The Tyranny of the Gift: Sacrificial Violence in Living Donor Transplants

Medical anthropology can bring to living donor transplant useful insights on the nature of gifting, family obligations, reciprocity and invisible sacrifice. Whereas, ethical reflections and debates on the marketing of tissues and organs, especially sales by living strangers, have proliferated to the point of saturation, the larger issue of the ethics of ‘altruistic’ donation by and among family members is more rarely the focus of bio‐ethical scrutiny and discussion today, though of course it was much debated in the early decades of kidney transplant. As the proportion of living over deceased donors (especially of kidneys) has increased markedly in the past decade, the time is ripe to revisit the topic, which I shall do via three vignettes, all of them informed by my 10 years as founding Director of Organs Watch, an independent, university‐based, anthropological and ethnographic field‐research and medical human rights project. Whereas living‐related (altruistic) and living‐unrelated (commercial) donation are often treated as very different phenomena, I will illustrate what social elements are shared. In both instances, paid kidney sellers and related donors, are often responding to family pressures and to a call to ‘sacrifice’. The author argues that the rise in living donation has not been associated with sufficient attention to the pressures on the donors, such as the sense of obligation felt by children to forfeit a kidney for an elderly parent. See also editorial by Kaplan and Williams in this issue on page 497.