seen as dead or just brain dead; In Japan, "it is impossible to procure organs from the brain dead in Japan (136)." Culturally implications make it incredibly difficult for family members to decide if there family member is dead so that the organs can be harvested, thus "together with official and popular discourse and valued tactic knowledge, work in associations to compound medical judgement and influence the meanings that are associated with a diagnosis of brian death (Lock 138). So even though an individual might indicate they are an organ donor on their license, this symbol gets convoluted when the question of when to get the organs is presented; "If organs are to be transplanted then they must be kept alive and functioning as close to 'normal' as is possible (Lock 140)." Although the person has left that body, the biologically organism is treated as a live to maintain the value of the organs so when family members are approached it makes it difficult to differentiate dead and a life, especially if a doctor does not know their religious/spiritual beliefs (Lock 141)

The trouble with indicating organ donation on your drivers license as such an easy process at the Washington Department of Licensing indicates that it is simple to prepare for procurement. Krakuer indicates that life-sustaining practices such as receiving an organ can help a person avoid age but getting to the point, presented by Lock, is not just a matter of life or death. It is a matter of doctors, the law and family members finding a happy medium in order to decide when and if it is appropriate. The slogan sponsored by the WA DOL is, "You have the power to GIVE LIFE," I argue that once the individual is unconscious and personhood as left the power (i.e. brain dead) it is the ultimate decision of the doctor and family to decide on death for procurement.

Finding Identity

The aspect of finding yourself and in turn identifying who you are is an obvious aspect of everyday life. Being able to ascribe an identity to yourself is complicated because there our so many components that contribute to how we are who we are; among the contributing factors to self are gender, body, consumption, education, and food. In this cartoon it speaks to many different levels of identity and the search for self through a global positioning system (GPS). In this comic a middle age women seeks out the electronics department in hopes to find herself. She appears to have gone down a long journey to discover herself; she has tattoos all over her body, several piercings, a choker necklace and what seems to be a mohawk. These traits she reveals physically tend to match the traits of an adolescent teen that is considered punk-rock or rebellious. The important point to note here is that although some sort of identity is expressed she is still on the road of self discovery internally as well as externally. The comic here represents a variety of pressures that human beings feel because of the struggle to represent the real you when your physical identity is not congruent.

In Elliot's "The Face Behind the Mask" he describes the medicalization of social phobia and how it effects ones ability to live life. The question he greets the reader with is why is "medicalizing a personality trait called shyness" so plausible in America and why do we need to (Elliot 58)? Personality is a way of presenting yourself to the rest of the world, "and you want your personality to be 'dazzling' (Elliot 60)." Self-presentation attracts others to and is what makes you appealing within our society, for instance being out-going, opinionated or creative versus being shy. As Elliot says personality is "to make yourself interesting and attractive to other people, how to make them like you and respect you and want to be around you (60)." Thus, the next step if people are not attracted to your personality is to seek self-improvement. This point is, as Elliot addresses, "You might have been given a certain kind of personality but with the right kind of help you could change it (61)." In the comic above the women is seeking to find her true identity, therefore in Elliot's notion her personality creates her social identity and how she is viewed but she can develop and change to improve herself to become socially acceptable. There is a constant desire to claim an identity, to be somebody, "We must master and control the qualities we already possess in order to gain the good opinion of others (61-62)." Therefore, it is crucial to overcome poor traits with medication because it allows the individual to master the desire traits as well as control them to the point where society is attracted to the personality. Elliot argues that the self-presentation in social spaces are a performance because of the social expectations involved which cause humans to regulate what they do and don't do. In the situation of social phobia and creating a better representation for society we are compromising our own feeling of self-identity.

In Elliot's article, "Amputees by Choice," he discusses amptemnophilia or the desire or attraction to become an amputee (209). The people desiring to amputate a body part often do so because they feeling that they are "stuck in the wrong body" or their "body is incomplete with their normal complement of four limbs (211)." Elliot recognizes though that in their description of their feelings they reflect "through language of self and identity to explain why they want these interventions (211)." Although their physical bodies are indicate our form of normalcy they do not feel fully connected. Therefore when the person loses a physical extremity they are actually gaining so much more of who they feel they are. The true self is thus "produced by medical science (211)." Identity in this is seen as self-improvement but not a societal norm of self-presentation. However, the amputees want their self-presentation to portray how they are feeling inside, as Elliot puts it there is "A struggle between the impulse toward self-improvement and the impulse to be true to oneself (211-213)." It seems to be implied that after the amputees reach their limbless destination that they have a sense of achievement or well-being that they lacked before, as one amputee proclaims "You have made me the happiest of all men by taking away from me a limb which put an invincible obstacle to my happiness (114)." Whether one was the amputated for desired it the social space available for them was invaluable in creating a subculture which they could be a part of, one individual who wants to be amputated even says to Elliot, "The internet was, for me, a validation experience (217)." The common experience here allows these individuals to publicly validate their identity, in turn.

A common theme between the two articles in the importance of feeling less stigmatized by society to seek out one's true identity. In the comic, there is an evident identity search going on that has materialized on the women through tattoos, piercings, and clothing. In "The Face Behind the Mask" a pill allows the people suffering from social phobia to reveal who they are in a matter of self-presentation to others. And in "Amputees by Choice" individuals are trying to creating a symbiosis between their internal self and how others perceive them, thus taking it one step further by going surgical to embody what embody's them.

"Eating and Thinking"

“Thinking and Eating at the Same Time: Reflections of Sistah Vegan” by Michelle R Lloyd-Paige illustrates Lloyd-Paige’s point of view on animal products and her quest to be spiritually sound as a result of the evident correlation, she found, between her academic work and the treatment of animals and humans. In this chapter of Sistah Vegan Lloyd-Paige portrays her identity as a black woman through food knowledge. Lloyd-Paige began her veganism through a spiritual movement at her church, her and many other church goers, predominantly black women, began a fast at the beginning of each year where participants were not permitted to eat meat, sugar or dairy (Lloyd-Paige 3). “The fast was voluntary and supposed to detoxify the mind, body and spirit (Lloyd-Paige3).” Routinely after the fasting, Lloyd-Paige would reintegrate body, meat and sugar back into her diet; however in 2005 she found that her body was reacting poorly to the reintegration and her doctor recommended that she reintroduce soy products (a staple during the fast) into her diet (4). In November of 2005 she recognized “how the food [she] ate contributed to social inequalities, and it “marked [her] transformation to eating like a vegan (4).” Lloyd-Paige states earlier in her realization of the need to eat vegan is that her lifestyle did not match up with what she believed and taught. She recognized that being able to choose what to eat was a privilege by middle to upper class citizens and when she made a choice in her food she was partaking in “patterns of indifference and oppression (2).” Thus, Lloyd-Paige came to the realization that her eating habits were radically different than what she taught and practiced, she states that “the contents of a lecture I had just presented four days prior on the global inequities in food distribution; a vague recollection of a statement from PETA about the cruelties associated with chicken production; the remembrance of how surprisingly good I felt physically while on a forty-day spiritually motivated fast from meant and dairy at the beginning of the year; and my own desire to live an authentic lie—yanked me into an uncomfortable realization that…I was not living according to my beliefs (1-2).” Her awareness of the mistreatment of animals also related to how she felt people of color were treated historically and in the present. She argues that the blatant disregard for how animals are treated is inhumane and we have no valid right to treat them this way. She states that although humans feel they have some sort of “dominion” over animals “we were [not] given the right to be cruel, brutal and heartless (Lloyd-Paige 4).” She compares this treatment and domination over animals to the treatment of Native Americans in the European conquest of Northern America (5). Although she does link her vegan practice to healthy living standards and the remarkably increasing number of obese African Americans and Hispanics (6), she mostly correlates it to her belief in the innate human and animal right that all are worthy to be treated humanely and with respect. Thus, her eating habits are recognition of how animal products are produced and marketed as a direct correlation to the treatment of people of color throughout time and she has continued a spiritual journey of veganism as a means to resist being a contributor for inequality and oppression. Therefore, her eating habits are also a representation of her ideology of social standards.

Adjusting food intake habits as a means to represent a particular ideology is a common practice among not only black female vegans but also in American Christianity (Griffith). In “Don’t Eat That” Griffith explains the Christian discipline of historically fasting, or obtaining thinness as a means to receive “true nourishment” from Christ (Griffith 36). Within the Christian doctrine the body should be perfectly modeled because the body was also seen as “central for pushing the soul along the path to progress (Griffith 38).” Thus, excessive weight from food intake would limit the progression of the soul and Christ’s workings within the Christians body. However, the Christian diet also influenced eating purposely and embracing the food one ate, “the pleasures of eating, like other physical pleasures, were to be savored and taken very seriously…lest one fall into gluttony (Griffith 39).” Thus the Christian dieters believed that they should eat foods that would replenish the bodies and eat with care because too much was a bad thing (Griffith 39). Griffith states, “The advice to eat only such foods as were individually pleasing was followed by a lengthy exposition of the proper and most spiritual diet (Griffith 39).” This concept of food intake is similar to Lloyd-Paige’s refusal of animal products because it is shaped by an ideology or spirituality that makes the individual or group pay particular attention to what they put in their body. In both situations the individual cannot consume what conflicts with their belief systems; for Lloyd-Paige she is a vegan because of the treatment of animals and the Christian dieters, Griffith speaks of, must control their eating and weight to take pleasure in their food experience as well as acquire a closer relationship to Christ.

On the same note Macrobiotics also shapes eating habits through a spiritual ideology of yin and yang, furthermore it allows women to balance gender inequalities, similar to Lloyd-Paige’s lifestyle to stop eating animal products to make an attempt to balance societies social inequalities. Macrobiotics is part of the “diet culture” that always pushes the practitioners to “do the right thing” because there are so many constraints on the individual to follow the right eating habits and attain balance (Crowley 37). Crowley argues here that Macrobiotics “in fact offers practitioners a fluid gender identity, and that this is one sources of its lasting popularity (Crowley 38).” Therefore Macrobiotics offers the individual the opportunity to “manipulate how the spiritual essences of yin and yang manifest themselves in the body (Crowley 38).” Different types of food can either be masculine or feminine and how they are prepared for instance “grilling a (yin) celery stalk changes the structure and quality of the celery’s gender—from female to male, from passive to strong (Crowley 40).” By identifying gender through food women are capable of adjusting sexist gender roles, as woman proclaims, “I could not be teaching or have published books, if it weren’t for the power macrobiotics gave me (Crowley 46)!” The practices of Macrobiotics enables these women to change the roles of gender practices so they are able to have a balanced spirituality, like Lloyd-Paige’s veganism as a means to stand up for social equality and increase the respect between humans as wells as animals.

Unfortunately though Nutritionism has become nationally accepted as a way to view food and in turn has affected consumption patterns in terms of what people think they should eat. Scrinis argues that the “focus on nutrients has come to dominate, to undermine, and to replace other ways of engaging with food and of contextualizing the relationship between food and the body (Scrinis 39).” The problem with this re-contextualization is it limits people to interacting with their food that allows for social identity, spiritual identity and gender identity. Furthermore reducing food into nutrients and numerical symbols limits its functionality and forces it to move on from “food discourses and consumption practices (Scrinis 42).” In the case of Macrobiotics the problem is that food here represents so much of being able to balance an entire gender identity—by limited foods to nutrient based ideology it ignores the cultural constructs that my enable a women to empower herself through use of yin and yang. Furthermore, Scrinis presents the marketing of food as a means to “distract attention from both the overall nutrient profile of a food” but by doing this it also takes food out of a political context, such as the political ties that Lloyd-Paige explains with meat products and the treatment of people of color. Food practices varying but in these situations it seems that food is tied to a spiritual belief or social order that enables the individual.