This narrowing of focus left out two aspects of body-product exchange that Fantus had been concerned about when he developed the metaphor, and which his predecessor doctors had focused on in the beginning of using body products as therapeutics: creating an adequate supply, available when needed and making sure that all patients could access that supply. I argue in the book that the metaphor and its backlash created a narrowing that has led both to contemporary laws that regulate body products mostly from the aspect of supplier payment, and a situation in which those other aspects are often not well met—a safe and adequate supply and availability based need. This, in turn, has led to current injustices in the use of body products as therapeutics, not just those which are banked, but unbankable ones, such as organs.
What I learned as I investigated the body banks was that the metaphor had an unfortunate and unintended effect on body-product exchange. By understanding its history, and remembering the body product exchange before the body bank, we can begin to address current injustices.
Can you say more about those injustices? How do they play out? How does “banking” play a role in perpetuating or even instigating them?
Take perhaps the most common nonbankable body product today—kidneys. It is no secret that every year, more Americans go on lists as waiting for a transplant than donated organs become available. The disparity between supply and demand keeps growing. In these conditions of scarcity, not all who need this body product can get it. Those with resources, can, if they choose, leave the U.S. and travel elsewhere to purchase an organ through international grey markets. On average, those with more socioeconomic resources tend to receive kidneys, and those with fewer resources tend to supply organs. Because in the United States race tends to follow class, this tendency means that there are also racial disparities; a disproportionate number of racial minorities are suppliers, while African Americans tend to receive kidneys proportionally less often than European Americans.
This disparity is unjust. Many people have suggested that providing some sort of compensation to families who supply kidneys from a deceased loved one, or even those who act as living kidney donors, might decrease the scarcity, and thus this injustice. Such compensation is outlawed by the National Organ Transplant Act, passed in 1984. As I explain in the book, although early body products were always purchased by doctors, by the time organ transplantation became reasonably successful, the banking metaphor, and the backlash against markets in body products which it helped to create, supported swift passage of this law.
In law, we thus divide body products into two categories: those which we legally mandate as gifts only—all organs—and everything else, which can be gifted or sold, at the discretion of the supplier. Organs is defined broadly—bone marrow, for example, is an “organ.” This means that bone marrow, which can now be extracted from the blood in a procedure similar to the way blood plasma is harvested, cannot be sold by anyone. (Blood plasma is routinely sold, by the way.)