OBM Transplantation

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OBM Transplantation is an international peer-reviewed Open Access journal, which covers all evidence-based scientific studies related to transplantation, including: transplantation procedures and the maintenance of transplanted tissues or organs; assimilation of grafted tissue and the reconstitution of removed organs or parts of organs; transplantation of heart, lung, kidney, liver, pancreatic islets and bone marrow, etc. Areas related to clinical and experimental transplantation are also of interest.

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Mauss and Organ Transplants: Ideas of Connectivity between Recipients and Donors and the “Spirit of the Gift”

Malcolm Voyce *

Macquarie Law School, Macquarie University, Sydney, Australia

Correspondence: Malcolm Voyce

Academic Editor: Yasuhiko Sugawara

Special Issue: Ethical and Legal Issues in Organ Transplantation

Received: July 22, 2020 | Accepted: October 29, 2020 | Published: November 16, 2020

OBM Transplantation 2020, Volume 4, Issue 4, doi:10.21926/obm.transplant.2004124

Recommended citation: Voyce M. Mauss and Organ Transplants: Ideas of Connectivity between Recipients and Donors and the “Spirit of the Gift”. OBM Transplantation 2020;4(4):9; doi:10.21926/obm.transplant.2004124.

© 2020 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Abstract

This article aims to describe the relationship between donors and their recipients in the context of organ transplants. This analysis is made in the light of Marcel Mauss’s work, offering an expansion on an analysis of his discussion on the “spirit of the gift” and his idea that gifts require reciprocation. It is argued that some recipients of donated organs receive a personal element from the donor in that there is a transfer or sharing of the donors’ personality and spiritual qualities. The article examines the nature of this form of “interconnectedness”. The article considers the qualities of this form of interconnectedness between donors and recipients by examining two specific cases of gift giving. One such case concerns the accounts of the reception of organs by recipients and how they may feel connected with a donated entity. The second case of gifting is the case of Tibetan lamas concerning their funeral ceremonies, where, following cremation, their relics are donated to disciples. This “donation” does not take place by dissecting useable parts of a body for use in another person, but rather by ingestion of the remains of the corpse following cremation. This example shows how such “donations” are seen as incorporating the spiritual qualities and attributes of the donor [1]. The article concludes that while scholars have employed different forms of metaphors to understand the cultural context of organ donations this article analyzes the elements of the “spirit of the gift.” This form of analysis may best be understood in terms of Mauss’s notions of the return of the gift and the creation of a “communal bond”.

Keywords

Mauss; reciprocity; gifts; organ transplants; Buddhism

1. Organ Donations as Gifts

This article was inspired by the novel of Javier Marius called Tomorrow in the Battle Think of Me (1997) [2]. In this work, Marius examines the connectivity that two men may have between each other through having sex with the same woman.

Marius relates how the sleeping with the same woman “establishes a relationship that our languages no longer reflect, but that certain dead languages do.” He contends that there is in existence an ancient Anglo-Saxon verb, no longer in use, that has not survived, that describes the relationship or kinship acquired by two or more men who have slept with the same women, even though such intercourse happened at different times. This verb he conjects originally meant “comradeship”, or “conjunction” or “travelling companion” [2].

While this story may be a literary device it represents the concern of this article which is; how do we describe the form of connectivity between donor and donee in organ transplants? It is admitted that not all people feel any connection with the donor and get on with their life regarding the new part merely as one would with a new engine in car.

To establish the shape and form of connectivity in organ transplants two examples are deplyed. The first example describes the experience of a few recipients who receive organs in the usual course of events and who notice the qualities of the donor in the organ.

One story in this context delineates the issue of connectivity (or dis-connectivity). This story narrates how a man who had a hand transplanted and his belief that the new hand did not give him a sense of wellbeing or integrity; eventually he had the hand amputated [3]. The case highlights how people who receive transplants may well have to deal with the incorporation of other bodies.

The second example utilised is from Tibetan culture where the “donors” who are the recipients of funeral relics, have commented how ingestion of these relics establishes a sense of interconnectedness [1]. This example from Tibetan culture is used as an imaginative mental framework to throw light on the cultural context of organ transplants. A discussion is therefor made from Tibetan Buddhist accounts to throw light on organ donations in order to examine a form of connectivity between organ donors and recipients.

2. The Scholarship on Organ Transplants and Mauss

As regards organ transplants, scholars have deployed several frameworks of analysis, such as viewing transplants as commodities, sacrifices or gifts. In this article, the idea of transplants as gifts, is developed mainly because this frame indicates a possible response to a donation such as gratitude or thankfulness or what I prefer to call “connectivity”.

Organ donations were first described as “gifts” in the early 1970s, by Titmuss, Fox and Swazey. These authors utilised the work of French sociologist and anthropologist Marcel Mauss, whose Essai sur le Don was published in English as The Gift. This work became paradigmatic for scholars analysing organ transplants [4].

Mauss’s aim was to provide an alternative account of capitalist social relations, which he regarded as based on the idea of market relations and self-interest [5]. For Mauss the idea of a gift outlined a “general theory of obligation” to provide an account of the human foundations on which our society was built [6].

A common summary of Mauss’s work was that recipients of gifts feel obliged to return gifts in kind, as part of the donor’s soul becomes entangled in the gift, wishing to return home and thus compelling the recipient to make a return [5]. It is argued that it is important to add to this standard reading an examination of the connectivity of such gifts by examining the idea of the “spirit of the gift” as explained by Mauss.

While organ transplants have been analysed by different forms of metaphors such as commodification, cannibalism or altruism this article deploys Mauss’s notion of the “spirit of the gift” to comprehend the nature of the exchange and importantly the kind of connectivity that may exist between donors and recipients.

To assist my reading of Mauss, the work of Bateman is noted who has commented on the connection between Mauss and Émile Durkheim: Mauss was the latter’s nephew and both men shared a common interest in ideas of social solidarity. Bateman also notes how the original French title of the work deploys the word don: this is significant because the term becomes “gift” in English, indicating that the title of the book could be translated into English as An Essay on Giving [4]. Moreover, this emphasis on gifts may have obscured the fact that Mauss, while he frequently did refer to “gifts” (cadeaux), also referred to “services” and “benefits (presentations). In his conclusion, Mauss characterises these sorts of practices as “total social facts” (faits sociaux totaux).

These factors indicate how Mauss’s work reflects broader ideas of social solidarity and that something may be lost, should we not adopt a broader concept of giving than that which conceptualises the return of the gift, and therefore the possibility of participating in a wider view of social solidarity [4]. I now expand on this approach to examine the nature of this connecting substance.

Mauss work utilised comparative ethnography and although he realised his generalisations could be criticised, it has been acknowledged that Mauss ultimately produced a “kind of myth, he did capture something essential” [5]. Mauss described what he saw as a common pattern of gifts and sacrifices in “archaic societies.” He wrote that while “in theory [gifts] are voluntary, in reality given and returned obligatory; apparently free and disinterested [they are] nevertheless constrained and self-interested” [6].

However, Mauss’s concept of a “gift” and the requirement of reciprocity has not been found to exist in deceased donations as practiced in most Western countries. Indeed as Shimazono notes deceased organ donation may be seen as a “modern” gift as such gifts are made possible by modern technology [7]. For instance, in the United States, donations are “voluntary, altruistic, and anonymous.” It is noted that in some countries connections between the donor families and recipients are encouraged [8]. This situation is at “odds with Mauss’s paradigm” as a wall of separation has been placed between donor and recipient that would seem to prevent any type of personal relationship, which was a key part of Mauss’s concept of gift exchange [9].

Despite this, the suggestion in Mauss’s as regards the idea of reciprocity should not be rejected entirely as regards donations. Should we take time to examine the concept of the “spirit of the gift” and the notion of hau (binding force of the gift) in Mauss’s work, it is possible to develop a reading of Mauss that helps one understand the idea of reciprocity in a fashion that has implications for an understanding of organ transplants.

Mauss indicated that a gift had a personality of its own which was distinct from the personality of the donor [6]. Such gifts create a spiritual bond (hau) between the donor and the recipient, which should be returned [10]. Of greater interest here is the nature of hau, which may be seen to be linked to forms of natural forces, which by their very nature are inalienable and cannot be possessed, in the sense that one aspect of the gift still belongs or resides in the giver, even after it has been “given away.” In this context the term “inalienable” indicates the essential power of spiritual forces across land, water and forest [11].

Mauss drew much of his inspiration from the New Zealand Maori: in Maori philosophy, the body is considered to be a vessel of wairua (spirit) and mauri (life-force), and all parts of the body exemplify hau (vital spirit). This ontology has resonance for organ donations because, as Mauss pointed out, to make a gift of something to someone is to make a present of some part of oneself. In Maori belief the body is not an inanimate object but instead part of a broader ancestry that provides a link between the physical and spiritual worlds, connecting the individual to their extended family and tribes [12,13].

3. An Example from Tibetan culture of Intercorporality

It has been indicated that the possibility of reciprocity has generally been discounted as regards donations. However, some recent scholarship has indicated that anonymity might not necessarily mean there is a “form of alienation and passivity” but rather that this situation may, on the contrary, provide an “imaged canvas for novel ideational manoeuvres” [14].

It will be argued therefore that while feelings of debt or gratitude may exit in the mind of recipients what concerns me is the nature of mutuality between donor and recipient: this may be called a “communal bond” that may exist between donor and recipient. By the term “communal bond” I mean the way donors and recipients share, on both a conceptual and a bodily level, the experience of “natural forces”.

This approach may be illustrated from the Tibetan Buddhist world as an aspect of the trikāya (the enlightened body) that is not limited by time or space [15]. A later explanation will be made of this interpretation of the trikāya includes the idea of a bodily and spiritual commonality between people and natural forces.

Here reference is made to the notion of trikāya as a means to develop ideas of intersubjectivity, namely the way bodies may be interconnected or linked with each other, rather than conceived of as discrete [15].

This approach to organ transplants as gifts has been developed from the ethnographical work of Tanya Zivkovic on Tibetan lamas. She studied the death and rebirth ceremonies of Tibetan Buddhists in the Darjeeling region. She has shown that the willing ingestion of bodily relics of a deceased lama imaginatively recreates the presence of the lama in the recipient. Relics taken from cremation grounds in the form of ashes or bones has also been seen as representing the former presence of the deceased [16].

This ingestion facilitated forms of inter-subjectivity from one body to another through the “transmission or intensity of force.” This form of exchange allows recipients to be “affected in a way that leads to an intimate awareness of the body of another” [1]. Thus through these transfers of relics there was created what may be called a “communal spiritual body” between lamas and their disciples [1,17,18].

Zivkovicz has shown how, through a shared belief in the trikāya disciples may a experience a sense of shared intersubjectivty. This intersubjectivity represents not only a sense of interconnectedness between different individuals but also of intercorporality [15,17]. Through “intercorporality” aspects of a lama’s body may be remade in the lives of disciples [15].

The social and spiritual worlds in Tibetan Buddhism constitute a dynamic of intersubjective engagements between lamas and monks within a spiritual universe involving gods, elemental nature spirits, hell beings, ghosts and enlightened beings [1]. The Tibetan practitioner may cross between these human and divine worlds as subjectivity is “neither independent or unified” and does not have “singularity” as a “bonded entity” [1]. In this understanding, the body does not “entail a notion of the subject or of self-hood as some skin encapsulated, seamless monad possessed of conceptual unity and continuity” [19].

Reference is made to the notion of trikāya in later Mahayana Buddhism. In ascending order of abstraction they are: the nirmāna-kāya, seen as the apparitional or physical body of the Buddha, namely Siddhartha Gautama; the sambhhoga-kāya, seen as the body of bliss, the reward body or the exalted and splendid manifestation of the Enlightened personality, which is only visible to those with advanced spiritual capacities; lastly, and by contrast, the dharma-kāya is the absolute body of the Buddha that is formless and imperishable. This third form of body indicates to practitioners that different levels of attainment are made possible through specific mediative practices. The notion of multiple bodies also promulgates the idea that the body is not a singular discrete object but instead represents a plurality of interconnected bodies [15].

While the cultural context of Tibetan Buddhism may be seen to be far removed from the medical operations involved in transplants it is suggested the above ideas provide a motif for notions of connectivity that exist between donors and recipients.

4. Illustrations of Intercorporality and Intersubjectivity as regards Recipients of Organ Donations

Several scholars have analysed organ donations, utilising notions of “intercorporality” and “intersubjectivity” to argue that, even in a situation where the donor does not know the recipient, the donation is not impersonal or neutral as the recipient may receive and retain the qualities of the donor. As Waldby concludes, “circuits of tissue exchange are relational and social” [20]. The issue this article has been developing is therefore as follows: what is the relation between donors and recipients when they are not known to each other? Furthermore, what are the social or religious connections established between donors and recipients?

To develop the argument that there is indeed a form of connectivity at play here, the article deploys the work of Zivkovic to show how, in certain circumstances, the transference of relics enables recipients to dwell in the spiritual body of the trikāya. This explanation of the giving of relics as an example of the way “spiritual forces” can be transferred from one person to another through the transfer of body parts. Implicit in my argument is that reciprocity is evident through an understanding of the hau concept developed by Mauss. I argue that reciprocity may be envisaged in different forms, as already shown by empirical work done with patients as regards their attitudes towards receiving an organ.

As has been noted Mauss conceptualised that a gift must have reciprocity to be construed as such. I have also stressed that, as regards donations, it is usually thought that there can be no reciprocity. The standard argument runs that, as the donor is dead, the donor would not have been able to visualise the person who might receive their organs and therefore be unable to develop any sense of reciprocation towards a donor.

However, if we invoke the notion of the “spirit of the gift,” we may envisage that the recipient may experience along with the delivery of a gift a particular nature or spirit of the donor that creates a bond between the donor and the recipient. We may also note Mauss’s postulation that the “spirit of the gift possessed an inner force that was invested with life and carried the individuality of the donor” [21,22].

My interest in Mauss is in the nature of spiritual force inherent in the gift that “pushes for recognition” [23]. As Mauss himself asks, “what power resides in the object given that causes its recipient to pay it back?” [6]. Mauss goes on to say:

This is because the taonga [“everything that may properly be termed possessions, everything that makes one rich, powerful, and influential, and everything that can be exchanged … precious articles… sometimes even the traditions, cults, and magic rituals”] is animated by hau [the spirit of things] of its forest, its native health and the soil … in reality, it is the hau that “wishes to return to its birth place (lieu desa naissance) to the sanctuary of its forest and the clan, and to the owner” [6].

Three points may be made concerning this quotation. Firstly, the nature of taonga is linked to the person, the clan and the earth; as such, a gift functions as a vehicle for mana, which embodies a magical and spiritual force [6,24]. Secondly, this spiritual force is linked to ancestors and practices that establish clan solidarity. Thirdly, it is connected to the natural world: earth, seas, and forest.

In these ways, the hau exists as a spirit that co-constitutes both donor and recipient [24]. It cannot be transferred like a form of commodity because it is not capable of possession; it comes from the donor’s clan and cultural tradition, as well as from its native soil and natural elements. Moreover, the hau also has a “vital essence,” as “the assumption behind any material form is an invisible, dynamic power that makes it what it is. It is at once the source of appearance and potential for action … and has an “expression of an inner nature. If interfered with, contaminated, or “lost,” the object or being that is its emanation - in this case, a human, will lose its integrity and decay and die” [5,25,26].

It is a premise of this article that this generative force reflects the natural processes that approximate an aspect of the trikāya idea of bodily substances, in that an organ transplant also transfers the experience of connectivity. This happens at different levels: firstly, at the level of clan or lineage; secondly, at the level of bodily experience in the sense of the interconnectivity of a common body; and thirdly, the realisation of a spiritual essence as the element of all natural manifestations.

5. The Incorporation or Disconnect of “Other” Body Parts

As has been noted a body of empirical research on organ donations that has shown the effect of the incorporation of bodily parts into another person, specifically how that has altered the recipient’s sense of integrity and wellbeing. In this regard several studies have reported that recipients expressed disruption to identity and bodily integrity, as well as interconnectedness with the donor, even when the recipient perceives the organ donor as a stranger [3,18,19,20,27].

In this regard, Karl-Leo Schwering has demonstrated from his interviews with people who received body parts how such recipients re-established a form of bond with the donor through “the intermediary of his or her imaginary speculations.” Thus recipients, through what Schwering calls the “myth of the gift” create “imaginary scenarios” as a response “to the unknown to the anonymous.” He reports how recipients restored on the “plane of the imaginary” the specific relationships of the “primary sociality in which the relation of the giving generally thrives” [28,29].

Monica Konrad found similar results in her work on gamete and egg donations. She inquired how gift relationships can be established when reciprocity is impossible [30,31]. In an attempt to reconstruct a form a kinship, she demonstrates that “anonymity is not necessarily a form of alienation.” She shows how ova donors and recipients consistently imagine their relationships to a “somebody” at the other end of the transaction, even though they do not know that person’s identity. It is in this imaginary extension of relations into the unknown that Konrad finds “the lurking gift” [32]. Konrad develops this argument through the importation of a concept from geology, transilience, which indicates how a leap is made from one stratum or substance to another. The concept of transilience, in Konrad’s view, explains not the physiological outcome of ova donation itself, but the relationships envisioned by donors and recipients as a consequence of substances “gifted” between anonymous others.

6. Conclusion

This article has attempted to understand organ transplants by deploying an aspect of Mauss’s work to give a background explanation to those who wish to help the psychological coping of recipients and assist in the positive rehabilitation after a transplant operation.

In this sense, the article explains the “absence of investigation” that exists to comprehend “such personality changes and the scepticism regarding whether such changes are possible” [22].

The article therefore describes the relationship between donors and recipients of organ transplants by analysing two examples that deal with the form of connection established between the two parties involved. The article therefore build on that line of scholarship that has noted how recipients receiving transplants have experience changes in their processes of self-formation and the establishment of a new identity.

As an imagined framework to understand this process reference was made to how relic donations were perceived in Tibetan Buddhism as constituting a form of linkage with one’s teacher and their inherent religious qualities emanating from a universal spiritual essence. In this, this instance there was a harking back to the qualities of the donor and the religious qualities that linked the donor to natural and spiritual forces. This linkage may be seen as more than an instance of reciprocity because there was the establishment of a particular kind of a communal bond.

To support this approach a formulation was made of Mauss’s insight on the nature of hau that enables a linkage or connection to the spiritual aspect of the donor’s body and its celestial connections. The significance of this finding opens the door for future research on the nature of the communal bond and the importance of this connection for the psychology of organ recipients. It is arguable therefore, that organ transplants as gifts are more than simply a form of “sociality”: a gift affects the social and spiritual fabric where both donors and recipients share an imagined bond.

Author Contributions

Malcolm Voyce did all the research work of this study.

Competing Interests

The author has declared that no competing interests exist.

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