Expanding the conceptual toolkit of organ gifting

The Gendered Body Work of Muslim Arab Mothers Who Donate a Kidney to Their Children

PURPOSE

Previous studies showed that among the pediatric ESRD patients who receive a kidney donation from a parent, in most cases the mother is the one that agrees to donate her kidney to the sick child, whereas fathers are less willing to donate. The present study sought to explore decision making regarding which parent would donate a kidney to their child among Muslim Arab parents of pediatric ESRD patients.

DESIGN AND METHODS

The study design is a cross sectional qualitative study. We conducted semi-structured interviews with thirty-one parents: twenty-five mothers and six fathers, who donated a kidney to their child.

RESULTS

Parents tended to refrain from donating a kidney to a sick daughter; mothers were more willing to donate than fathers. Our findings imply that culturally constructed notions of gender and motherhood are mobilized to the realm of health and illness, and mothers' body work is an influential factor in determining survival chances of pediatric ESRD patients and their quality of life.

CONCLUSIONS

Our study shows that kidney donation made by mothers to their children represents a gendered body work and powerfully demonstrate gender relations in Arab society. Cultural artefacts shape parents' differential propensity to donate organs for a female or a male offspring.

PRACTICE IMPLICATIONS

It is recommended that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney for their offspring, and also to encourage both parents to donate a kidney to a sick daughter. Education campaigns are needed to raise awareness and encourage changes in the attitudes of the Muslim families of pediatric ESRD patients toward parental kidney donation.

Assembling organ donation: situating organ donation in hospital practice

In this article I argue for the need to situate deceased organ donation in and as a hospital practice. This study puts the spotlight on the practical conditions that enable and emplace organ donation in the hospital setting. The analytical move serves the political purpose to inform and interrogate dominant policy framings intended to address the problem of organ shortage. I present an ethnographic investigation that draws upon a Science and Technology Studies (STS) approach to make visible the sociomaterial arrangements that bring together people, things and politics in the assembling of organ donation at a Catalan hospital. A progressive and indeterminate process which might fall through and become disassembled at any given time. This, as I explain, challenges current opt-out policy that unnecessarily reduces donation to an individual choice to be decided upon in life. Instead, and drawing on ethnographic materials, I propose a situated and relational understanding of organ donation: an embedded health care and procurement practice enacted as a collective accomplishment. I conclude that (more) responsible donation policies need to be informed by, and attuned to, the situated practicalities and enduring tensions that condition and constrain the assembling of organ donation at the hospital setting.

The grief ritual of extracting and donating human milk after perinatal loss

Perinatal loss is a major life crisis involving multiple losses, including the loss of future hopes and dreams, of being pregnant, and of self-esteem, to name a few. In the present study I focus on mothers who experienced perinatal loss and chose to extract and donate their human milk to nonprofit milk banks. Through an analysis of 88 women's personal testimonials, collected between 2017 and 2019, I uncover the ritualistic attributes of the extraction and donation process. The bereaved mothers in this study experienced ambiguous loss, comprising the combination of the physical absence and psychological presence of their baby. The process of extracting and donating their milk constitutes a grief ritual, allowing mothers to maintain and reconstruct the continuing bonds with their babies. The present study extends current understandings of organ donation in times of loss, highlighting the unique nature and consequences of the milk donation process through its conceptualization as a grief ritual.

From waste product to blood, brains and narratives: developing a pluralist sociology of contributions to health research

The aim of this paper is to examine the meaning of the concept of donation in health research. Drawing on a set of narrative interviews with people invited to donate biosamples for research and a range of other studies, we identify several conceptual themes that speak to the complexity of the current landscape of critical thinking about donation. These conceptual themes are: the language of 'donation'; a hierarchy of biosamples; alternative informational value; narratives as donation; coincidental donation, convenience and degree of invasiveness; and rights, consent and benefits of research participation. We call for a reconceptualisation of research donation to encompass not only the numerous types of sample readily classed as donations, but also other types of data and contributions, including narrative interviews, psychometric data, patient-reported outcome measures, record-linkage, and time and effort. We argue for the development of a pluralist sociology of research donations, and suggest that a 'sociology of research contributions' might better capture this complexity.

'Saying no to organ donation': an empirical typology of reluctance and rejection

In Germany, as well as in other countries, organ shortages are usually explained by a relative unwillingness to donate among a population which is assumed to be caused by a lack of information and mistrust of the system. As we can see in the data of our qualitative research (focus groups and interviews), lack of information or mistrust are not the only reasons for people to be reluctant to agree to the donation of their organs after death. In fact we can identify four positions: (1) information deficit; (2) mistrust; (3) no killing; and (4) bodily integrity. The first and second are the two prominent explanations in the public discourse about low donation rates. The third and the fourth instead have neither been adequately articulated nor been discussed as a proper argument. Therefore, by means of sociology of critique, we discuss their contribution to the discourse as comprehensible reasons for reluctance and present them as credible positions of criticism: These two positions illuminate fundamental and universal values of the inviolability of the person and human dignity. Thus, both positions are consistent and morally justifiable and should be addressed with sensitivity.

Toxic money or paid altruism: the meaning of payments for identity-release gamete donors

Public discourses commonly frame gamete, organ and other forms of bodily donation as altruistic 'gifts'. However, despite on-going debates about the ethics of payments to donors, few studies have examined the views of donors themselves regarding the meaning of payments and their compatibility (or not) with understandings of these practices as gifts. This article addresses this issue, analysing 24 in-depth interviews with UK identity-release gamete donors. It was crucial to all participants that their donation be viewed as fundamentally other-oriented, motivated by the desire to help others. However, whilst egg donors often accommodated payment within this narrative, male participants explained that any money would taint the gift they had given. I argue that sperm donors faced particular challenges to incorporating payment within a gift narrative for two key reasons: first, sperm donors relied on a discourse of 'pure altruism', including absolute opposition between gifts and market exchange, in order to present their donation as other-oriented. In contrast, egg donors were also able to mobilise a discourse of relational giving to present their donations as a personal gift. Second, according to a continued stereotype of sperm donors as financially motivated students, their payments have already been culturally earmarked as side-line earnings.

'Doing good by proxy': human-animal kinship and the 'donation' of canine blood

This article demonstrates the relevance of animals to medical sociology by arguing that pet owners' accounts of veterinary decision-making can highlight key sociological themes which are important to both human and animal health. Based on semi-structured interviews, the article argues that interspecies 'kinship' allows for the extension of sociological claims regarding altruism, self-interest and mutuality from human blood donation to companion animal blood 'donation'. Furthermore, this study extends sociological understanding of the human-animal bond by showing how the dog's status as kin meant they were expected to donate blood, and that the act of donation itself represents an important opportunity for family 'display'. However, owners who do not or cannot donate blood themselves describe pet blood donation as an opportunity to lessen associated feelings of guilt or obligation through 'doing good by proxy'. These findings raise critical sociological and ethical questions concerning the risks and benefits of donation, and for how we understand third-party decision making. Finally, the article argues for the close entanglement of human and animal health, and concludes that sociologists of health and medicine should explore the radical possibility that decision-making in healthcare more generally might be influenced by experiences at the veterinary clinic, and vice versa. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).