Book Review: Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico

Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico. Megan Crowley-Matoka, Durham: Duke University Press, 2016, 316 pp.

In Domesticating Organ Transplant, Megan Crowley-Matoka situates Mexico within a broader discussion of transplantation and situates the experiences of Mexicans—donors, recipients, and transplant professionals, among others—within a context of local values and realities. Despite popular assumptions that transplantation in Mexico must be tainted by criminality, the book demonstrates the everyday ways in which transplant technology—particularly important given Mexico’s high rates of diabetes and kidney disease—is (or is not) made accessible to patients in need. Yet the book does so while arguing that particular qualities of Mexican life, qualities that Crowley-Matoka argues render Mexico a “slippery state,” complicate the willingness of Mexicans to fully embrace transplantation. Such qualities also shape Mexicans’ experiences when they do embrace transplantation. Throughout, Crowley-Matoka carefully balances broader structures of analysis, developed from the growing ethnographic literature on transplantation as well as older debates about classic concepts like the gift, with deeply powerful accounts from her research in the city of Guadalajara.

Crowley-Matoka’s ethnographic evidence is compelling, and her sensitive examination of what are very often matters of life and death makes clear how intimate experiences reveal a good deal about life in contemporary Mexico and the politics of transplantation more generally. For example, the book contrasts Mexico’s reliance on living donors, typically kin, with the embrace of cadaveric transplants elsewhere in the world. Crowley-Matoka rejects the popular explanation that superstitious cultural beliefs are the sole obstacles to the embrace of organ donation, instead tracking the “biounavailability” of usable organs to unfamiliarity with and skepticism about the idea of brain death. This unfamiliarity and skepticism derive as much from everyday clinical happenings and a larger distrust of the government and its institutions as they do from religious perspectives. Crowley-Matoka’s concept of the “slippery state” is an especially useful one here, capturing relationships with and under a state that shapes “unsettled, unsettling political conditions” (p. 14). In the slippery State of Mexico, the government is both a provider of essential services and a source of disappointment, distrust, and sometimes fear. Crowley-Matoka writes of the ways in which this slipperiness manifests in clinical dynamics—between transplant coordinators and the families of potential donors, for example—with Mexico’s long history of political and financial scandals, rendering actors, as she puts it, “illegible to one another” (p. 14).

These clinical dynamics reflect the challenges facing transplant professionals who take pride in Mexico’s high rates of living donation while also struggling with often inadequate resources and the time constraints inherent in the transplantation process. Crowley-Matoka thoughtfully describes the tremendous pressure these professionals face, in particular the need for some of them to constantly weigh the value of one life against another. Her use of the Spanish term agilizando to capture the ways in which some transplant professionals, patients, and patients’ kin assert the value of particular lives demonstrates one strategy for surviving in a slippery state. As transplant professionals tell Crowley-Matoka, however, advocating for one life often means forsaking another. This more fundamental question—which lives matter most?—makes Crowley-Matoka’s analysis relevant to any context in which limited resources or blurry categories (like brain death) complicate life.

The dynamics explored in the book are not just institutional. Crowley-Matoka considers the ways in which expectations for who should give and who should receive an organ are shaped by gender and other roles within families, noting, for example, the feminization of organ donation, by which mothers in particular become naturalized donors. Despite the high rates of donations from kin in Mexico, however, refusals to donate are also common. A beautiful case in which a woman receives a transplant from a geographically and emotionally distant sister, creating a strong bond between them, is tempered by Crowley-Matoka’s reminder of the siblings and other kin who did not offer to donate their own organs. Organ donation from kin, she notes, can appear to reflect the seeming centrality of the family in Mexican culture, but other moments—e.g., the silence after mentioning the need for a donor—reveal the sometimes-tenuous ties within families and make for painful reminders of the limits of love.

Importantly, the book also examines life after transplantation, when access to resources and support remain critical and when the liminal status of bodies—better but rarely well—becomes chronic. For many of the transplant patients Crowley-Matoka encountered, access to continued care depended on formal employment and the health insurance it brings. Yet even post-transplant, many struggled to find and keep work. Successful transplantation could not mediate the harsh realities of employer discrimination and potentially unproductive bodies. Here and throughout the book, Crowley-Matoka’s analyses firmly position transplantation within a context in which both transplantation’s remarkable promise of life and its dark potential for abuse are problematized by the unpredictable and unruly—organs, social relationships, the state.

Crowley-Matoka presents transplantation as a technology that changes not only how people imagine and experience their own bodies but also how they understand their value in the world and to each other. Transplantation, as she demonstrates, is not just productive of biomedical success (or, failure) but of subjectivities that are deeply connected to, and in fact shaped by, each other and the world around them.

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