Marie‐Andrée Jacob, Matching Organs With Donors. Legality and Kinship in Transplants, Philadelphia: University of Pennsylvania Press, 2012, 219 pp, £42.60.
| DOI | http://doi.org/10.1111/1468-2230.12061 |
| Author | Alain Pottage |
| Date | 01 January 2014 |
| Published date | 01 January 2014 |
REVIEWS
Marie-Andrée Jacob,Matching Organs With Donors. Legality and Kinship in
Transplants, Philadelphia: University of Pennsylvania Press, 2012, 219 pp, £42.60.
This book is about the ‘craft of matching’; it describes how medical procedures,
bureaucratic protocols, and documentary practices are woven together to sanc-
tion the transplantation of kidneys from living donors. Most of the action takes
place in Israel, in the period when, although it was not illegal to sell a kidney,
hospital administrators and ethics committees would sanction a proposed dona-
tion only if they were satisfied that it was motivated by true altruism. Donor-
recipient couples were expected to show either that they were members of the
same family or that they shared an existing relation of friendship. Everyone was
perfectly aware that a good many donations, especially those ostensibly made
from one ‘friend’ to another, actually involved payment; the tenfold increase in
‘altruistic’ donations over a period of a few years was in itself a ground for
suspicion. Nonetheless, despite this awareness of the realities of the situation,
almost all donations passed through the various layers of bio-ethical scrutiny and
psychological evaluation. Marie-Andrée Jacob is interested in the workings of
the machinery which moved things forward. She alludes to the developments in
medical technology (notably the evolution of anti-rejection drugs such as
cyclosporine) which have extended the range of potential donors beyond the
small group of close genetic kin, thereby creating the problematic category of
altruistic/venal transactions, but her real interest is in how bio-ethical technol-
ogies take on a life of their own.
Some of Jacob’s informants were quite self-conscious about the exceptionality
of Israel’s approach to the regulation of kidney transplants, but the author quite
astutely presents these peculiarities as indices of the workings of bioethical
regulation more generally. Her ethnography picks out a number of symptomatic
episodes in the processes of matching: the consent form that has been photo-
copied so many times over that each exemplar resembles not so much a copy as
a faded – and, crucially, illegible – relic (59–61); the enigmatic photograph of the
two couples, one Israeli and one Palestinian, who had engaged in a kidney ‘swap’
to overcome problems of compatibility within each couple (149–153); the story
of ‘Sandra Benedict’, the American convert to Judaism for whom the procedure
of informed consent was ‘not an issue’ because she felt that she was being ‘moved
along like, you know, when you’re in an elevator . . . moved by the hand of
God, effortlessly’ (41). This sense of matters being ‘moved along’ suggests an
essential theme in Jacob’s account of the workings of the bioethical apparatus.
Sandra Benedict felt that she had been brought together with her recipient by
the love of God, but the impelling force revealed in Jacob’s analysis is entirely
mundane; it emerges from the articulation of standardised forms, routinised
verbal formulae, and conventionalised tropes of kinship. Nonetheless, there is
something almost as uncanny – or, perhaps, not entirely human – about this
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© 2014 The Authors. The Modern Law Review © 2014 The Modern Law Review Limited. (2014) 77(1) MLR 148–154
Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
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