of other troubling consequences. Among these is an overwhelming commodification of the human body (Scheper-Hughes and Wacquant 2003; Sharp 2000b). Today the human body is a treasure trove of reusable parts, including the major organs (lungs, heart, liver, kidneys, pancreas, intestine, and bowel); tissue (a category that includes bone, bone marrow, ligaments, corneas, and skin); reproductive fragments (sperm, ova, placenta, and fetal tissue); as well as blood, plasma, hair, and even the whole body (Hogshire 1992; Roach 2003). In 1978, Forbes estimated the worth of the full range of the human spare parts industry in the United States at $700 million, with a projected annual growth rate of 15 percent (Solomon 1978). Furthermore, by 1998 the country could boast more than one thousand biotechnology firms that manufactured products from bodily materials (Nelkin and Andrews 1998: 30-31). Today the trade in body parts has expanded well beyond this nation's boundaries, such that the international tissue market alone is worth at least $500 million annually (AP 2000).
Clearly, the cadaveric human body has become a highly lucrative entity: as many as 150 parts can be reused, and an individual body alone is worth more than $230,000 on the open market (Hedges and Gaines 2000; Pantagraph 1991). The manner in which body parts are categorized also affects their value. Long-standing legislation within the United States renders illegal the direct buying and selling of human organs so that their retrieval, distribution, and placement are managed solely by nonprofit organizations. These exchanges are strictly controlled at both state and national levels, as dictated by the 1984 National Organ Transplant Act (NOTA) and the Uniform Anatomical Gift Act, which was passed by all fifty states by 1973 (Maeder and Ross 2002: 44). Furthermore, organ procurement and placement are overseen by the United Network for Organ Sharing (UNOS) in Richmond, Virginia, under contract through the U.S. Department of Health and Human Services (HHS). UNOS administers the Organ Procurement and Transplantation Network (OPTN), established under NOTA and funded by Congress. Tissues, on the other hand, have encountered significantly less regulation and are handled largely by a wide array of for-profit national and international firms. Beyond the boundaries of organ transplantation, the reuse of human skin can be crucial to survival for persons who have been severely burned; other tissues are employed regularly for such purposes as dental and orthopedic reconstruction, cornea transplantation, and a wide assortment of cosmetic surgeries. When taken as a whole, the human “body shop” (Andrews and Nelkin 2001; Kimbrell 1993; Nelkin and Andrews 1998; Rothman 1997) shapes a significant portion of high-end millennial medical practice in America.
As Paul Brodwin (2000c) has argued, the intensity of ethical debates surrounding radical biotechnologies is evident in the levels of anxiety they generate, and organ transfer is no exception. Among the strongest ideological underpinnings of transplant medicine is the adamant denial of body com-modification. The collective horror Americans share for the utilitarian use of human bodies is apparent in our folklore. Negative associations link the reuse of body parts with Hollywood's original rendering of Frankenstein's monster. A persistent theme within futuristic Anglophone fiction is the routine and frequently clandestine medical or industrial use of human bodies to sustain society and feed individual or corporate greed. Classics include Harry Harrison's Make Room! Make Room! (1964; the basis for the film Soylent Green, in which the general populace is fed recycled humans without its knowledge); Robin Cook's Coma (1977; in which healthy people are drugged and held in comatose states until their organs can be removed for sale); and the darkly comical rendering found in Monty Python's the Meaning of Life (wherein procurement officials arrive at a man's home and assert their rights to retrieve his organs while he is still very much alive, all because he has signed his donor card). The corporate preying on the body stands as a symbolic form of necrophagy—or what Youngner has dubbed “nonoral cannibalism”—where a chilling utilitarian ethos drives villains to harvest body parts without guilt (Youngner 1996: 35; for similar language, see Fox 1993; Lindenbaum 2004; Scheper-Hughes 1998b). In these tales only sensitive heroes can still recognize the humanity of captured or discarded souls.
What such fictional stories (and parodies) reveal is that body commodification—especially within the highly celebrated arena of organ transplantation—quickly erodes an already shaky public investment in medical trust. In response to such deep concerns, the transplant industry has generated an elaborate array of powerful euphemistic devices that obscure the commodification of cadaveric donors and their parts.
Precious Things
The most elaborate and pervasive rhetoric involves the shrouding of body commodification in the language of a gift economy. This language is evident in early bureaucratized form in the wording of NOTA, or the 1984 National Organ Transplant Act. Today the language of the gift permeates nearly all discussions of organ transfer, which is defined as a very particular kind of social giving in America. Most important, organs are nearly always described as “gifts of life,” a turn of phrase that has long been used within the blood industry (and especially by the American Red Cross) and now in reference to ova donation (Ragone 1999). Both realms differ from organ transfer in that they are marked by histories of direct agency-to-donor monetary compensation. In the specific context of cadaveric donation, the vast majority of organs are offered by donors' surviving kin to anonymous strangers; procurement specialists help negotiate the transfer of these body parts to surgeons, who will then transplant them in their own ailing patients. Without question, much money is exchanged, but payments made by insurance companies, individual patients, transplant hospitals, and procurement agencies are typically described as covering technical, transportation, and other support services, rather than being linked directly to the cost of the organ itself. An important shared understanding within transplant circles is that taboos surround discussions of the financial worth of organs. Furthermore, strict moral sanctions insist that donor kin should receive no direct payment for a gift offered as an ultimate form of altruistic sacrifice.
Nevertheless, I have seen on rare occasions itemized price sheets for various organs. In one hospital where I conducted research, staff regularly distributed detailed price information directly to potential recipients so that they would know the enormous costs entailed in acquiring a kidney, heart, lung, or liver. Staff saw no reason to be secretive about this. Nevertheless, because such procedures are rare, they emerge as subversive acts. Perhaps more obvious is the fact that a transplant unit defines a tremendously prestigious program for any hospital, both assuming a high community profile and generating significant income for surgeons and for the institution itself. Procurement offices, too, though nonprofit firms, operate on impressive annual budgets dispensed by UNOS. Inherent tension underlying the daily struggle to maintain transplantation's credibility arises from the fact that transplantation is as lucrative as it is medically miraculous. One dominant solution to this conundrum involves the deliberate and ceaseless denial of even the more obvious forms of body commodification.
Cadaveric donation further complicates this configuration. Whereas a vast percentage of kidney transplants in this country involve living pairs of relatives, friends, or colleagues, in nearly all cadaveric cases the donor is an anonymous stranger to the respective set of organ recipients. In those situations where living donor and kidney recipient know one another, both parties understand the kidney as being a special kind of gift to which no monetary value can be assigned.9 This initial shared understanding eventually may become a source of either increased mutual love or insurmountable conflict. As Renee Fox and Judith Swazey explain, the “tyranny of the gift” springs from the sense that the giving of so precious a thing—a part of oneself—can never be fully reciprocated (1992:39-42). A different configuration arises in the context of anonymous cadaveric donation, where recipients are generally told only the age of their donors, their family status, the region of the country from which they came, and sometimes their cause of death. Recipients find it difficult to shake the sense that someone else had to die so that they could live, their anxieties exacerbated if they imagine how close kin—typically the donor's spouse, offspring, or parents—must have suffered when faced with the donor's sudden and unexpected death.
As a result, donated cadaveric organs simultaneously emerge as interchangeable parts, as precious gifts, and as harboring the transmigrated souls of the dead. Whereas transplant recipients are encouraged by hospital staff to depersonalize their
