Last Best Gifts in the NYT

by Kieran Healy on January 27, 2007

My book, Last Best Gifts: Altruism and the Market for Human Blood and Organs, is reviewed this weekend by Virginia Postrel in the New York Times. Obviously, I’m delighted: Virginia’s review is generous and perceptive, and in many ways it’s hard to think of a better choice of reviewer. For one thing, as many readers will probably know, Virginia is herself an organ donor—she gave one of her kidneys to her friend Sally Satel—and now regularly writes about the organ shortage and market incentives. For another, she has also followed the growth of economic sociology as a subfield, writing a very good piece about it for the Boston Globe a while ago. And last, she has a generally libertarian point of view, and the stereotype is that libertarians and academic sociologists should be flinging abuse at each other on the topic of altruism, self-interest and the market— especially when it comes to markets in things like human organs. I wrote the book partly in the hope that it would advance the debate beyond some of the entrenched clichés that both sides cling to. Virginia’s review encourages me that I might have been in some way successful in this respect.

{ 18 comments }

1

dearieme 01.27.07 at 1:43 pm

I’ve heard it said that, at least in Britain, some racial/ethnic/cultural groups are happy to accept transfusions and organs but reluctant to donate. Do you happen to know whether this is urban myth, or has some truth in it?

2

eszter 01.27.07 at 1:53 pm

Congrats, Kieran, this is a wonderful well-deserved review!

3

tom s. 01.27.07 at 2:48 pm

Postrel does a good job of picking up the way the book exposes the market/altruism dichotomy as a simplistic way of looking at the issue, and how organizational concerns and the industrialization of the process are important. Last Best Gifts certainly changed the way I look at the debate, and got me out of that unproductive way of thinking.

Yet at the end, I think she can’t help her libertarian self peeking through when she writes:

“The idea that markets inevitably corrupt,” Healy writes, “is not tenable precisely because they are embedded within social relations, cultural categories and institutional routines.”Commerce isn’t antithetical to culture; it is part of it.

This ending casts the debate back into the “role of markets” arena, which – it seems to me – the book shows is not the most important of questions.

Despite that quibble, it’s a good review of a fine book and I hope it gets it widely read (and purchased!). Congratulations.

4

tina 01.27.07 at 3:00 pm

Yes, a well-deserved review, indeed! Way to go, Kieran!

5

Kieran Healy 01.27.07 at 3:17 pm

I’ve heard it said that, at least in Britain, some racial/ethnic/cultural groups are happy to accept transfusions and organs but reluctant to donate. Do you happen to know whether this is urban myth, or has some truth in it?

It depends which groups you mean, and where. In the U.S., African Americans are less likely than others to donate, but also less likely to be listed for or receive a transplant. (The reasons for this difference on both the supply and demand sides are disputed.) Elsewhere, in some communities (such as Orthodox Jews in Holland if I remember right) there as been some debate explictily raising the question of whether its right to receive transplants if one is also unwilling, as a matter of religion, to donate organs. These cases are both different from the idea that some groups routinely or self-consciously receive without being willing to give, though.

6

DC 01.27.07 at 4:11 pm

I note that none of the listed reasons for your obvious delight are the possibility that you might shift some feckin’ books…

7

Kieran Healy 01.27.07 at 5:25 pm

That’s why the University of Chicago Press is happy.

8

DRR 01.27.07 at 6:34 pm

This ending casts the debate back into the “role of markets” arena, which – it seems to me – the book shows is not the most important of questions.

Goodness. Anything but markets.

9

Jaybird 01.27.07 at 6:54 pm

People appointed to public office by people like George W Bush should be in charge of seeing who should (and thus, who should not) be getting donated organs.

Any other way of doing it will skew things unfairly toward the wealthy.

10

P O'Neill 01.27.07 at 7:59 pm

The sales bounce will be another blog-worthy topic.

11

Consumatopia 01.27.07 at 9:16 pm

People appointed to public office by people like George W Bush should be in charge of seeing who should (and thus, who should not) be getting donated organs.

You might think you’ve got a good case for markets, but actually you’ve got a good case against them, unless you’re prepared to argue that Bush’s influence has somehow corrupted the transplant process.

12

tom s. 01.28.07 at 8:57 am

Goodness. Anything but markets.

What I was trying to say is that, from my reading, Last Best Gifts shows that the particular form of market, or the particular form of other arrangement, is more important than the “market or altruism” debate, and that just saying “Markets!” or “Altruism!” doesn’t even begin to address the crucial questions, which are ones of organization and structure.

13

a very public sociologist 01.28.07 at 10:35 am

In reply to dearleme there have been cases over the years where people have turned down blood transfusions and transplants on religious grounds. I can hazily recall a furore from years ago where parents refused such procedures for their child using these arguments. If memory serves the child was removed from their custody. Perhaps someone can help jog my memory?

14

Virginia Postrel 01.28.07 at 12:08 pm

the particular form of market, or the particular form of other arrangement, is more important than the “market or altruism” debate

To allow such arrangements and organizations to evolve in a positive fashion, they must be legal in the first place. By completely prohibiting “valuable consideration” in exchange for organs, the law prohibits the development of social arrangements and organizations that would effectively mix altruism and other motives. The law, in other words, comes down on the side of the most simplistic version of “altruism,” with all sorts of perverse effects–the most important of which is an ever-growing waiting list of 68,000 kidney patients who could be helped by living donors. The “markets” that might develop if compensation were allowed are not denatured blackboard models; they would be embedded in all sorts of social, legal, and medical institutions. The transplant system is, for technical and financial reasons, extraordinarily complex–complexities that would not disappear if organ donors were paid. Donor motivations are equally complex. (Right now, of course, everyone but the donor gets paid. Nobody expects surgeons to work for purely altruistic motives.) But you cannot discuss the sociology when you flatly prohibit the economics.

15

harry b 01.28.07 at 2:39 pm

I’m more or less persuaded that the modified markets virginia postrel proposes in kidneys should be, well, experimented with. But I also found myself asking how much of a dentit would make if, instead of contracting in, you had to contract out of donation (ie, a law change which presumes that all organs are donated, unless the accident victim has explicitly decided not to donate)? And what effects would that law change have on other donating behaviour (eg whether people would be more or less willing to act as living donors?).

Congrats on the review Kieran. OF course, I’d have bought the book eventually anyway, so you should subtract 1 from the sales bump when you get round to calcualting it.

16

Tracy W 01.28.07 at 4:18 pm

People appointed to public office by people like George W Bush should be in charge of seeing who should (and thus, who should not) be getting donated organs.

Any other way of doing it will skew things unfairly toward the wealthy.

I think we can deduce from this that you believe skewing things towards the politically-well-connected is fairer.

17

Brandon Berg 01.28.07 at 4:38 pm

Perhaps it would help if someone near the top of the list, or members of his family, were there when asking the deceased’s next-of-kin about donation.

18

strewelpeter 01.29.07 at 7:57 am

This is slightly beside the point , but I was quite taken by a piece I half heard on todays thought for the day on
Page link, transcript will be up later on today
Real Audio link

It seems that there is a young lad who does not want to die a virgin, hes stuck in a hospice and the God Botherers got into a tizzy about his request to hire the services of a prostitute before he dies. In fairness to them though it seems they handled it well in this case.
I was wondering if there would be a response from unattached females volunteering to take on the challange in a less commercial more loving way. I’d like to think that if I were in the situation to I’d be willing to share in this lads fulfilment before he dies.

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