While in the academy…‘the body’ is generally treated as a text or a trope or as a metaphor that is ‘good to think’ with, in the larger society and in the global economy ‘the body’ is generally viewed and treated as an object, albeit a highly fetishized one, and as a ‘commodity’ that can be bartered, sold or stolen.
– Nancy Scheper-Hughes (“Bodies for sale,” 1)
This paper will bring the practice of the global trade in human organs to bear on a discussion of recent theorizations of biopolitics in order to reveal the way in which this practice announces the urgency of a re-theorization of our political subjectivity under global capitalism (Cazdyn 5-6). Even in the throes of radical commodification, the body manages to continue to occupy a space in which it demands special consideration through articulations of residual beliefs regarding the sanctity of the body. Of particular interest is the way in which this movement to protect the ‘sacred integrity’ or ‘wholeness’ of the body at all costs constitutes an unusual moral intervention in late capitalism and interrupts the process of the commodification of the body. Why does this moralistic discourse emerge in the context of corporeal dispossession while economic dispossession fails to elicit the faintest whisper of moral outcry? An examination of the global organ trade, a literal undoing of the body politic under late capitalism, facilitates the construction of a concrete portrait functioning as a sort of autopsy of the processes of dispossession at work in this practice and will shed light on more insidious and less visible and immediately theorizable forms of dispossession. By looking (non-metaphorically) at the politics of corporeal movement under biopolitics and bioeconomics and the way in which bodies are divided into saleable parts under global capitalism, it is possible to develop a modus operandi that will allow us to identify, understand, and address these more covert forms of dispossession.
A description of the global black market trade in organs in its current incarnation will not be a focus of this paper as this practice is an extremely complex and multifaceted one, taking on different forms in different regions, thereby resisting summarization. Rather, this discussion will work from Nancy Scheper-Hughes’ contention that within the global organ trade, organs are distributed in an identical manner to all other types of resources under late capitalism (“Bodies for sale” 4). According to Scheper-Hughes, “the flow of organs follows the modern routes of capital: from South to North, from Third to First World, from poor to rich, from black and brown to white, and from female to male” (“Global traffic” 193). Working from the premise of a general tendency within which wealth consistently overdetermines the body, this paper will interrogate the politics of movement in this context in which organs occupy the unique position of life-giving capital that is widely “needed” and desired, but cannot be legally purchased.
A discussion of this practice requires that organs be viewed not only within the context of late capitalism, but that we view organs as unmediated capital. The global organ trade is symptomatic of the way power is working under capitalism to maximize production in which body parts themselves are transformed into capital. The human body becomes divisible and destructible; the productive value of the body no longer lies in its potential for labour, but instead in its components. This paper seeks to identify the repercussions of a practice that enacts a one-directional allocation of organs as capital, looking to the methods of selection employed by biopolitics and bioeconomics that result in the extension of some lives and the abbreviation of others through the organ trade under global capitalism.
As organ transplantation increasingly becomes the standard of care or norm in the treatment of a multitude of diseases, the market value of organs has skyrocketed in relation to the productive limitations defining this practice. With the exception of the ability to produce animal organs for human usage, as of yet there exists no standard practice by which to procure organs for this purpose other than through the willed donation or sale on the part of the divisible body, to take place either during life or following death. In the case of the live donor or seller, the procurement of the organ is viewed as an exchange through which the donor or seller forfeits biological capital and for this reason must be compensated for his or her loss. The normalization of this practice creates an unprecedented demand for human organs as well as an unprecedented moral directive that those who can afford to do so must attempt to extend their lives, by any available means, through the procurement of organs for transplantation (Waldby and Mitchell 187). As Catherine Waldby and Robert Mitchell write, there is now “a cultural desire for, and sense of entitlement to, self-regeneration among the aging populations of the wealthy North” (162). This drive is symptomatic of the reach of what Foucault calls regulatory biopower in that this practice reflects the repercussions of advancements in medical research and technology within a globalized world defined by a radical inequality in economic conditions through which to “make live” (Foucault 241).
For the normalization of the practice of living donor organ transplantation to take root within global neoliberal capitalist culture, a fiction of scarcity had to be instituted to simultaneously instill fear in potential organ consumers and a sense of opportunity and profitability in potential organ vendors. As Eric Cazdyn writes, “the logic of the market requires a withholding—or even a destruction—of any surplus goods…so as not to push prices so low that they jeopardize the integrity of the system itself” (26). Dependent upon the ideological entrenchment of this fiction of scarcity in organs available for transplant, the medical discourse of organ transplantation constructs the practice as the sole mode of treatment on the table for discussion, unrivalled in its efficacy, rather than as an elective practice and merely one of several treatment options (White 25). In this context of “invented needs and artificial scarcities” (Scheper-Hughes, “Bodies for sale” 3), there is no foreseeable reason why patients would not prefer the option of transplantation to alternate treatments. The relations of power structuring the transplantation process coercively “intervene to make live” (Foucault 248) through the cultural imperative to extend life at all costs by means of, within this specific sector, the procurement of organs for transplantation.
Introducing what he calls “a ‘biopolitics’ of the human race” (243), Foucault asserts that this new “technology of power” (242) is exercised on a larger scale than was disciplinary power, shaping “a global mass that is affected by overall processes characteristic of birth, death, production, illness, and so on” (242-243). Addressing these biological processes “at the level of their generality” (246) as well as “a whole series of related economic and political problems” (243), biopolitics “is applied not to man-as-body but to the living man, to man-as-living-being; ultimately, if you like, to man-as-species” (242). Biopolitics determines the conditions for life for “a new body, a multiple body, a body with so many heads that, while they might not be infinite in number, cannot necessarily be counted” (245). Of pertinence for this discussion is the manner in which biopolitics works to “incapacitate individuals, put them out of circuit or neutralize them” (244) by way of managing the “relations between the human race” (245). In contrast to disciplinary power as it functioned under the sovereign nation-state—actively killing some while passively allowing others to live at the l
el of individual bodies (241
)—the “massifying” regulatory power of biopolitics actively ensures continued life for some while passively allowing death for others on the international scale of the human species as a whole (247). Taken at face value, this biopolitics makes the rich live through the indoctrination of the belief that extending life through organ transplantation is not an elective decision but an unquestioned path of action, and lets the poor die through the creation of conditions for life that drive poverty-stricken organ-possessors to sell their means to biological life.
Foucault writes that the regulatory power of biopolitics works “to improve life by eliminating accidents, the random element, and deficiencies” (248). I argue, however, that the regulatory power we see manifested in the current operation of the global organ trade works only to improve life that occupies a dominant position within the global flow of capital. The tenure of this form of life is extended through organ transplantation, while the corporeal material required to extend these lives is procured from the subservient form of life which endlessly contributes to the economic system from which they cannot escape through their labour, often without even receiving a living wage in return. How does the ideal of individual autonomy and entrepreneurship as central to neoliberal culture fit into this? At first glance, it seems as though the population from which organs are procured are quietly relegated to a state of exception—a system in which autonomy and responsibility for one’s own livelihood is forced upon us all, that is, all except this population as standing reserve. However, even this obviously exploited population is subsumed into the neoliberal discourse of individual autonomy and responsibility for one’s own destiny through the insistence that giving would-be organ sellers the opportunity to improve their financial status through entering this exchange of capital from which they would otherwise be prohibited to participate is somehow giving this population the promise of an otherwise unattainable upward mobility.
The global organ trade constructs a lack of organs available for transplant as the enemy or threat to the human population or man-as-species (Foucault 256). As Foucault writes, “the enemies who have to be done away with are not adversaries in the political sense of the term; they are threats, either external or internal, to the population and for the population” (256). In the context of the global organ trade, the enemy is not a “bad” or “inferior race” (255). Instead, the enemy is the death that threatens to rob the global economy of its main contributors to the accumulation of capital; more specifically, the enemy is the lack of resources through which these lives can be extended and fortified. Foucault’s theorization of racism as justification for murder is inadequate to explain the process of human exploitation occurring within the global organ trade. The violence inflicted upon organ-supplying populations is not predicated on assumptions of inferiority of race. Instead, this exploitation is denounced through neoliberal narratives pronouncing the infallibility of the ideal of autonomy and the ‘generous’ provision of opportunity for economic advancement. Working towards “the elimination of the biological threat to…the species” (Foucault 256), the global organ trade has worked to eliminate the threat of borders closed to the trade of organs, thus eliminating the threat to the survival of the segment of the species with the power to dictate the survival of the species as a whole under global capitalism. The creation of sites of production for these ‘desperately needed’ organs adheres to the rules of limitless accumulation: organs are simply procured from any site of economic deprivation and desperation featuring an international airport.
In a neoliberal global market economy driven by consumer desire and a model of subjectivity in which individuals are defined solely as consumers, the consumer rarely balks at the labour practices leading to the satisfaction of desire. Why, then, does the consumer cringe at the thought of the desperation leading individuals to sell organs? As Scheper-Hughes writes, we “can all too easily fall prey to an uncritical moralizing rhetoric, a knee-jerk reaction against body commodification to which still attaches fairly ‘primitive’ sentiments of bodily integrity and sacredness which demand that the body be treated as an exception” (“Bodies for sale” 3). Where to draw the line demarcating which possessions should and should not be sold out of economic desperation? As Lesley Sharp questions, “[c]an or should we hold sway over the body’s parts if they are of value on the open market?” (49). Why does the affluent Western observer of the organ trade value biological bodies with more fervour and protectiveness than are mobilized in response to the lack of economic or material conditions that allow the body to live in extreme poverty? Today, we hardly flinch when we hear the daily toll of lives lost in Iraq, but hearing about the sheer numbers of Iraqis driven to sell their organs by an unemployment rate as high as 70 percent (Jarabi) and for as appallingly little compensation as $700 (Al Jibouri and Freeman) gives us pause.
Cazdyn also warns against falling into the trap of moralizing, asserting that this discourse can distract us from the crucial question raised by processes unfolding under bioeconomics: what can these processes in their current incarnations tell us about “the general transformation of power underway today”? (18). Viewing the global organ trade as symptomatic of what he calls bioeconomics, “an emerging global ideology…that exceeds various nationalisms and that feeds off of the current logic of contemporary capitalism” (15), Cazdyn argues that though related to bioeconomics, eugenics and biopolitics cannot adequately describe political subjectivity under global capitalism (16). He makes a distinction between biopolitics and bioeconomics, asserting that biopolitics works “toward constituting national subjects from the body up” under the nation-state, bioeconomics flourishes under global capitalism, “constituting global subjects who are at the mercy of their diseased bodies and can appeal to no one save the most impotent NGOs” (Cazdyn 16). The economic mechanism of control instituted by bioeconomics is entirely determined by the forces mobilized to drive capitalism in general, “scarcity, sustainability, and profit,” but in service of a greater goal: “to set in motion an ideological justification for the lack of democracy” (Cazdyn 18). This justification is often articulated as follows: ‘sure, it would be nice to extend medical services and other social programs to everyone regardless of inability to pay, but if we did so, our economy would collapse, silly!’
The bio under Cazdyn’s bioeconomics is defined by an economic equation through which health is positioned as directly proportional to wealth, and suffering inversely proportional to ability to pay for medical treatment. Put crudely, those who have access to the capital required to ward off death will live, while those cut off from the flow of capital who are subject to suffering and disease are so often cut off from the medical treatment available to those who can pay. Inequality is inherent to the logic of bioeconomics, an economic system “based on the unapologetic logic of the capitalist market” that “is not at liberty to suspend the rule of profit and expansion under any circumstance” (Cazdyn 16). There are no exceptions to the rule; health is bought and sold like any other commodity. The logic is infuriatingly simple and straightforward; this partially explains the moral outrage emerging in response to organ sales. There exists a residual belief that health and the physical body should somehow escape capitalism, that they should be treated as an exception and not be dete
rmined and distribut
ed by economic affordability. However, capitalism as an economic system will not permit this exception: as Cazdyn suggests, “so many are dying not because capitalism is failing, but because it is succeeding, because it is fulfilling its logic” (17).
The advent of the global organ trade is sometimes perceived as a positive development, reflecting the view that globalization should be celebrated for its extension of economic opportunity to otherwise excluded and un-coincidentally poverty-stricken populations. This logic suggests that both organ vendor and organ recipient benefit from the exchange: the organ vendor received much-needed cash in exchange for surgery while the organ recipient purchases as otherwise unattainable restoration of life, thus enabling continued accumulation. The global organ trade ensures that the poor are no longer excluded from the global market economy. Participation in global trade is no longer inaccessible to these populations. Instead, participation becomes coercive as the trade continues to expand and populations become increasingly economically deprived, and therefore, desperate to acquire the means to ongoing material life even if this acquisition threatens their own personal means to ongoing corporeal life. Organ vendors are included in global trade, though only by means of exploitation. As Deleuze writes, “[m]an is no longer man enclosed, but man in debt” (6). The problem posed by this inclusion of populations valued only for their exploitability in an exchange of capital is the threat posed by the possibility that the exploitable will acquire too much capital, enough to relieve this desperation that is the very condition of inclusion. To guard against this threat that the position of the exploitable be measurably improved through the trade, the process is surveilled in order to protect a delicate balance of the economic imbalance. This is a process of policing to ensure the mono-directionality of capital’s flow. As Eugene Thacker notes, “[t]he problem of security for biopolitics is the problem of creating boundaries that are selectively permeable” (27).
Étienne Balibar suggests that the late capitalist system cannot survive any limitation being placed upon its propensity towards accumulation through exploitation, and for this reason “elimination or extermination has to take place, ‘passive’ if possible, ‘active’ if necessary” (129). The form assumed by this process in the context of the global organ trade is a ‘production’ of ‘development’ of “specific populations” into “viable donors” in what Lawrence Cohen calls a “biopolitics of suppression” (11). In order to allow global capitalism to fulfill its destiny, the process of accumulation must not be hindered by a pesky shortage in organs! In response to this threat, organ donors are produced as the exploitable, available-to-be-killed population required by “the system” to ensure its survival (Balibar 129). As Balibar contends, material conditions inadequate for the proliferation of life are reproduced for the sole purpose of exploitation; this is certainly the case for the “superfluous” populations from which organs purchased by wealthy ‘Westerners’ are excised (128). Balibar argues that all forms of seemingly disconnected discrimination and exclusion taking place concurrently and robbing populations of the means of life must be viewed in relation to their overall ramifications (128). As Balibar writes, these “zones” in which donors are produced amount to systems of indirect murder: “In the face of the cumulative effects of different forms of extreme violence or cruelty that are displayed in what I called the ‘death zones’ of humanity, we are led to admit that the current mode of production and reproduction has become a mode of production for elimination” (Balibar 128). An examination of the global organ trade illuminates this process and reveals the strict biopolitical division of the world’s population through the conditional investment in donor populations in order to excise the desired resources while maintaining these populations’ dependency. In this sense, the populations existing within the “death zones” cannot properly be called life under a global economic system that defines life as accumulation while simultaneously requiring these excluded populations as the possibility for accumulation.
Zygmunt Bauman notes that security is maintained under global capitalism through a strict regulation of movement and travel. A discussion of the role of travel in the context of the global organ trade is especially pertinent considering that the enormous distances traveled by organs sold for international transplantation and the speed of this travel are unprecedented for medical interventions. The phenomenon known as “transplant tourism” exemplifies the dual and contradictory movement invoked by globalization as articulated by Bauman: “[g]lobalization divides as much as it unites; it divides as it unites” (2). Bauman describes globalization as a process within which some are liberated from previously-constrained spaces by newfound access to movement and travel on a global scale, while others are imprisoned within increasingly constrained spaces. Arguing that the “the freedom to move” is “the main stratifying factor” (2), Bauman terms the first group, “the increasingly global and extraterritorial elites” (2), tourists, while the second group, simultaneously lacking mobility and enabling that enjoyed by the first group, are the vagabonds (92).
Bauman’s description of the relation between the two groups suggests a type of Darwinian natural selection. He writes that the ‘vagabonds’ are “the mutants of postmodern evolution, the monster rejects of the brave new species…the waste of the world which has dedicated itself to tourist services” (92). Indeed, trapped within a space increasingly devoid of resources to support life, the ‘vagabonds’, driven by desperation to sell organs, do become an ‘inviable’ form of life viewed as a standing reserve by the organ-purchasing ‘tourists’ who possess the capital required to extract the coveted biological capital in the form of organs from the ‘vagabonds.’ As Waldby and Mitchell remark, “‘spare’ kidneys in third world bodies are resignified as a negotiable surplus” (162). Thus, Bauman insists that the opportunity for continuing ‘tourism’ is dependent upon a continued stationary gridlock of the ‘vagabonds.’ Within the bodies of the ‘vagabonds,’ the organs are viewed as wasted; capitalism dictates that the organs would be better put to use within the bodies of the global elite, in which case the organs are mobilized to work towards accumulation, while they were seen to be ‘wasting away’ in the bodies of the ‘vagabonds.’ However, this form of accumulation is of course limited, not limitless. The supply of ‘vagabond’ organs is finite, and as long as ‘tourist’ lives are extended while those of the ‘vagabonds’ are cut short, the organ-supplying ‘vagabond’ population will eventually be killed off completely. Does this practice constitute “biocolonialism” (Nelkin and Andrews 33)?
Now that the divisible human body has entered the globalized market under late capitalism, body parts are distributed in a manner identical to all other commodities on the world market: they are sold to the highest bidder. However apt this description of organs functioning in the global market as commodities may be, Waldby and Mitchell caution that organs offer long-term benefits, unlike many commodities, and this factor must be taken into consideration (177). Waldby and Mitchell assert that organs are “extremely complex forms of generative value that are not used and consumed in the usual sense but incorporated by the recipient as the condition of continuing life” (177). This examination of the global organ trade reveals the way in which particular forms of power allow medical technology and
g the extension of life at all costs on economically deprived populations under global capitalism.
Ronald Munson attempts to justify the asymmetrical allocation of organs based on universal neoliberal commitment to self-determination and autonomy, despite the disparity in income level – there are no exceptions to this commitment to autonomy, no matter the stakes of inability to pay. Through what Cazdyn would call “a simple economic analysis…to justify human suffering” (17), Munson offers a now ubiquitous argument for a legalized and regulated system to replace the black market organ trade. As Scheper-Hughes writes, “the neo-classical economists of the global economy, and a new class of bioethicists following their lead, now argue that free markets, including body markets, are liberating in their valuing of individual choice, autonomy and the impersonality of the economic exchanges” (“Bodies for sale” 3). Munson’s argument is at bottom informed by an assumption that we should be driven to eradicate disease and ward off death by procuring organs for transplantation from living donors, rather than relying solely on cadaver organs and allowing those who are unable to secure cadaver organs for transplantation to die. Munson argues that in order “to reduce human misery and save lives, we should try to increase the number of living kidney donors” by creating a regulated system through which organ ‘donors’ are financially compensated (116). Acknowledging that organ sales within this system would continue to benefit the rich while exploiting the poor, Munson argues that this is not symptomatic of the organ trade itself but of larger problems of global inequality (117). As he writes:
in a just world…people wouldn’t have to sell a kidney to meet the basic needs of their children. We don’t live in such a world, however, and the relevant question is whether, in the society we inhabit right now, we should condemn paying living donors as unethical and prohibit the practice (117).
In defense of this argument, Munson cites “our commitment to allowing individuals to be self-determining” (117), thus appealing to the neoliberal ideal of individual autonomy. Munson suggests that a failure to legalize compensated organ donation would amount to a stripping of individuals’ rights to mobilize their economically-valued possessions in the form of corporeal property in times of need.
The obvious counter-argument to Munson is that the organ sellers do not actually exercise autonomy and freedom of choice by voluntarily offering up their organs for sale but are instead coerced to sell their organs out of economic desperation. Autonomy remains ever-elusive to those living in “the social and economic contexts that make the choice to sell a kidney in an urban slum of Calcutta or in a Brazilian favela”; this ‘choice’ is not selected from among a variety of options at hand, but rather is made out of desperation and is “anything but a free and autonomous one” (Scheper-Hughes “Global traffic” 197). Scheper-Hughes writes that the consumer demands of the affluent global North enforce the dominance of an economic valuation of organs as means to financial survival for the working poor who would otherwise view their organs as sacred and indissociable parts of the self but are forced to defy these cultural beliefs in order to survive (“Global traffic” 210-211). Waldby and Mitchell suggest that we must avoid paternalism at all costs, and that disallowing legal and “fair” compensation for organ vendors inevitably constitutes paternalism (173). They ask why it is that we feel more comfortable with the moral coercion required in order to procure organs from related donors in gift system of organ transplantation than with the economic coercion required to procure organs from the poor (Waldby and Mitchell 173). It could be argued that related donors do not exercise autonomy and freedom of choice when agreeing to have organs removed for the benefit of family members. This desperation or coercion can be seen as moral or relational rather than economic, although economic factors can also play a role in these decisions.
Would the establishment of a regulated and controlled global market monitoring the trade in human organs result in decreased exploitation of the economically desperate? Could a system be created through which organs would be allocated on the basis of medical need rather than ability to pay through the establishment of an international grants system? If a grant system was instituted, how would organs be allocated? What criterion of allocation would be utilized: merit, lottery, health, utility, age, ‘need’? How would the ‘market price’ of organs be determined? Would a fluctuating price for something so ‘sacred’ and ‘priceless’ as a human organ ever be widely accepted? If the market price for organs is determined in relation to the highest price offered for the commodity on the world stage, it would become like the international oil market in that the highest bidder would set the price. These questions will only become more urgent in coming years as the baby boomer generation ages. These consumers, armed with wealth and a fierce desire to fend off death, will create an enormous demand for organs. Demand for every commodity has been transformed by the impact of this generation. Why would organs be an exception to this rule? The prospect of an enlarged market suggests increased exploitation if a mechanism to reverse the current pattern of distribution is not instituted. Today, the economic capacity of the organ recipient determines the market value of organs. It will become imperative to create a biopolitics that can institute a barrier to the distribution of organs based on wealth as it is likely impossible to reverse the cultural valuation of medical interventions in the service of extending life at all costs.
The logic of capitalism and its engine, biopower, dictate that distribution is identical in every sphere of life; thus, the mono-directional global trade of organs is of interest due to its unprecedented division of bodies, rather than the direction in which these body parts flow. An examination of the global organ trade allows us to concretely visualize “the material transformation of the paradigm of rule” of biopolitics (Hardt and Negri 22). Driven solely towards limitless accumulation, capitalism redistributes organs so that those contributing to the accumulation of wealth are outfitted with the means to extended life while non-contributors draining wealth from the system through usage of social services are stripped of their organs. The distribution pattern put in place by global organ trade is demonstrative of the status of divisible bodies under global capitalism, exemplifying the way in which radical inequality arising out of this system must be viewed as “not only a political matter, but also a biological matter” (Thacker 27). The practice of the global organ trade reproduces the systemic inequality that is inherent to capitalism directly and without mediation on the individual, physical body, rather than indirectly through economic deprivation and its eventual biological repercussions. For this reason, it is pertinent to speak so concretely of biopolitics and bioeconomics through a discussion of the global organ trade and to focus critical attention on this practice in an attempt to bring forth possibilities for change.
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