The Operative Heart

THE HISTORY OF TISSUE AND ORGAN TRANSPLANTS IN WESTERN MEDICINE HAS always been involved with questions of singularity, sharing, and politics. As early as the sixteenth-century, Gaspari Tagliocozzi, a surgeon who was also Professor of Anatomy and Professor of Medicine at the University of Bologna, wrote of grafting skin to form a nose on those who were noseless (recall that in those days nasal amputation was a common form of punishment—we are speaking thus of the reconstitution of a citizen, of reconstruction as a political and ethical act). While proud of his accomplishment in fabricating a nose from an individual's own tissue, Tagliocozzi warns against grafting noses from one body to another. His warning is based precisely on the idea of individuality:

The singular character of the individual entirely dissuades us from attempting this work on another person. For such is the force and power of individuality, that if anyone should believe that he could accelerate and increase the beauty of the union, nay more, achieve even the least part of the operation, we consider him plainly superstitious and badly grounded in the physical sciences. ¹

Inherent in the sense of individual bodies is the notion that there are specific individual properties that cannot be transposed. Indeed, as Nuland notes, the story of transplantation became "the story of our evolving comprehension that the cells of each of us harbored within them something that is theirs alone." The question then becomes, "How can a potential recipient be made less xenophobic, less destructive of protoplasm from a donor? In other words, how can one person be made more tolerant of the transplanted tissues of another?" ²

It is precisely with the discovery of cyclosporin that an entirely new horizon opens up: cyclosporin becomes the chemical of tolerance, one which enables doctors to manage the immune system and selectively accommodate the foreign, to "quell xenophobia." Thus, in 1986, Winslade and Ross repose the question of individuality, but this time with a radical alternative in mind:

Are we spirits who happen to possess bodies and in fact need those bodies in order to manifest ourselves in this particular material world? If so, then it is not much concern whether we are inhabiting a pure or mixed-parts body. Are we, instead, minds-and-bodies, a kind of computer-like system in which the bodies are our hardware and the minds our software, our operating systems, as it were? If so, then the software, like any software, can run on any compatible body, although often not as well on the body-hardware for which the mind-software was originally intended . . . individual integrity lies presumably in the brain or in the more complex parts of the nervous system culminating in the brain (although even here a serious problem lurks as researchers investigate the transportability of brain tissue). The rest, outside and inside, is mere packaging of operating parts, to be used, and, when exhausted, to be replaced. ³

Thanks to modern technologies of medicine, we have come the distance from unimpeachable individual specificity to wide-open interchangeability. And it should be clear by now that throughout these meditations on the distinct, unique, and nontransferable properties of individual bodies is a corollary ontological value pertaining to the notion of individual identity as something inherent, unchanging, and nontransferable.

The historical possibilities of entertaining such a profound re-evaluation of individuals and their bodies creates complex questions of technology and ethics, ontology and otherness. It is in this context of opportunity and crisis that we can read Jean-Luc Nancy's L'Intrus, which precisely situates itself historically:

Less than twenty years ago, one didn't graft, especially not with the use of cyclosporin, which protects against the rejection of the graft. Twenty years from now, it will certainly be a matter of another sort of graft, with other methods. A personal contingency thus crosses a contingency in the history of techniques. In an earlier...