Last Best Gifts

Last Best Gifts Altruism and the Market for Human Blood and Organs

by Kieran Healy

University of Chicago Press, 2006
Cloth: 978-0-226-32235-3 | Paper: 978-0-226-32237-7 | Electronic: 978-0-226-32238-4
DOI: 10.7208/chicago/9780226322384.001.0001

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ABOUT THIS BOOKAUTHOR BIOGRAPHYREVIEWSTABLE OF CONTENTS

ABOUT THIS BOOK

More than any other altruistic gesture, blood and organ donation exemplifies the true spirit of self-sacrifice. Donors literally give of themselves for no reward so that the life of an individual—often anonymous—may be spared. But as the demand for blood and organs has grown, the value of a system that depends solely on gifts has been called into question, and the possibility has surfaced that donors might be supplemented or replaced by paid suppliers.

Last Best Gifts offers a fresh perspective on this ethical dilemma by examining the social organization of blood and organ donation in Europe and the United States. Gifts of blood and organs are not given everywhere in the same way or to the same extent—contrasts that allow Kieran Healy to uncover the pivotal role that institutions play in fashioning the contexts for donations. Procurement organizations, he shows, sustain altruism by providing opportunities to give and by producing public accounts of what giving means. In the end, Healy suggests, successful systems rest on the fairness of the exchange, rather than the purity of a donor’s altruism or the size of a financial incentive.

AUTHOR BIOGRAPHY

Kieran Healy is assistant professor of sociology at the University of Arizona.

REVIEWS

“Exploring an issue usually left to philosophers and economists, Kieran Healy goes beyond ethical and economic debates and investigates the organizational and cultural contexts behind people’s motivations to donate ‘human goods.’ Whether enough of these much needed goods are provided depends less on potential donors’ altruistic motives than on the structure and practices of the organizations handling the donations. Elegantly argued and well-written, Last Best Gifts makes a landmark contribution to our understanding of the social foundation of the moral order of exchange.”--Jens Beckert, Max Planck Institute for the Study of Societies

— Jens Beckert

“In Last Best Gifts, Kieran Healy offers a timely, sophisticated, and original analysis of the complex organizational terrain of blood and organ donation. In doing so, he unpacks the crucial role that organizations and institutions play in creating the contexts for, and the meanings of, giving. His analysis suggests that the relationship between gifts and commodities, between giving and selling, is more complex than many scholars acknowledge.”--Wendy Espeland, Northwestern University

— Wendy Espeland

"As an economic sociologist, Healy adds important dimensions to the intensifying debate over organ procurement."

— Virginia Postrel, New York Times Book Review

Illustrations

Acknowledgments

Exchange in Human Goods - Kieran Healy
DOI: 10.7208/chicago/9780226322384.003.0001
[blood donation, organ donation, gift relationship, donor, recipient, complex organizations]
This chapter discusses issues concerning blood and organ donations. It suggests that exchange in human goods does not fit well into the classical account of the gift relationship and explains that the key difference is that it cannot involve a face-to-face transaction between the donor and recipient. This is because blood and organs for donations are collected and distributed by complex organizations. This chapter also provides a summary of the chapters in this volume. (pages 1 - 22)
This chapter is available at:
https://academic.oup.com/chica...

Making a Gift - Kieran Healy
DOI: 10.7208/chicago/9780226322384.003.0002
[organ donation, cultural account, U.S., lobbying, socially acceptable, sudden bereavement, organ transplantation]
This chapter traces the emergence of the cultural account of organ donation in the U.S. from the late 1970s to the 1990s. It explains that advocates promoted the idea of organ donation by publicizing a specific set of arguments for donation, lobbying politically and working to placate or sideline their critics. This helped make donation a socially acceptable choice in the face of sudden bereavement. This chapter argues that the standard account of organ donation represents a consensus produced through the professional efforts of organ transplantation advocates. (pages 23 - 42)
This chapter is available at:
https://academic.oup.com/chica...

The Logistics of Altruism - Kieran Healy
DOI: 10.7208/chicago/9780226322384.003.0003
[organ procurement organizations, procedure process, service populations, operating budget, logistical scope, procurement policies]
This chapter investigates why some organ procurement organizations (OPOs) manage to collect more organs than others. It evaluates the structural and organizational forces at work in the procurement process. These include the service populations of OPOs, their size and operating budget, their logistical scope, and their procurement policies and strategies. This chapter also considers other factors such as individual decisions to sign a donor card, mortality rates and road safety laws. (pages 43 - 69)
This chapter is available at:
https://academic.oup.com/chica...

Collection Regimes and Donor Populations - Kieran Healy
DOI: 10.7208/chicago/9780226322384.003.0004
[blood supply, blood donation, Europe, collection regimes, students, Red Cross]
This chapter examines how the social organization of the blood supply affect the quantity of blood collected and the character of the donors who give it. The analysis of blood supply and patterns of donation across Europe shows that different collection regimes not only affect the size and shape of the donor pool but also shape the character of donation. An example of this is the high rate of blood donation among students in countries where the Red Cross is in charge of the blood supply. (pages 70 - 86)
This chapter is available at:
https://academic.oup.com/chica...

Organizations and Obligations - Kieran Healy
DOI: 10.7208/chicago/9780226322384.003.0005
[HIV, blood supply, U.S., blood suppliers, collection organizations, gift-based relationship, profit-based relationship]
This chapter examines the impact of the emergence of HIV in the early 1980s on the blood supply in the U.S. It analyzes how organizations in control of different parts of the blood supply reacted to this crisis. This chapter argues that the exchange relationships linking blood suppliers and recipients to collection organizations shaped what these organizations did during the crisis. It also shows that the effects of gift-based and profit-based relationships were not what the conventional wisdom predicted. (pages 87 - 109)
This chapter is available at:
https://academic.oup.com/chica...

Managing Gifts, Making Markets - Kieran Healy
DOI: 10.7208/chicago/9780226322384.003.0006
[organ donation, blood donation, human goods, logistics of procurement, gift of life, cultural account]
This chapter sums up the key findings of this study on the exchange of human goods or organs and blood donations. It analyzes whether changes in the logistics of procurement are undermining the moral order of exchange encapsulated in the idea of the “gift of life” that procurement organizations have worked so hard to establish. This chapter also argues that the short-run logistical demands placed on procurement organizations are in tension with the cultural account of donation that they have produced over the long run. (pages 110 - 132)
This chapter is available at:
https://academic.oup.com/chica...

Appendix: Data Sources and Methods

Notes

Bibliography

Index