Spare Parts: Organ Replacement in American Society Review

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(More customer reviews)Organ replacement brings unhappiness on everyone. This book is a narrative of the development of organ replacement in the United States during 1968-1990. After these many years of field research, the writers have given up this field of study because it is too emotionally rending. Their closing complaint is of "...an overly zealous medical and societal commitment to the endless perpetuation of life and to repairing and rebuilding people through organ replacement"(210). Organ replacement, being a life-and-death technology, has plunged the symbolic act of giving into social norms that bring unhappiness on donors, personnel, and recipients.
Organ replacements have come from problematic sources and have had problematic results. Animals, anencephalic infants, cadavers, living donors, and artifices (like the Jarvik artificial heart) were the sources to date. In results, the body rejects transplants, whether single or multiple organs, transplants within the body, or transplants among bodies. Anti-rejection drugs like Cyclosporine and FK506 had effects that interact, disable, and kill the recipients. Moratoria on natural and artificial replacements resulted.
Suffering and death in organ replacement raise religious and ethical problems. A universal cultural complex is the "gift complex," first described by Marcel Mauss in the 1920's. Gift-giving everywhere in the world has these social norms: one must give, accept, return, and redouble a gift. Plunging this symbolic act into the normative system of organ replacement contaminates both donors and recipients. First, the obligations to give and to receive bring pressure to cooperate in the process. But, second, the obligations to return and redouble a gift are impossible to fulfill.
Organ replacement converts gift-giving into a market. Live donors generally resist donation of own or other's organs and there is a natural shortage of cadavers, so there is a shortage. Resulting market forces include requiring patients and families be "offered the opportunity to consent," redefinition of brain death, largely ineffective laws against commercial marketing of organs, and the transition of the field away from service to the critically ill and toward services to those most likely to survive.
Egalitarianism is the rationale for extending organ replacement to those who are most likely to survive becomes the rationale for generalizing organ replacement in the population. Price rationing becomes "non-price rationing," their evasive term for government death panels. They moan, "As poverty, homelessness, and lack of access to health care increase in our affluent country, is it justifiable for American society to be devoting so much of its intellectual energy and human and financial resources to the replacement of human organs"? (208)

Their narrative everywhere exposes the government dog. NIH scandalizes medical universities and hospital corporations by offering enormous grants. Physicians, hospital, and universities want to win the race for technological prowess. Practitioners disguise their experiments as "therapy." All compromise by making themselves "gatekeepers," supposed to protect the patient (179). "Primary gatekeepers" are the medical establishment, who ignore safety data, write incompetent protocols, and lack technical expertise and sophisticated medical practice. "Secondary gate keepers" are the medical and administrative bureaucrats, like the government overseers who fund these experiments but are too august and sacred to submit to even an interview when the subjects die. "Tertiary gatekeepers" are the journalists, editors, peer reviewers, and social scientists who create unrealistic expectations of "wonder drugs," and "miracles," or just look on ("participant observation") with a patient tolerance that hopes for the best. All the gatekeepers meet, study, discuss, and fail to act responsibly.


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The developments that have occurred in the field of organ transplantation during the 1980s and early 1990s, and the simultaneous rise and fall of the Jarvik-7 artificial heart are the subject of this vividly written and absorbing new volume. In Spare Parts, fascinating, interconnected stories of organ transplantation and the artificial heart are recounted in an interpretive framework that explores the vision of the "replaceable body."Themes of uncertainty, gift exchange, and the allocation of scarce material and non-material resources underscore a discussion that openly examines the escalating ardor about the goodness of repairing and remaking people with transplanted organs.Likewise, the stories open questions of life and death, identity, and solidarity.This important book offers insights into the symbolic and anthropomorphic meanings associated with the human body and its organs, and into the ways that medical professionals come to terms with the concomitant aspects of transferring vital body parts.Both artificial and donor organs, as well as the process of transplantation, are the subject of a thoughtful discussion which touches on the medical myths and rituals that they generate.Chronologically, Spare Parts begins where the authors' previous book, The Courage to Fail, leaves off.More than a sequel, however, this work reflects their increasingly troubled and critical reactions to the expansion of organ replacement.Likely to be controversial, this book is must reading for bioethicists, medical sociologists and anthropologists, health-care lawyers, planners and administrators, nurses and physicians, medical journalists and science writers, and concerned lay readers.

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