- Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico by Megan Crowley-Matoka
In Domesticating Organ Transplant, Megan Crowley-Matoka presents the reader with a seemingly innocuous statistic: that over 80 percent of all kidney transplants in Mexico are performed using organs from living, related donors (33). Indeed, she demonstrates how it is oftentimes a source of national pride, given that organ donations from family members make transplantation possible in a place where the availability of cadaveric organs, for complex reasons, is limited. Yet, what this superbly researched and thorough ethnography effectively shows is that living, related donation problematically goes unquestioned and unexamined in Mexico, in large part, because it "meshes seamlessly with long-standing cultural logics, social hierarchies, and modes of everyday survival" (60). She highlights, for instance, that women are far more likely to donate a kidney than receive one, which is a fact that can render structural disparities invisible in a society where women are often assumed to be self-sacrificing. The discursive feminization and familialization of transplantation in Mexico not only enables transplantation by making it culturally legible and ethically permissible, it can also enable a "medicalized violence of stratified survival" (55). This is an important and timely book particularly given that living donation is increasingly being promoted and practiced worldwide, and it teaches us that the kinds of bodies that are rendered appropriate and available for transplantation in each context should not be taken for granted.
The book is comprised of an introduction and six chapters, which are divided evenly into three parts, followed by a short conclusion. It is based [End Page 525] on ethnographic research conducted at two public hospitals in the city of Guadalajara over a 12-year period from 1998 to 2010. Chapter 1 demonstrates how idealized notions of the "strong" Mexican family as well as the feminized iconic donor render transplantation familiar and culturally commonsensical in ways that problematically situate the practice of living, related donation outside the realm of ethical concerns. Through careful examination of transplant records, Crowley-Matoka underscores how these idealized notions of the "strong" Mexican family and feminized iconic donor among transplant professionals, patients, and family members do not adequately account for the complex and uneven ways organs move from one family member to another. By meticulously teasing out the data on hundreds of donors and recipients in the transplant programs, she uncovers the unsettling role that structural disparities, economic dependence, familial expectations, and "the everyday, brutal calculus of trying to minimize risk for the family as a whole" (51) play in who gets an organ and who does not.
The myriad reasons for the conspicuously low rates of cadaveric organ transplantation in Mexico are addressed in Chapter 2. Based on keen observations of dozens of potential cadaveric organ donation cases, Crowley-Matoka eschews commonplace explanations for the lack of brain-dead donors, such as family refusals. Instead, she explains how putting the brain death concept into actual practice is difficult because it is dependent on "the precise orchestration of human, technical, informational, and political resources" (82), which must come together within a very limited time frame in order for it to be successful. In overburdened, state-run Mexican hospitals, any number of things can derail the cadaveric organ transplantation process—such as faulty equipment, a lack of cooperation from medical staff and/or government officials, a lack of trust between transplant professionals and donor families, and a lack of appropriate legal documentation—long before families are faced with the decision to donate.
There is no cure for kidney disease and only three treatment options exist (peritoneal dialysis, hemodialysis, and transplantation). In Mexico, these treatments are not widely available. When they are available, they tend to be very expensive and time-consuming, and demand adherence to a strict diet, require a strong support system, and produce other kinds of health problems like depression and fatigue. In light of all this, Chapter 3 describes how patients with kidney disease in Mexico face a bleak prognosis even when the disease is diagnosed in...