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May 29, 2009

On Kidney Transplantation

One of the most effective and thoughtful critics of traditionally dominant traditions of bioethics practice in the West is Leigh Turner.  Turner recently remarked in an article that an increasing range of voices and approaches is present in bioethics scholarship.  While I spend a fair amount of time on MH Blog spelling out some of my concerns with traditional conventions of such scholarship, it is important to evaluate the broad scope of the work with an eye to Turner's point.  To that end, I am especially pleased to note an article published in the current Hastings Center Report, which epitomizes what Cat Myser has taken to calling an anthropologically or social-science informed bioethics.  The title of the article is Conversations with Kidney Vendors in Pakistan: An Ethnographic Study.

It is available free full-text.  Here is the Abstract:

The growing concern about the shortage of kidneys available for transplantation has led some physicians, economists, and bioethicists to call for monetary inducements and “regulated” organ markets as a way of expanding the number of kidneys obtained from living, unrelated individuals. In contrast, those opposed to the idea of organ sales believe that such practices lead to exploitation of the most vulnerable people in society for the benefit of the privileged. Missing from the literature is in-depth sociological work on the vendors—the men and women who opt to undergo nephrectomy for money—and the on-the-ground realities that frame their decision. Very little is known about the sociological and psychological effects on vendors and on the families and societies they belong to when faced with a situation in which the only way to address financial difficulties is to sell a kidney.

Our aim is to turn the light on those who sell kidneys. Our research provides a “thick” description of the lives of kidney vendors and their families in Pakistan, people who stand at the center of organ commerce and yet have remained largely invisible. We attempt to open a window into their lives, to capture through their narratives what it “means” to them and their families when circumstances compel them to sell a kidney, and the ways in which this act affects connected existences.

This is a wonderful article, full of appropriate and relevant challenges to methodologically individualist and atomistic (see Taylor 1995) approaches to the ethics of kidney transplantation in developing countries.  (Indeed, as the authors note, there are very few analyses of any kind addressing kidney transplantation in developing countries; the vast majority assume developed world contexts, which underscores Myser's work on the whiteness of bioethics).  The anthropological term I mentioned here -- "local moral worlds" -- seems especially relevant to this article, and to unpacking the lived experiences in which the vendors, families, and larger communities inhabit.

Kudos to the Hastings Center Report for publishing such a fascinating, thick analysis, using tools and concepts critical to a rich notion of ethics -- dare I say, a notion of ethics as part of the medical humanities?


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