Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America by Kara W. Swanson (review)

Banking on the Body opens with an account of Connie Culp, the first American woman to undergo a face transplant after having been severely disfigured by a shotgun blast to the head. The groundbreaking surgery in 2008 included a new mouth, nose, and cheeks, and, afterwards, Culp was once again able to talk, smile, and smell. It was a transformation of Culp’s appearance, her quality of life, and so much more. For Kara W. Swanson, an associate professor of law at Northeastern University, this procedure transformed all human faces and signified that it was “now a body product” to be “harvested from one body for use by another” (1). Culp’s story is one of medical ingenuity and ultimately positive, but it also fits within a larger history where “the human body has become a source of property and value, as well as a source of hope to the dying and the disfigured” (2).

By examining human milk, blood, and semen, this engaging and topical book clarifies how bodies and body products have been organized and exchanged in the United States over the past century. In doing so, Swanson highlights the significance of two interrelated concepts: the banking metaphor and the gift/commodity dichotomy. In 1937, Dr Bernard Fantus of Cook County Hospital in Chicago borrowed the term “bank” from the world of money and markets to describe the process of stored blood in his hospital. Blood banks were a fresh way to think about maintaining the American blood supply and, not surprisingly, came under fire for the implied association between body products and money. Yet Fantus’s aim was not to promote commercial enterprises. Amid the toil and deprivation of the Great Depression, Fantus sought to “subvert the market allocation of blood solely to those who could afford to pay.” Cannily, “by treating blood as money, he was trying to circumvent the need to pay money for blood” (7–8). The term “bank” proved resilient, and the banking metaphor has grown as the dominant way of understanding the tradable value of “disembodied fluid” as well as other body parts (7).

Even as this metaphor became pervasive in American society, medical professionals, lawyers, and laypersons have argued that body products are commodities and ought to be exchanged like other goods in the marketplace. This perception has conflicted with the spirit of Fantus’s original blood bank, and, according to Swanson, a paradoxical and problematic byproduct of such a change in thinking was the gift/commodity dichotomy, which describes the gifting and sales of body products as “opposite and mutually exclusive exchanges” (9). It fed into, reinforced, and thereafter represented the idea that body products should inhabit “two very distinct legal regimes” (240). In the first instance, blood, breast milk, and sperm can be bought and sold legally, whereas, in the second instance, a federal law called the National Organ Transplant Act prohibits the sales of organs, including bone marrow.¹

Looking ahead, Swanson asserts that Americans must re-evaluate this bifurcated approach and jettison outdated notions about the inherent dangers of including body products within property law. The starting point of regulation, she contends, ought to be that body products, as property, are regarded as civic property. This requires attention to “the use and allocation of body products, in addition to payment and pricing” (247), although it also requires thinking about the effects on patients and acknowledges “markets can be harnessed in support of a normative vision” (248). Part of this proposal is the rehabilitation of the paid professional donor. In the chapters on blood and breast milk, the reader is exposed to the demise of this donor for various political and economic reasons, and it would be worthwhile, writes Swanson, to rejuvenate the image of this donor, as well as make the case that this individual plays a valuable role in achieving communal health goals.

Over the course...