Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico by Megan Crowley-Matoka (review)

Everyone, it seems, has heard stories about black-market organs in Mexico. This book is not about that, although its author notes that, in the course of doing research for it, she encountered a fair share of queries about kidney thieves. Megan Crowley-Matoka's study instead tackles a vastly more complicated set of questions related to organ transplantation. Based on ample quantitative data drawn from medical case files and extensive interviews and ethnographic fieldwork carried out in Mexico's largest and most active kidney transplant program, the study starts with the premise that organ transplant indexes a series of politically charged and theoretically significant divides between nature and culture, self and other, life and death, gift and commodity, science and spirituality. The book persuasively shows how organ transplantation offers a fruitful vantage point from which to explore the ways individual and national selves get imagined and how these imaginings become materialized as resources that have important clinical and political consequences.

Crowley-Matoka divides her study into three theoretically sophisticated and deftly organized sections, each containing a set of paired chapters. The initial section investigates the kinds of bodies that are and are not available in Mexico for organ transplant. The first chapter examines how particular kinds of bodies are rendered most appropriate and available to the demands of transplantation. The author finds a "pervasive familialization" of living organ donation, in which idealized and ideological notions of the iconic Mexican family function as a rhetorical tool and national resource to improve transplant possibilities. It also explains how, despite the almost precisely equal number of male and female living organ donors in Mexico's two largest transplant programs, organ donation is routinely rendered "women's work." The second chapter interrogates the lack of viable organs. It argues that organ unavailability stems primarily from resource limitations, political corruption, and conceptual ambiguity surrounding brain death as an analytical category. The book's second section explores who does and does not receive donated kidneys. The third chapter examines how transplantation plays out in a clinical and moral matrix. It analyzes how medical professionals have a hand in rendering some patients "agile" and thus excellent candidates for organ donation and others "ungainly" and therefore less viable. The fourth chapter follows the temporal trajectory of patients from initially learning of their need for a transplant, to receiving a transplant, and finally to adjusting to life with a donated organ over the long term. The author reveals that the long-term promises of transplantation often turned out to be elusive. The final section examines the key analytical frames through which transplantation is understood. Delving deeply into the social life of the kidney, chapter five situates transplanted organs in a larger regime of value, in which donated organs inhabit a liminal space between commodity and gift. Kidney donations, the author deftly demonstrates, happen in contexts of highly charged relations of social connection, hierarchy, and emotion. The book's final chapter explores the ways the iconic figures of scientist, saint, and monster pervade the lives of both the professionals who enact transplantation and those who study them.

A beautifully written and theoretically perceptive exploration of both the biological and existential realms, Crowley-Matoka's study deserves a wide readership. It makes a significant contribution to scholarly literature on medical anthropology, bioethics, and moral politics in Mexico. Its greatest strength lies in the way it carefully unravels the social lives of organs and complexities of transplantation, and links this analysis to a larger exploration of the moral politics of bodily sacrifice and national aspiration. It skillfully details how transplantation changes how people experience and imagine their own bodies, and how both these experiences and imaginings shape the way actors understand their value in the world and to one another. Specialists of Mexico will especially appreciate the book's sensitive examination of how that country...