Arizona organ transplant policy and global norms

Reading Marc Lacey's article, "Transplants Cut, Arizona Is Challenged by Survivors," in Sunday's New York Times brought out the contradiction between Arizona's policy and global norms on transplantation.

Arizona has decided to cut Medicaid funding for transplants. That decision in all likelihood affects a lot of potential transplant recipients because if you're that sick, you're probably not working and if you're not old enough for Medicare, that means that you probably end up on Medicaid. In short, if you are blessed with insurance or personal wealth, you can have an organ or tissue transplant in Arizona. If not? Tough luck. Hope you had a nice life.

But the World Health Organization's Guiding Principles clearly proscribe this policy. Guiding Principle 9 is:

The allocation of organs, cells and tissues should be guided by clinical criteria and ethical norms, not financial or other considerations. Allocation rules, defined by appropriately constituted committees, should be equitable, externally justified, and transparent.

To be fair to the State of Arizona, lawmakers received a report from state health officials stating that transplants "were rarely successful." The problem is, that information just isn't correct. According to Lacey's article, "The cure rate for bone marrow transplants cited in the report to the Legislature was either zero or 7 percent . . . But transplant experts put the actual survival rate, based on national studies, at over 40 percent."

I find it morally abhorrent that some bodies (those owned by people lucky enough to have good health insurance) are "deserving" of life saving medical treatments while others (the ones relying on Arizona's Medicaid system) are not.

And on a personal note, I am extremely fond of one particular bone marrow transplant recipient. I am very happy that she's in that 40% of survivors.

Amazing creatures

It is often the case, especially in IR, that "bodies" as they are discussed in the literature are human. Most of my research explores the ways we open this debate up to include other bodies in the world--like bacterial communities in our guts and the ocean, choanoflagellates, oil-eating bacteria in the gulf, to name just a few. And these are just the tiny ones.

When I started doing this research 5 years ago it seemed pretty out there and I had trouble finding much written on the subject. Science studies gave me what I needed to keep going. A steady diet of Latour and Serres and Haraway. And theorist Jane Bennett guiding me to read thinkers such as Jullien, Spinoza, and Dewey kept my political science interesting.

Now it just warms my heart to see articles about fantastic creatures popping up everywhere with quotes like this:

The world is full of microbes, and we spend a lot of worry and effort trying to keep them off and out of our bodies. It is humbling to ponder that still swimming within that microscopic soup are our distant cousins.*

So many bodies out there that affect our politics and bodies. Here's to greeting them with this kind of spirit.

*http://www.nytimes.com/2010/12/14/science/14creatures.html?_r=1&emc=tnt&tntemail1=y

NY Times article: "Organ Donation: Let the Market Rule?"

Ariel Kaminer: Organ Donation, Let the Market Rule?" NYT, Dec. 11, 2010

Among the several points to ponder in this article is this:

Gary Becker, the Nobel laureate who teaches economics at the University of Chicago, has proposed something even more radical: paying people to part with their organs now, while they are still using them. You’ve got two kidneys but you can get by with one. You’ve got only one liver but you don’t really need that meaty chunk at the end. How does $30,000 sound?

In an interview, he said the idea should not be that shocking. As long as exchanges were carefully regulated, no one would be forced into it. It would solve an otherwise intractable problem. And unlike the current system, in which friends and relatives are often guilted into becoming donors, a market-based approach would compensate families fairly for their discomfort and risk.

This is odd for a few of reasons.  The first is that Becker's suggestion goes totally against the WHO Guiding Principles, and no mention is made in the article that there is such a thing.    The second is the claim that friends and relatives "are often guilted [sic] into becoming donors."  Where's the evidence for that????

And then there's a third problem: Becker thinks that it is possible that such a system could be "carefully regulated" and that "no one would be forced into" selling their kidney or chunk of liver.  Wow.  If he's worried about people being "guilted" in donating now, why shouldn't he worry about people be "guilted" into selling their organs?  How could a regulatory system possibly prevent a person whose family needs money from selling an organ out of a sense of guilt rather than (as Becker might have it) as homo economicus rationally making a profit by alienating a piece of his body-property.


There are other things in this article, too, including a pilot program in which

an organ-recovery team will trail ambulances responding to 911 calls, ready to leap in if the patient dies and is a viable donor.

 Gives "ambulance chaser" an entirely new meaning.

Comments?

Justice Brennan writing for the court on the Constitution, criminal obscenity & the nature of sex

Roth v. United States, 354 U.S. 476, 487 (1957)

(Thanks to my son for posting this on his blog.)

Brides' bodies

Go . . .Here's my attempt to spark a conversation.

Honeymoon murder

As mentioned in previous post, I'm challenging readers and authors of this blog to get the conversation going by adding a few comments about a situation, in this sad case the murder of a bride on her honeymoon and the arrest of the groom.  The bride was from Sweden, the groom from the UK, the murder happened in South Africa, and couple's wedding picture shows them in traditional Indian attire.  The husband is reported elsewhere to be wealthy.  None of the articles I read referred to the history of bride burnings, though (and perhaps it was just me) the emphasis on the murder of the Indian (Indian-Swedish) bride seemed to whisper the allusion.

This is NOT about the innocence or guilt of the husband. And it's not about Indian bride burnings -- well at least not wholly. 

I want to comment briefly on the bride as simultaneously celebrated -- worshiped, almost -- and fragile.  The celebration (the gown, the festivities, the bride in the center of it all) highlight a feminine power: she is the desired, celebrated object.  But despite her power, she is weak, especially (generally) compared to the groom. Her body is "given away" in some traditions.  No matter how egalitarian the relationship, her physical security depends on the genuineness of the groom's love and declarations of care because of his greater physical strength. 

When brides die or are killed, we are jarred by the contradiction between the power inherent in the celebration of them and the relative powerless and vulnerability of the female body.

And this is the case even today when many (most?) people are living together before marriage -- if they marry at all.  (And there is, indeed, some question as to whether this couple were officially married despite the ceremony they went through.)

It seems to me that the murder a cohabiting girlfriend, even if the death involved as many global connections as this one, would not be nearly as sensational as this, the murder of a bride.

OK, Folks:  How do you see the embodied story behind this situation?

A Challenge . . .

I have a proposal.  In addition to posting summaries of what we're working on (really interesting -- thanks, Lauren & Stefanie), I suggest we post brief "situations" (anecdotes, cases, etc.) and then in about a paragraph or two comment on the situation from given your theoretical/analytical take.  The idea is to get a conversation started and invite others to comment on the post.

So, my challenge is twofold: post a situation; comment on someone else's situation.

Ready, set, . . .