This week marks the ninth anniversary of my liver transplant;  I have had nine more years of life than could have been expected in past times.

I remain in awe at this life saving procedure and in permanent gratitude to my donor.

But still there are many problems. There aren’t enough organs: up to 1,000 people die every year due to a shortage of organs for transplant, that is 3 people every day; and while 96% of people in the UK believe in donating organs only 30% are on the donor register. So if you haven’t thought about it , maybe this is the time?

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This year I highlight a small piece of writing from my transplant pages – the fuller version can be found at https://kenplummer.com/transplants/

Illness as altruism: on the kindness of strangers

The ways in which society organises and structures its social institutions.. can encourage or discourage the altruistic in man

Richard Titmuss, The Gift Relationship

There is a wonderful and well-known line towards the end of Tennessee William’s A Streetcar Named Desire when Blanche Du Bois, the anti-heroine, is being taken off gently to the mental hospital and she proclaims that she has ‘always depended on the kindness of strangers’. In my mind, this statement always hovers close to another: Sartre’s equally famous statement in his play Huit Clos (No Exit): that ‘hell is other people’. We live with kindness and cruelty: both at the same time. But in my illness I saw much more of the kindness of strangers.

More than anything, the transplant showed me the supreme gift of a stranger, unknown to me, who enabled me to live. She donated her body to a complete stranger. And this stranger was me ( but there were a few of us: her body parts helped to saved a number of lives). Without her I would simply not be here. And nowadays across the world every day people engage in these major acts of altruism, giving their body parts for the love of humankind. Millions are doing it.

Long ago, just as I was graduating, the eminent social scientist Richard Titmuss wrote a book called The Gift Relationship. It was about the different bases for donating blood – some countries like the UK depend entirely upon volunteers, while others like the USA, depend much more on the cash market. I read it when I started teaching and it posed the key question: should our welfare be subject to market forces or should it be directed by the wider and more humane ideas of care, altruism and benevolence? I believed the latter then and I believe it even more now. I hate the idea that the modern world has turned our health and our bodies into a commodity to be bought and sold. This most cherished gift should be kept out of the market; and not least because with this market there comes a continuing gulf between the rich and the poor – with the poor selling- their body parts in many poorer countries so that the rich in other parts of the world may live. (And if you don’t believe me, have a look at the brilliant work of Nancy Scheper-Hughes, the cultural anthropologist, on all this. See ‘The Organ Detective … ).

But my enhanced sense of altruism did not just arise from the supreme life gift of the donor. I was also struck throughout my illness by the ways in which people in general care, support, even loved me. It was rare that I encountered a harsh word, or an unkind comment. I did, of course; but overwhelmingly the experience was one of being engulfed in the kindness of everyone; and the special love of those nearest and dearest – my partner, family friends and significant others.

The idea of altruism is a very complex one with a long philosophical debate behind it: paradoxically, altruism and self-interest seem to move hand in hand – we are selfish altruists. Adam Smith in his Theory of Moral Sentiments put these tensions forward very vividly.

Tapping into what I sense to be a widespread altruism, I believe that the way ahead for the supply and organisation of donor organs lies in the system known as ‘presumed consent’ in which potential donors have to take specific ‘opt out’ actions to be excluded from organ donation (rather than requiring specific actions to be included). This is a system that brings its own problems, but it is found working well now in several European countries (including Spain, Belgium and Austria). It is a system recommended for the UK (in a report chaired by Elizabeth Buggins, The potential impact of an opt out system for organ donation in the UK: 2008: see http://www.odt.nhs.uk/pdf/the-potential-impact-of-an-opt-out-system-for-organ-donation-in-the-UK.pdf) but so far it has only been implemented in Wales. On 1 December 2015, Wales became the first UK country to introduce a soft opt-out system for organ and tissue donation. I believe there are obvious good practical reasons for this – more organs becoming available and the end of the shortage; but also good human ones too. It flags, symbolically, a culture that is concerned compassionately for others.

Market worlds, caring worlds

During my illness, I came to see more clearly and much more sharply a key divide in the modern world. It is quite simply between those who espouse market values and see the importance of competition, consumption and selling and those who espouse caring values who stress the importance of mutuality, sharing and looking after each other. Of course they are not mutually exclusive and can run in tandem with each other. But in general market values are given an overwhelming priority – in business, in governments, and increasingly in welfare – schools, hospitals, prisons etc are all now opened up to market values. Everything is given a cost, a silly business plan, monitored, and put into completion with everything else. Economics favours such a view with its belief in rational man who is always pursuing self-interest. At its worst, it creates a society of envy, greed, corruption, inequalities. Unfortunately, over the last twenty years of my life this view has been overwhelmingly the ascendant and dominant view- often called Thatcherism or neo-liberalism, and identified strongly with the rule of capitalism. Many books and much research has demonstrated the horrors that such practices have produced.

By contrast, when I was ill I kept finding people who were not ‘in it for self and money’; nurses for example in the main are dedicated to hard work and care for little tangible pay off. Of course they want more – and no wonder when their human worth is matched so poorly when compared to the ever-expanding army of sport and media celebrities paid fortunes for little talent. Doctors too- though they do get paid good compensation – are nevertheless overwhelmingly dedicated to their calling. The endless monitoring of them weakens trust in government interventions. More than this, I found all kinds of casual evidence that people wanted to do good, to help me along, to give support – from closest friends to distant strangers. Of course self-interest is often close by, but altruism is indeed to be found in many places in the modern world. And my point is that this is the unsung underside of the market structures. We give all our attention to money making and consumption, when in families and hospitals, communities and homes, schools and colleges there are millions of people who put human values of care and engagement with others way ahead of the values of the markets. Often living on a pittance and frequently belittled – the ‘shit workers’ of the care world – they are the unsung heroes of the modern world. We need to reconsider who we should be really valuing. Carers need more pay, and more recognition as the truly important people of a society.

Transplant surgery and organ donating is a potent symbol for generosity, caring and altruism. It tells the story of laying down one’s own body to help a stranger. The donor-transplantation world is embedded in the potential for human kindness. To turn it over to the market is a tragedy of colossal proportions.

 

About kenplummer

For over 40 years I worried about things sociological; now I have time to stand and stare.

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