Early Notes on a New Research Project
Most tissues removed in the course of a surgical operation are considered abandoned by the operated patient. I abandoned my tonsils when I was 5 years old and my appendix when I was 38. Although most abandoned tissues are discarded, anonymously abandoned tissues can be used for research purposes without the operated patient’s express consent. Abandoned tissues are by definition not donated—an act that would link them morally and ethically to a donor to whom particular debts, obligations, and honors would entail. There are no quilts, gardens, or sculptures honoring organ abandoners like there are for organ donors. An abandoner doesn’t enter the Maussian ring of indebtedness and reciprocity that organizes many of the social processes and anthropological analyses of organ transfer. An abandoner isn’t owed a thing.
Transgender people undergoing reconstructive surgeries have been abandoning genital tissues for decades. Unlike my infected tonsils and appendix, these abandoned genital tissues are not afflicted by pathologies or physiological defects; they are simply unwanted by the patient. Dr. Miroslav Djordjevic, of the Belgrade Center for Genital Reconstructive Surgery and Mount Sinai Hospital in New York City has identified such tissue not as material to be discarded but as potential to be realized. “We have to [begin using these body parts] as soon as possible,” Djordjevic said in December 2019, in order “to stop putting healthy organs in the garbage.” The “healthy organs” he was referring to are parts of trans women’s genitals that instead of being disposed of after surgery, might be put to another use.
Djordjevic is not alone in seeing trans people’s bodies as unique sources of material value. Emerging research suggests that uteruses abandoned by young, healthy trans men could be transplanted into cisgender women who desire to gestate a pregnancy and require a uterus transplant in order to do so. Others have speculated that if taken in a single large graft, a trans man’s vagina and uterus could be transferred into the body of a trans woman who wants the ability to carry a baby. Penile tissues abandoned by trans women have been harvested for nearly a decade and used in research to develop penile components central to treating erectile dysfunction. More recent research has made use of whole penises taken from trans women in the production of tissue scaffolds that could one-day replace a penis lost to disease or trauma. The basic science and funding for this latter effort has relied on investments from the US military and its private and public partners, looking for strategies to replace the penises of American soldiers that have been lost in combat.
For researchers like Djordjevic, disposing of a trans person’s abandoned genital tissue is wasteful. He calls them “healthy tissues” to denote their status as non-diseased organs, though removing them is meant to materialize a trans-specific kind of “healthy” body that is better off without them. Body parts that are unwanted and that have for years been gratefully abandoned, do not make the same moral demands on recipients as those vital organs donated by families grieving their recently dead.
But if trans bodies are to become material resources for the consolidation of desirable gender in other bodies—providing the stuff that makes the “right” kinds of masculine men and feminine women—organ transplant regulations demand that their tissues will have to be transformed from “abandoned” to “donated” in order to make the passage from one body to another. In so doing, new relations will be established, as will new theories about how and to what effects shared body parts link particular people and institutions together.
If trans genital surgeries were reframed from individual acts of self-transformation into means of procuring tissues for others, the unique dynamic of the situation would obviate two of the well-established critiques of living organ transfer. The first critique, especially focused on living kidney transfer, is that organ transfer debilitates and imperils the donor body to the benefit of the recipient body. In the case of the trans person as donor, however, the given organ is one that the giver neither medically needs nor emotionally wants. Far from imperiling the health of the trans surgical patient, many advocates of trans surgery argue that removing genital and reproductive organs from a trans person is itself a life-saving act. While penises, vaginas, and uteruses are not life-sustaining organs, advocates of their transfer emphasize just how crucial they are to those who do want them. Uterus and penis transplant have been justified by asserting that the intactness and functionality of these body parts is crucial to living a good life. Like hand and face transplants before them, the extent to which functional genital and reproductive organs improve a recipient’s “quality of life” is used to justify the complexity of the intervention.
The second criticism of organ transfer that is eliminated when a trans person is a donor of genital tissues is that organ transfer often occurs under coercive and thus ethically contestable conditions. Whereas economic or family pressures may compel a person to sell or donate a kidney, trans surgical patients direct and advocate for their own surgical treatment, often despite a great many obstacles. Unlike other organ donation scenarios, in order to access genital altering procedures, the trans person has already been required to undergo extensive administrative screening—more than for nearly any other non-life-threatening surgical procedure. Trans folks have long needed permission to remove parts of their bodies; the construal of these parts as resources is new. The attenuated and bureaucratic screening process required for genital reconstructive surgery establishes the difference between organs that are needed but nonetheless lovingly donated, and those that are unwanted and abandoned to waste. These are important distinctions (and the trans patient is an important exception) because they would provide a way for procurement teams to work around the principles of donation/reception that currently determine the paths that organs take between living bodies. Donor candidates in this case are not just any persons with organs to give, but trans people whose status as trans makes them bioavailable in a way that no other group currently is.
There has been enough medical history written about the innovations built on the raw material of marginalized bodies to know that looking down the line to the ultimate use of these “discarded” tissues is not premature, even if the realization of the technology is still a generation away. In our contemporary moment of trans surgery, in which a model of informed consent is slowly replacing a patriarchal, exclusionary, punitive, and frequently adversarial clinical dynamic, and in clinics where trans medicine is ethically organized and skillfully practiced, trans patients remain vulnerable to numerous forms of economic, social, bureaucratic, and physical violence. The subjects of overt and ongoing criticism from the popular media and lawmakers, and frequently suffering health disparities that cut their lives short, trans people know there is good reason to be skeptical of strategies that locate our value not in us as people, but in how our bodies can contribute to the normative gendering of others. After decades of marginalized health care, insurance denials, and exclusionary clinical practices, what would it mean to be valuable? How would that new form of value connect our bodies to others?
In the acts of imagined exchange that I’ve described, the trans body is recuperated as a giver of important material rather than a consumer or abandoner of it, insofar as their parts will enable forms of sexed and gendered embodiment that they themselves have denied. Unwanted uteruses can make mothers; unwanted penises, virile and penetrating men. As a medical anthropologist wading into this new area of research, my questions are not about whether the interventions I’ve described will be helpful or harmful, for certainly these are not mutually exclusive things and they move in multiple directions at once. Bodily capacitation is not a silly or simple desire, and normativities have real, often deeply pleasing, effects. Instead, what is compelling me along in this project are questions about the new relations produced in this dynamic, the new forms of value it generates, and an eye for how the inclusion of sexual and reproductive body parts adds an asterisk to the well-explored problems of living organ transfer. If trans people remain abandoners, we get nothing from the new-found value of our bodies. But as donors—of sources of some of the most challenging-to-replicate body parts that are, at the same time, so crucial to widely held definitions of gendered personhood—we make an awkward fit in the Maussian model. Here, the trans body is uniquely bioavailable, eager to be rid of pieces and parts that some desperately need, and that others could never dream of giving up. These acts recuperate the trans body and trans person as working into the symbolic order, if only in pieces.
About the Author
Eric Plemons is Associate Professor in the School of Anthropology at the University of Arizona, where he also directs the program in medical anthropology. He is Co-Chair of the UA Transgender Studies Research Cluster, and Co-Chair of the Association for Queer Anthropology.