Medicine, Health Care and Philosophy

, Volume 17, Issue 2, pp 171–181 | Cite as

Neither property right nor heroic gift, neither sacrifice nor aporia: the benefit of the theoretical lens of sharing in donation ethics

  • Kristin ZeilerEmail author
Scientific Contribution


Two ethical frameworks have dominated the discussion of organ donation for long: that of property rights and that of gift-giving. However, recent years have seen a drastic rise in the number of philosophical analyses of the meaning of giving and generosity, which has been mirrored in ethical debates on organ donation and in critical sociological, anthropological and ethnological work on the gift metaphor in this context. In order to capture the flourishing of this field, this article distinguishes between four frameworks for thinking about bodily exchanges in medicine: those of property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. These frameworks represent four different ways of making sense of donation of organs as well as tissue, gametes and blood, draw on different conceptions of the relations between the self and the other, and bring out different ethical issues as core ones. The article presents these frameworks, argues that all of them run into difficulties when trying to make sense of reciprocity and relational interdependence in donation, and shows how the three gift-giving frameworks (of heroism, sacrifice and aporia) hang together in a critical discussion about what is at stake in organ donation. It also presents and argues in favour of an alternative intercorporeal framework of giving-through-sharing that more thoroughly explicates the gift metaphor in the context of donation, and offers tools for making sense of relational dimensions of live and post mortem donations.


Aporia Gift-giving Intercorporeality Organ donation Phenomenology of the body Property right Relationality Sacrifice Sharing Tissue donation 



The article is part of the research project Towards an Ethics of Bodily Giving and Sharing, funded by Riksbankens Jubileumsfond, Sweden, and written during my time as in-residence research fellow at the Swedish Collegium for Advanced Study, Uppsala University, Sweden. My thanks go to both of these.


  1. Becker, L.C. 1980. The moral basis of property rights. In Property, ed. R.J. Pennock, 187–220. New York: New York University Press.Google Scholar
  2. Björkman, B., and S.O. Hanson. 2006. Bodily rights and property rights. Journal of Medical Ethics 32: 209.PubMedCentralPubMedCrossRefGoogle Scholar
  3. Cadwallader, J.R. 2010. Archiving gifts. Ethics, politics and bodily modification. Australian Feminist Studies 25(64): 121–132.CrossRefGoogle Scholar
  4. Campbell, A. 2012. The body: Property, commodity or gift? In Reconceiving medical ethics, ed Cowley, C., 15–29. New York: Continuum Publishing.Google Scholar
  5. Chen, S.C., et al. 2006. Attitude toward living donor liver transplantation in Taiwan. Transplantation Proceedings 38: 2108–2110.PubMedCrossRefGoogle Scholar
  6. Christman, J. 1994. Distributive justice and the complex structure of ownership. Philosophy and Public Affairs 23(3): 225–250.Google Scholar
  7. Crossley, N. 1995. Merleau-Ponty, the elusive body, and carnal sociology. Body and Society 1: 43–63.Google Scholar
  8. Derrida, J. 1997. Given time: 1. Counterfeit money. Chicago: The University of Chicago Press.Google Scholar
  9. Derrida, J. 1999. Adieu to Emmanuel Levinas. Stanford: Stanford University Press.Google Scholar
  10. Derrida, J. 2001. On cosmopolitanism and forgiveness. New York: Routeledge.Google Scholar
  11. Diprose, R. 2002. Corporeal generosity. On giving with Nietzsche, Merleau-Ponty, and Levinas. Albany: State University of New York.Google Scholar
  12. Dunham IV, C.C. 2008. Body property: challenging the ethical barriers in organ transplantation to protect individual autonomy. Annals of Health Law 17(1):39–66.Google Scholar
  13. Fox, R.C. 1996. Afterthoughts: continuing reflections on organ transplantation. In Organ transplantation: meaning and realities, ed. S.J. Younger, R.C. Fox, and L.J. O’Connell, 252–272. Wisconsin: University of Wisconsin Press.Google Scholar
  14. Fox, R.C., and J.P. Swazey. 2001. The courage to fail: a social view of organ transplants and dialysis. Piscataway: Transaction Publishers, Third.Google Scholar
  15. Gallagher, S., and A.N. Meltzoff. 1996. The earliest sense of self and others: merleau-Ponty and recent developmental studies. Philosophical Psychology 9(2): 211–233.CrossRefGoogle Scholar
  16. Haddow, G. 2005. The phenomenology of death, embodiment and organ transplantation. Sociology of Health & Illness 27(1): 92–113.CrossRefGoogle Scholar
  17. Henaff, M. 2010. The price of truth. Gift, money, and philosophy. Stanford: Stanford University Press.Google Scholar
  18. Honoré, T. 1961. Ownership. In: Oxford essays on jurisprudence. Oxford: Oxford University Press.Google Scholar
  19. Horner, R. 2001. Rethinking god as gift: marion, derrida, and the limits of phenomenology. New York: Fordham University Press.CrossRefGoogle Scholar
  20. Jarvis, S. 2001. Problems in the phenomenology of the gift. Angelaki: Journal of Theoretical Humanities 6(2):67–77.Google Scholar
  21. Joas, H. 1983. The intersubjective constitution of the body-image. Human Studies 6: 197–204.CrossRefGoogle Scholar
  22. Joralemon, D. 1995. Organ wars: the battle for body parts. Medical Anthropology Quarterly 9(3): 334–356.Google Scholar
  23. Käll, L.F. 2013. Intercorporeality and the sharability of pain. In Dimensions of pain, ed. L.F Käll. Oxon and New York: Routledge.Google Scholar
  24. Lauritzen, P., M. McClure, M.L. Smith, and A. Trew. 2001. The gift of life and the common good: the need for a communal approach to organ procurement. Hastings Center Report 31: 1.Google Scholar
  25. Leder, D. 1990. The absent body. Chicago: The University of Chicago Press.Google Scholar
  26. Leder, D. 1999. Whose body? What body? The metaphysics of organ transplantation. In Persons and their bodies: rights, resposibilities, relationships, ed. M.J. Cherry, 233–264. Hingham, MA: Kluwer Academic Publishers.Google Scholar
  27. Lock, M. 2002. Human body parts as therapeutic tools: contradictory discourses and transformed subjectivities. Qualitative Health Research 12: 1406–1418.PubMedCrossRefGoogle Scholar
  28. Locke, J. 1956. Second treatise of government, Chap V, p 27. Mineola, NY: Courier Dover.Google Scholar
  29. Mauss, M. 1966. The gift. Forms and functions of exchange in archaic societies. London: Cohen & West.Google Scholar
  30. Merleau-Ponty, M. 1968. The visible and the invisible. Evanston, Illinois: Northwestern University Press.Google Scholar
  31. Merleau-Ponty, M. 2006. The phenomenology of perception. London: Routeledge.Google Scholar
  32. Milbank, J. 1999. The ethics of self–sacrifice. First Things 91: 33–38.Google Scholar
  33. Milbank, J. 2001. The midwinter sacrifice: a sequel to ‘Can Morality Be Christian?’ Angelaki: Journal of Theoretical Humanities 6(2):49–65.Google Scholar
  34. Mongoven, A. 2003. Sharing our body and blood: organ donation and feminist critiques of sacrifice. Journal of Medicine and Philosophy 28(1): 89–114.PubMedCrossRefGoogle Scholar
  35. Nancy, J.-L. 2002. L’Intrus. CR: The New Centennital Review 2(3): 1–14.CrossRefGoogle Scholar
  36. Parry, J. 1986. The gift, the Indian gift, and the ‘Indian gift’. Man 21: 453–473.CrossRefGoogle Scholar
  37. Radin, J.M. 1996. Contested commodities. Cambridge, MA: Harvard University Press.Google Scholar
  38. Scheper-Hughes, N. 2007. The tyranny of the gift: sacrificial violence in living donor transplants. American Journal of Transplantation 7: 507–511.PubMedCrossRefGoogle Scholar
  39. Schicktanz, S., J.W. Rieger, and B. Lüttenberg. 2006. Geschlechterunterschiede bei der Lebendnierentransplantation: Ein Vergleich bei globalen, mitteleuropäischen und deutchen Daten und deren ethische Relevanz. Transplantationsmedizin 18: 83–90.Google Scholar
  40. Schrift, A.D. (ed.). 1997. The logic of the gift. Towards an ethic of generosity. New York: Routledge.Google Scholar
  41. Shaw, R. 2010. Perceptions of the gift relationship in organ and tissue donation: views of intensivists and donor and recipient coordinators. Social Science and Medicine 70(4): 609–615.PubMedCrossRefGoogle Scholar
  42. Shildrick, M. 2008. The critical turn in feminist bioethics: the case of heart transplantation. International Journal of Feminist Approaches to Bioethics 1(1): 28–47.CrossRefGoogle Scholar
  43. Simingoff, L.A., and K. Chillag. 1999. The fallacy of the “Gift of Life”. The Hastings Center Report 29(6): 34–41.CrossRefGoogle Scholar
  44. Sque, M., S. Payne, and J. Macleod. 2007. Gift of life or sacrifice? Key discourses to understand organ donor families’ decision-making. Mortality: Promoting the Interdisciplinary Study of Death and Dying 11(2):117–132.Google Scholar
  45. Sque, M., T. Long, S. Payne, and J. Macleod. 2008. Why relatives do not donate organs for transplants: ‘sacrifice’ or ‘gift of life’. Journal of Advanced Nursing 61(2): 134–144.PubMedCrossRefGoogle Scholar
  46. Still, J. 2010. Derrida and hospitality. Theory and practice. Edinburgh: Edinburgh University Press.CrossRefGoogle Scholar
  47. Svenaeus, F. 2010. The body as gift, resource or commodity? Heidegger and the ethics of organ transplantation. Journal of Bioethical Inquiry 7: 163–172.CrossRefGoogle Scholar
  48. Svenaeus, F. 2012. The phenomenology of organ transplantation. How does the malfunction and change of organs have effects on personal identity? In The body as gift, resource, and commodity. Exchanging organs, tissues, and cells in the 21st century, eds. Gunnarson, M., and F. Svenaeus, 58–79. Södertörn studies in practical knowledge 6. Huddinge: Södertörn högskola.Google Scholar
  49. Titmuss, R.M. 1970. The gift relationship. London: Allen and Unwin.Google Scholar
  50. Truog, R.D. 2005. Are organs personal property or a societal resource? The American Journal of Bioethics 5(5): 14–16.PubMedCrossRefGoogle Scholar
  51. Varela, F.J. 2001. Intimate distances. Fragments for a phenomenolgy of organ transplantation. Journal of Consciousness Studies 8(5–7): 259–271.Google Scholar
  52. Waldby, C. 2002. Biomedicine, tissue transfer and intercorporeality. Feminist Theory 3: 239–254.CrossRefGoogle Scholar
  53. Wall, J. 2011. The legal status of body parts: a framework. Oxford Journal of Legal Studies 31(4): 783–804.CrossRefGoogle Scholar
  54. Watkins, P., J. Scheer, M. Ovnicek, and R. Kolts. 2006. The debt of gratitude: dissociating gratitude and indebtness. Cognition & Emotion 20(2): 217–241.CrossRefGoogle Scholar
  55. Weiss, G. 1999. Body images. Embodiment as intercorporeality. New York: Routledge.Google Scholar
  56. Wyschogrod, E., J.J. Goux, and E. Boynton (eds.). 2002. The enigma of gift and sacrifice. New York: Fordham University Press.Google Scholar
  57. Zeiler, K. 2013a. Between bodies in dementia care: An intercorporeal conception of personhood—A philosophical defense of the idea that individuals can be held in personhood by others. Medicine, Health Care and Philosophy. doi: 10.1007/s11019-013-9515-z.
  58. Zeiler, K. 2013b. Sociality of suffering and intersubjectivity in perception. Phenomenology of the body as a basis for rethinking parental live organ donation as non-choice and expressive of autonomy. Manuscript.Google Scholar
  59. Zeiler, K., L. Guntram, and A. Lennerling. 2010. Moral tales of parental live kidney donation. A parenthood moral imperative and its relevance for parental living kidney donors’ decision-making. Medicine, Health Care and Philosophy 13(3): 225–236.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  2. 2.Swedish Collegium for Advanced StudyUppsala UniversityUppsalaSweden

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