1. FAIRNESS AND THE TYRANNY OF
POTENTIAL IN KIDNEY
TRANSPLANTATIONS
Sharon R. Kaufman
Source: Current Anthropology, Vol. 54, No. S7,
Potentiality and Humanness: Revisiting the
Anthropological Object in Contemporary
Biomedicine (October 2013), pp. S56-S66
Lia Puspitasari
University of Tsukuba

2. Agenda
• Introduction
• How to examine
• Problems
• Scheme for fairness in US organ transplant distribution
systems
• Living Donation from Younger to Older Persons
• The Rise of Anonymous Donation and Web-based
Matching

3. FACTS ABOUT ORGAN TRANSPLANTATION
IN US
2.100 new patients are added to the organ donation
16 to 17 people die everyday while waiting for
transplants
10.000 to 14.000 people who die each year meet
the criteria for organ donation, but..
Less than ½ of those people actually become organ
donors.
Source: www.donatelifenw.org

4. Introduction
• Potential for greater longevity brings the problem of
fairness and equity in health.
80% 20%
<65 Years >65 Years
Source: Administration on Aging:2011
• How nations reconstitute the practice of fairness and the
idea of public good in an aging society.
• Kidney transplantation in US

5. Problems
• Scarce resources, no balanced demand and supply
• Ethical issues centers on age and the public good in that
the good of longevity making also contributes to
shortages and death.
• Clinical success of kidney transplantation performs radical
cultural work and unleashes potential:
• Statistically account for relations between older and younger
bodies
• Negotiate fairness, to see one’s own body as the vehicle for the
health and life of a loved one or a stranger, and to understand that
altruism and the market can be linked through living donation.

6. How to examine
• Describing the potentiality they assign to kidneys, elder
persons and the organ supply
• By exploring the effects of those potentiality in three
realms:
Scheme for
fairness in US
organ
transplant
distribution
systems.
Living donation
from younger
to older person
The rise of anonymous
living donation and
web-based matching.

7. Scheme for fairness in US organ transplant
distribution systems.
Old schemes- Allocation
• Began in 1986.
• First-come, first-served basis.
• Less efficient in terms of individual patient survival
• Less equitable in terms of fair distribution
• Fairness was manifest in time waiting
• Problem:
• Today, age has become central to its waning fairness.
• Demographic, medicine, and understandings of longevity have
changed
• Larger number of person age 65 years and older in waiting list
• Kidneys can not keep up with the demand
• Assumption that kidneys potential for giving life is wasted.

8. Proposed Schemes
OPTN/UNOS (Organ Procurement and Transplantation
Network of the United Network for Organ Sharing) Feb
2011 offered: “Concepts for Kidney Allocation”
Goal: to enhance post transplant survival benefit
1
2
20% of the kidneys with the longest potential life
span would be offered to candidates projected to
have the longest survival time with the organ
20% of the kidneys with the longest potential life
span would be offered to candidates projected to
have the longest survival time with the organ
80% kidneys in the pool would be “age matched”
to within 15 years of the candidate’s age
80% would not be age-matched and would be
distributed largely as they always had been

9. Living Donation from Younger to Older
Persons
Source: www.donatelifenw.org

10. • Greater scarcity and waiting time makes
larger number of donation from children or
family relatives to parents.
• Tyranny resides in the now routine social
fact of offering and giving, accepting and
receiving; in the bodily “gift” as a “natural”
feature of kin obligation, and the equation
of this kind of gifting with care and love.

11. The Rise of Anonymous Donation and
Web-based Matching
• 1990 formal requirements has been relaxed
• Altruism drives the rise of anonymous
donors: many donation from strangers.
• Web-based matching emerged.
• Shift to surgical-altruism

12. Social changes:
• Institutions for organ
procurement, disbursement and regulation
produced opportunities for altruism to be
expressed.
• Living donation (related or non-related)
came to be seen as the normal, natural
thing to do, more older people seeking
kidneys and more younger people donating
them followed seamlessly.

13. THANK YOU FOR LISTENING