Strange Harvest. Lesley A. Sharp
or bureaucratic or clinical practices, I may need to acknowledge that other often recent statements have become outdated only a few years following publication. Thus, I continue to be driven by a desire to remain involved as an inquisitive ethnographer.
The stamina such work entails derives its energy in large part from the unflagging support offered by a wide range of colleagues, friends, and family, many of whom, I suspect, may be unaware of how much their interest and encouragement have meant to me over the years. Within the all too often ingrown circles of academia, I have consistently encountered warmth and support, even among those who would not count themselves as medical anthropologists. Some of these people I know, for instance, through my work in Madagascar, rather than American clinics and the like. Long-term, persistent support from Elizabeth Colson, Nancy Scheper-Hughes, Stephen Foster, Burton Benedict, Frederick Dunn, Gillian Feeley-Harnik, Paula Rubel, Abe Rosman, and Morton Klass has made me realize how fortunate I am to have had so precious a collection of mentors as these. Their inquisitiveness about human nature, paired with rigorous method and theoretical interrogation, are qualities I attempt to model daily in my own pursuits. Still others, through their administrative capacities at Butler University, Barnard College, and Columbia University, have made my work possible and enjoyable—at times because of financial support, at others simply because their enthusiasm for my work gave me the shot in the arm I sometimes needed to continue with my research. Paul Yu, Geoff Bannister, Flora Davidson, Elizabeth Boylan, Judith Shapiro, and Richard Parker have been especially supportive. I am deeply appreciative, too, of the many hours of formal and informal discussion with a range of invaluable colleagues. I cannot possibly name them all, but here I wish at the very least to thank Brian Larkin, Nan Rothschild, Paige West, Maxine Weisgrau, Paul Silverstein, Jason James, and Karen Seeley at Barnard College; Brink Messick, Neni Panourgia, Sherry Ortner, Robert Sember, and Carole Vance, as well as members of the Seminar on Death, at Columbia University; and, elsewhere, Nancy Chen, Margaret Clark, Kata Chillig, Linda Green, Cecil Helman, Renee Fox, Linda Hogle, Sharon Kaufman, Joshua Lederberg, Margaret Lock, Patty Marshall, Emily Martin, Mary Beth Mills, Eleni Papagaroufali, Rayna Rapp, Carolyn Rouse, Janelle Taylor, and Dorothy Nelkin. Lynn Morgan, Helen Gremellion, and Megan Crowley-Matoka offered detailed and insightful comments on the manuscript itself.
A virtual phalanx of extraordinarily talented students has lent invaluable support, often wending their way into domains I could not reach because of time and other constraints. I simply could not have learned as much as I have without the assistance and involvement of Marcy Assalone, Marcie Brink, Heather Fisher, Katie Kilroy-Marac, Sarah Muir, Evi Rivera, Sonya Rubin, and Thurka Sangaramoorthy. Kari Hodges and Scott Michener provided invaluable technical expertise and humor, too. Other close friends have offered good cheer, keeping me laughing even during the worst of times. I am especially grateful for the friendship (and accompanying insights, clinical and otherwise!) of Maureen Hickey, Michael Grider, Vinita Seghal, Elan Louis, Lisa Tiersten, Tovah Klein, Linda Beck, Susie Blalock, Robin Rudell, Annie Raherisoanjato, and Hanta and Chris Rideout. Erika Doss has been an exceptional source of inspiration during various road trips and other serious or silly pursuits.
Among the greatest frustrations an ethnographer encounters is the inability to thank the many people by name who have made one's research possible—this stems not only from the sheer number of people involved but also from the promise of anonymity during interviews and other activities. Nevertheless, I must express my heartfelt thanks to the many people who have so willingly given of themselves; their generosity is astounding, for not once did anyone refuse a request for an interview or turn me away from an event. I am deeply indebted to the many organ recipients who described their experiences and shared their thoughts; the donor kin who so willingly opened their homes to me and offered such intimate details of their personal lives; the staff from a range of hospitals, research labs, and conferences who granted me time—and access—during hectic daily schedules; and the many employees and volunteers based throughout the country's organ procurement agencies who have taught me so much about the difficulties of compassionate work. Still other organizations, including LOLA, MOTTEP, NATCO, NDFC, NKF, TRIO, and UNOS have enriched my work in ways I find difficult to describe in words. Quite a number of people have been important guides and teachers, often serving as valuable sources when I have required clarification on some of the more intricate aspects of organ transfer. Still others have encouraged my work through invitations to present my findings to involved audiences; thus, I wish to thank by name Arlene Barnett, Henry Broadbent, Maggie Coolican, Larraine DePasquale, Chris Gil-more, Kenny Hudson, Greg Holman, Shanon Moser, Barbara Musto, Miriam Perez, Leo Trevino, Susan Stoops Watson, and, most of all, Christine Wilson. Any errors that remain within this text are, of course, mine alone.
The research from which Strange Harvest emerges would never have come to fruition were it not for an unending stream of support from a range of generous institutions. These include the Project on Death in America of the Soros Foundation's Open Society Institute, The Wenner-Gren Foundation for Anthropological Research (grant 7017), a range of faculty research grants made available through Barnard College, including several that were funded by the Mellon Foundation, and an academic grant from Butler University that launched the initial project back in the early 1990s. Two separate residencies at the Hastings Center for Bioethics, where I was a Visiting North American Scholar during the summer of 2002, and later at the Russell Sage Foundation throughout the 2003-4 academic year, enabled me to gather my thoughts in wonderfully peaceful settings that allowed me to write this book. A year's sabbatical from Barnard College was also essential to this project. I have been fortunate to have been able to work with Randy Heyman, Jacqueline Volin, and Susan Ecklund at the University of California Press. Eugene Kain and Bill Nelson deserve special praise for their artwork. I am also deeply indebted to Stan Holwitz, who has offered unwavering support on every project I pursue. One could not wish for a kinder and more encouraging editor.
Finally, I am deeply thankful for the haven provided by my family. In a sense, it is for them that I have pursued this work for so long. This book is dedicated to my mother, whose intelligence, hilarious wit, and intellectual presence I miss terribly. My father, who read this manuscript with meticulous care, has proved subsequently to be a reliable source of lively discussion and a firm anchor as well. Erik and Paula have similarly stimulated me to rethink some of my questions, although it is their love that has mattered the most. Similarly, Ross, Julio, Emily, Ruthie and Wally, and Mary and Frank have all, in their own unique ways, kept me going and laughing, too. Most important of all is Andy's love and support, and the joy that Alex brings daily to my life. My work is secondary to such happiness as this.
Introduction
Strange Harvest
Organ transplantation in the United States has entered a state of crisis, albeit one of its own design. The boldness of this statement rests on the supposition that transplantation simultaneously epitomizes technical genius and medical hubris in this country. Specialized surgeons now understand the function of highly sophisticated organs so well that they routinely remove these organs from the recently deceased, using them in turn to replenish life in their ailing patients. Nevertheless, even after fifty years of practice and refinement, transplantation looms as a troubling realm of medicine, especially within the lay imagination. Although it stands as an icon of medical accomplishment—and in some quarters may even be considered a routine response to a range of severe health problems—it nevertheless generates a host of perplexing questions about healing and illness, medical versus social definitions of death, the hybridization of human bodies, and nonmedicalized constructions of personhood, individuality, and the embodied self.
As a widespread surgical technique and lucrative arm of medicine, transplantation has generated a plethora of literature: its persistent ability to fascinate ensures its recurrent treatment within the mainstream press (early developments were featured on the cover of Life magazine). Organ transplants also provide rich fodder for plots in a wide range of media, including thriller fiction, television dramas, and film. Further, transplantation, as an icon of medical accomplishment, defines a regular subject of scientific inquiry in such flagship medical publications as the Journal of the American Medical Association, the New England Journal of Medicine, and the Lancet. It also lays claim to a range of specialized periodicals, including Transplantation, Transplantation Proceedings, the