Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth Century America (review)

In 2007 a French woman who had suffered catastrophic face injuries as the result of a dog attack received a face transplant from a brain-dead donor. More recently, a farmer in Germany received a double arm transplant. Surgical interventions like these are dramatic because of the hope and the anxiety that they can inspire by their seeming victory over nature. Susan Lederer's Flesh and Blood is an insightful illumination of the evolution of transplantation and transfusion and the twentieth-century American culture that sought to understand those interventions. The replacement of skin, glands, bones, blood, and other tissue from humans and animals, both dead and alive, stirred the public imagination to consider the meaning of self and body and what our moral and ethical obligations to each other are. Her argument is that the interpretation of the body and its parts, and the transplantation and transfusion procedures applied to them, is formed in a particular culture and society and not simply the result of pre-existing or timeless human concerns.

Newly introduced surgical replacement procedures were often publicly welcomed and supported, as the author tells us, and were reflected in contemporary popular newspapers, movies, novels, and other media accounts. For instance, skin grafting could be newsworthy for a Hollywood storyline because of the nature of the disorder, such as severe burns or the species difference when animal to human grafting was undertaken. Blood transfusion was likewise welcomed for its reported ability to bring people back from the brink of death. Alternatively, the transformation brought about by transplantation and transfusion also harbored an unwelcome "dark side" as public fears of the possible transfer of racial and other traits in the blood from one animal or person to another were expressed. In some cases, the worry was translated into hospital policy, as in the segregation of blood units in early blood banks, or it was reflected in the popular media such as movies like the Dracula or Frankenstein productions.

Receiving tissue is half the story in this book, for where there is a need there must be someone willing to offer a portion of his or her body. Donors were often hailed as heroes for their willingness to give a part of their body to save another. The lack of any means to preserve tissue in the early history of tissue replacement meant that the donor had to be someone nearby, usually family or friend, and that the tissue transfers took place immediately between donor and recipient. This limitation meant that donors could be hard to locate when they were needed. Using money to buy tissue or organs was an obvious solution to the problem, but this quickly raised the ethical concern about the circumstances in which someone might give, or be forced to give, a part of their body. At the same time, some donors raised the worrisome possibility of earning a living as a donor. But the greatest concern was whether disease might be transferred with the tissue, a concern that was underscored in the 1980s by reports of as many as three-quarters of hemophiliac patients testing positive for AIDS because of contaminated blood transfusions. The tension between the gift relationship, the paid and volunteer donor, and the commodification of body parts is an important theme that runs through this history.

As medical knowledge about human and animal tissue grew, the public also took ownership of what some medical innovations would mean. In the late 1930s when blood could safely be drawn and stored (or "banked") for transfusion at a later time, the policy at some blood banks was to segregate white and black blood units despite the medical understanding that blood could be transfused to anyone safely once it had been properly typed. The public expectation, often with little or no discussion, was to separate the units to prevent the transfusion of "undesirable" traits, or diseases, including syphilis...