Patterning the geographies of organ transplantation: corporeality, generosity and justice

Abstract

Organ transplantation is now an established treatment for patients with end-stage organ failure, yet there are spatial inequalities in access to this procedure. This paper explores the uneven geographies of kidney transplantation in London, arguing that inequalities in access to organ transplantation are created through interlocking spatialities of corporeal difference, enacted through global movements of populations, national organ transplantation protocols and the internal immunological spaces of the body. The combination of these processes, operating at different scales, has produced a distinctive configuration in the embodiment of risk in relation to kidney transplants, particularly born by London's Black and Asian communities. Two ethical dimensions to this geography of organ transplantation are explored here: the ethical responsiveness to others shaping the generous practices of organ donation, and the medical practices categorising difference through techniques of blood typing, tissue matching and the spatial organisation of organ transplantation. In concluding, I argue both are critical to understanding the links between ethics and justice in the geographies of organ exchange in London. Further, I suggest geography is central to political debate about the exchange of biological material elsewhere, for it is only through tracing the intersection of ethical, corporeal and technological practices in situ that we can fully reflect on questions of justice within the developing bioeconomy.

What Is the Bioeconomy? A Review of the Literature

“…In the literature on health there are several contributions that criticise the commercialisation of bio-resources in areas such as trade in various forms of human tissues (examples of such criticism include questioning trade in cord-blood [62][63][64][65], oocytes [66][67][68], foetal tissue [69], stem cells [70], femoral head [71], or blood [72,73]. Examples of topics that are discussed are the ethics of commercialisation of bioresources [74], safety in blood supply [72], inequalities in access to bio-resources [75], or moral dilemmas of surrogacy [67]). …”

Molecular Life

“…Molecular life is patterned in different ways and in different contexts by biological susceptibility, by speculative capital, by territorial imaginaries, by clinical practices, and by past and present human mobilities, challenging and at times exceeding our understanding of what makes human bodily difference and how to pursue the promise of justice. In my own work, I have grappled with this in relation to the unequal geographies and ethical complexities of organ transplantation in London (Davies 2006 ). In this small case study, a conjunction of organ matching protocols, the institutional organization of transplantation teams, and the location of Southeast Asian communities at risk of hypertension results in the surprising emergence of communities with unequal access to transplanted organs on either side of the River Thames.…”

Rethinking responsibility and care for a postcolonial world

“…Moreover, although the literature privileges urban places, our argument extends to all places-urban, suburban, market towns, rural areas-all of which are co-produced through a ‗distant localness'. 3 Other discussions of responsibility in geography have revolved around responsible research praxis, political commitment and social justice, often articulated through the lens of responsible citizenship (Beaumont et al, 2005;Cloke, 2002;Davies, 2006;Gibson, 2006;Hay and Foley, 1998) but we do not focus on these here. 4 But in literature see Spivak (2007).…”