1.2.13 Biomedicine, Tissue Transfer and Intercorporeality - Waldby

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Feminist Theory

DOI: 10.1177/146470002762491980 2002; 3; 239 Feminist Theory

Catherine Waldby Biomedicine, tissue transfer and intercorporeality

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Biomedicine, tissue transfer andintercorporeality

Abstract More and more areas of medicine involve subjects donatingtissues to another – blood, organs, bone marrow, sperm, ova andembryos can all be transferred from one person to another. Within thetechnical frameworks of biomedicine, such fragments are generallytreated as detachable things, severed from social identity once they areremoved from a particular body. However an abundant anthropologicaland sociological literature has found that, for donors and patients,human tissues are not impersonal. They retain some of the values ofpersonhood and identity, and their incorporation often has complexeffects on embodied identity. This article draws on feminist philosophyof the body to think through the implications of some of these practices.Specifically, it draws on the idea of intercorporeality, wherein the bodyimage is always the effect of embodied social relations. While thisapproach is highly productive for considering the stakes involved intissue transfer, it is argued that the concept of body image has been toopreoccupied with the register of the visual at the expense of introceptivedata and health/illness events. Empirical data around organ transplantand sperm donation are used to demonstrate that the transfer ofbiological fragments involves a profound kind of intercorporeality,producing identifications and disidentifications between donors andrecipients that play out simultaneously at the immunological, psychicand social levels.

keywords body image, identity, organ transplant, sperm donation

As contemporary medicalized subjects, our experience of our bodiesincreasingly involves their potential for biotechnical fragmentation. Newsurgical and clinical practices enable the donation of new kinds ofbiological fragments to others and the reciprocal incorporation of others’fragments. Since the mid-20th century, with the development of effectivemethods of blood transfusion, individuals have been able to donate aportion of their blood for transfusion into another’s body. Organ trans-plantation has been practised since the late 1950s when the refinement oftissue typing, surgical techniques and immunological suppression allowedorgan donors to be matched with compatible recipients (Fox and Swazey,

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Catherine Waldby Brunel University

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1992). Now, in the early 21st century, more and more kinds of tissues canbe removed from one body and incorporated into another. Sperm, ova andembryos can be donated, banked and transplanted for reproductivepurposes, and foetal tissue can be introduced into the brains of people withdegenerative conditions. The recent development of techniques for thepropagation of human stem cell lines derived from embryos means thatembryonic tissues may become the source for a whole new range of trans-plantable tissues sometime in the future (Waldby, 2002).

The globalization of biomedical research and the commodification oftissue fragments have accelerated these systems of tissue exchange andcontinually broadened their scope. As Scheper-Hughes puts it, thesesystems are the product of an increasing commodification of the humanbody,

linked to the incredible expansion of possibilities through recent advances inbiomedicine, transplant surgery, experimental genetic medicine, biotechnologyand the science of genomics in tandem with the spread of global capitalism andthe consequent speed at which patients, technologies, capital, bodies and organscan now be moved across the globe. (Scheper-Hughes, 2001: 3; emphasis inoriginal)

These developments suggest that the experience of embodiment in FirstWorld economies will involve increasing participation in these newcircuits of biological exchange. Our health and fertility are more likely tobe owed to the therapeutic effects of another’s fragments – organs, blood,ova, semen, embryos or stem cells. We in turn will be obliged to donatewhat fragments we can afford.1 Hence the meaning of such fragments, theirsignificance within various orders of bioethical, capital and communityvalue, will be more and more at issue.

Within the technical frameworks of biomedicine and the commodityframeworks of biotechnology capital, such fragments are generally treatedas detachable things, biological entities that are severed from social andsubjective identity once they are donated or removed from a particularbody. That is, they are legally regarded as alienable – available for transferfrom the originator to others by donation or sale (Lock, 2002). Historically,the majority of tissues are made available by donation2 and, in the US,Canada, the UK and Australia, donors are legally precluded from claimingproperty rights to tissue once transfer has taken place (Rabinow, 1996). Inthis sense, the biological fragment is understood to no longer refer to thedonor after donation.3

Despite the clarity of this commodity model for tissue transfer, anabundant anthropological and sociological literature testifies to a quitedifferent experience of tissue transfer among donors and recipients. Forthose whose fragments are directly involved, tissues retain the trace of theirdonor to a greater or lesser extent. Human tissues are not impersonal oraffectively neutral; rather, they retain some of the values of personhood formany if not most donors and recipients. Hence, circuits of tissue exchangeare not only technical and therapeutic, but also relational and social. Togive an organ, blood, ova, embryos, sperm or cells is to be caught up in a

240 Feminist Theory 3(3)




social and embodied circuit in which the significance of one’s personhoodimbues the fragment. To receive and incorporate another’s organs or tissuesinvolves a complex modification of the recipient’s embodied identity, asthe habitual equation between the limits of the body and the contours ofthe ‘I’ is thrown into question.

In this article, I want to bring together two literatures that do not oftencommunicate, to try and better conceptualize the subjective and bioethicalstakes involved in these expanding circuits of tissue exchange. I havealready alluded to the first – the social scientific literature that documentsand analyses the personal and meaningful nature of tissue exchange for thesubjects involved. The second literature is that of feminist philosophies ofthe body. In particular, I want to utilize and build upon Gail Weiss’s theor-etical term ‘intercorporeality’ (Weiss, 1999) as a useful conceptual tool forconsidering the kinds of embodiment jeopardized and enabled by newtissue economies. As used by Weiss, ‘intercorporeality’ implies that noform of human embodiment is discrete and self-identical. Rather, eachperson’s experience of being embodied emerges from a field of embodiedrelationships and continues to refer to, and be modified by, such a fieldthroughout life. Each subject is a site of intersection where various modesof embodiment play themselves out and relations with others are realizedas forms of incorporation. Hence, the idea of intercorporeality contributesto a denaturalization of the relations between the limits of the body and thelimits of the ‘I’ understood as a discrete entity. In this regard, it may helpto conceptualize that most literal kind of boundary confusion involved intissue transfer.

Moreover, the empirical literature around tissue transfer can, it seems tome, contribute to the complexity of intercorporeality as a theoretical tool.Weiss’s development of the term works predominantly with the logic ofbody images, understood as the primary media relating identity to the body.In this, she builds upon a philosophical tradition that tends to locate thephenomenology of embodiment in the tension between a private introcep-tivity and a public and social negotiation of one’s body surface as appear-ance. In this article, I will argue that contemporary developments inbiomedicine and biotechnology provoke a reconsideration of the signifi-cance of introceptivity and visceral materiality as social and relationalsites. Certainly the interior of the female body has long been marked inWest European culture as a social site, a place of sexuality and maternitythat involves the intersection and production of others. The advent ofinternal medicine in the late 19th century has opened the interior of bothmale and female bodies to various modes of sociotechnical inscription. Theprogress of medical technology throughout the 20th century has renderedthe interior of the body increasingly available as a site of use, knowledgeand exchange (Waldby, 2000). It seems likely that the social circuits gener-ated by the exchange of biological fragments will become more widespreadand significant as biomedical techniques are refined, with implications forboth bodies and bodies politic. The idea of intercorporeality will, I hope,provide me with a way to consider some of these implications. In whatfollows, I will investigate Weiss’s development of the term and test out its

Waldby: Biomedicine, tissue transfer and intercorporeality 241




uses and limits as a mode of understanding the relationships that areformed through circuits of tissue exchange.

Intercorporeality

Weiss’s book Body Images: Embodiment as Intercorporeality (1999) is afeminist theoretical investigation into the constitution of the body imageor ‘imaginary anatomy’ (Gatens, 1996), the image(s) or models that thesubject develops of their own body as a condition of being in the world.Her study builds upon what is now a well-established field in feminist phil-osophy of the body. Feminist theorists such as Elizabeth Grosz, MoiraGatens, Iris Young and Judith Butler have investigated the ways that livingbodies incorporate and naturalize norms and ideas about gender, health,sexuality and identity. The idea of the imaginary anatomy or body imageis one of the major methodological strategies in this area of investigation.Weiss’s particular contribution to this field is to reread the foundationalbody image studies (Freud, Lacan, Head, Schilder, Merleau-Ponty) andsubsequent feminist studies in order to tease out the dynamics of inter-corporeality. She foregrounds the intersubjective nature of the body imageand its conditions of emergence:

Rather than view the body image as a cohesive, coherent phenomenon thatoperates in a fairly uniform way in our everyday existence . . . I argue . . . for amultiplicity of body images . . . copresent in any given individual, and which arethemselves constructed through a series of corporeal exchanges that take placeboth within and outside of specific bodies. (Weiss, 1999: 2)

For Weiss, the body image is always expressive of a history of inter-relationships, a site informed by engagement with others, and it is this thatguides her rereading of the literature.

The foundational literature on the body image can be found in psycho-analytic and neuropsychological work around child development, cerebraltraumas and neurological conditions. Within this literature, accounts of thebody image vary as to its mode of development, its dynamics and theircomplexity. What they have in common is the notion that functionalsubjects operate with an imagined and internalized map of their ownbodies, a corporeal schema that helps to coordinate experience, locationand modes of relationship to others. The development of a body image isfundamental to our spatial orientation to the world, a dynamic map of therelationship between our bodies and external things that allows us tonavigate in space without conscious attention. ‘The body image informs usfrom moment to moment and in a largely unthematised way, how our bodyis positioned in space relative to the people, objects and environmentaround us’ (Weiss, 1999: 9).

In the phenomenological and psychoanalytic work of Freud, Lacan,Merleau-Ponty and Schilder, the body image is also the site for the emerg-ence of subjectivity. For Freud (1914), the infant establishes the foun-dations of selfhood through the development of the body ego, a psychicalmapping of its own body that allows it to make fundamental subject/object





distinctions between its own boundaries and the flux of perceptual eventsthat engulf it. The body ego allows the organization of previously disorgan-ized perception by creating the initial conditions for a unified body image,which facilitates the coordination of sense data, motor activity andcommunication. The establishment of the body ego takes place throughwhat Grosz (1994: 32) describes as the ‘stabilisation of the circulation oflibido in the child’s body’, as the child invests and psychically mapsvarious parts of its anatomy. Weiss’s interest in this process lies in the rela-tional dynamics between infant body and maternal care that allow such astabilization and self-investment to take place. The mother’s nursing andinteractions with the infant form the precondition for its investment initself and for the emergence of a workable body ego. The mother’s care mapsthe infant’s body through touch, feeding and warmth while the motherforms the first object with which the infant can identify – its first ego ideal,in Freud’s terms. Weiss observes:

Primary narcissism . . . never involves an infant’s unmediated relationship withhis or her body, but from the start implies a complex series of interactions betweenthe infant and others. . . . The image the infant forms of his/her body throughprimary narcissistic investments in different bodily zones or regions will alreadyreflect the influences of others . . . long before the infant can recognise her/himselfor others as discrete entities. (Weiss, 1999: 16)

This account of the body ego implies a process precipitated by touch,nurture, physical intimacy and skin contact, but other psychoanalytic andphenomenological accounts of the early emergence of the body image tendto locate it in the order of vision and visuality. The very term body ‘image’locates the phenomenon under discussion in the realm of the specular: ‘Todevelop a body image is to develop an image of my body as visible to others’(Weiss, 1999: 33). Visual perception is so crucial in the development of thebody image because of the tension that emerges between the child’s innerand outer world. At a certain point, the child learns that the introceptiveexperience of its body – the body lived from the inside – can be coupledwith its body experienced as spectacle, seen from the outside, by itself inthe mirror and by others as object. Weiss, referring to Lacan’s mirror stageaccount of the body image, comments that:

The specular image offers the child a new perspective not only on her/his ownbody and her/his being-for-others but simultaneously allows the child to projecther/himself outside of her/his body into the specular image and, correspondingly,into the bodies of others. . . . It is the latter . . . that provides the ground for strongidentifications with others, identifications that expand the parameters of the bodyimage and accomplish its transition from an introceptive, fragmented experienceof the body to a social gestalt. (Weiss, 1999: 13)

The essentially social nature of the body image, its intercorporeality,derives, on this account, from its location in visual space. The subject issimultaneously alive to itself as point of view, introceptive and proprio-ceptive experience, and alive to others as spectacle, as object. The bodyimage emerges out of this tension, as the subject becomes subject by inter-nalizing and dealing with the fact of being visible and, hence, available for





others as projective surface. It emerges from a play of identification anddisidentification with others, and from the projection and introjection of thebody images and part images of others. Desire, love, care, hatred, neglectand other modes of relationship are negotiated in part through a shiftinginternalization and externalization of body image relations – what Schildercalls ‘body-image intercourse’ (Weiss, 1999: 33).

Moreover, the body image’s location in the domain of the visual opens itout to the multifarious forces of visual culture and representation, particu-larly representations of the body in medicine, fashion, cinema and the like.Body images as lived gestalt communicate with body images elaborated inthe wider social order. For Weiss, it is this location in the order of imagesthat prevents the development of the body image being simply a privateaffair. She writes:

Given that the body image responds directly to subtle physiological and emotionalchanges in our bodies, it may seem as if the body image should be characterisedas a personal or even private phenomenon. . . . And yet the ‘body image inter-course’ that Schilder describes, implies that body images are in continual inter-action with one another, participating in a mutually constitutive corporealdialogue that defies solipsistic analysis. . . . Through . . . processes of introjection,projection, and identification, the body image continually incorporates and expelsits own body (parts), other bodies and other body images. (Weiss, 1999: 33)

Physiology, trauma and body image

Weiss’s account of the intercorporeal body image is highly nuanced anddynamic. She presents a complex picture of a psychosomatic agency orprocess that is never static. The contours and constituents of any person’sbody image develop out of a network of images and relations. It can beneither completed nor stabilized; it is always subject to perturbation, trans-formation and fragmentation, according to the kinds of corporeal exchangesthat take place. In this dynamism, the idea of intercorporeality presents auseful way to understand the kinds of destabilizations of self that are ofteninvolved in various kinds of tissue transfer, described later in this article.The introduction of matter from another’s body into one’s own is the mostliteral kind of intercorporeality and, as we shall see, it frequently precipi-tates quite compelling dynamics of introjection and projection, identifi-cation and disidentification, between recipient and donor. This is despitethe fact that donor and recipient rarely meet face to face.

Nevertheless, Weiss’s development of the idea of intercorporeality tendsto binarize the body in a way that limits its deployment in analysing thearea of tissue transfer or medical practices more generally as modes ofintercorporeality. That is, while repeatedly acknowledging that physiologyand the processes of health and illness contribute to the formation of thebody image, the intercorporeality of the body image, its essentiallycommunicative nature, derives, for Weiss, from its location in an economyof images and visible surfaces. This location is, of course, intrinsic to thenotion of the body image as image. The visceral interior, on the other hand,remains dark and mute, excluded from social communication or exchange





except insofar as its evidence must be socially managed according to theprotocols of the abject. While it may contribute to the formation of the bodyimage from moment to moment, Weiss tends to cast its contribution aspresocial.

There is, however, an important moment in her text where she considersthe case of pregnancy as an instance in which the visceral interior servesas a site of intercorporeality. Weiss draws on her own experience of preg-nancy and on Young’s (1990) first person phenomenological account ofbeing pregnant to consider the particular material relationship betweenpregnant woman and foetus as an instance of co-embodiment. The pregnantwoman must negotiate the tension between the habitual sense thatwhatever is contained within one’s bodily boundaries is ‘self’ and the intro-ceptive evidence of another life within. Foetal life partakes of othernesseven though it is not autonomous. Young writes:

The pregnant subject . . . is decentred, split, or doubled in several ways. Sheexperiences her body as herself and not herself. Its inner movements belong toanother being, yet they are not other, because her body boundaries shift andbecause her bodily self-location is located in her trunk as well as in her head.(cited in Weiss, 1999: 52)

The senses of interior and exterior body lose their distinctiveness; ‘theexternality of the inside’, as Young puts it. ‘In pregnancy I literally do nothave a firm sense of where my body ends and the world begins’ (Weiss,1999: 52). The interior is no longer marked out as a space of physiologicalself-possession in contrast to the socially marked and shared surface of thebody. Pregnancy marks the interior of the body as a place of intersectionwith others – the foetus, the sexual partner who helped conceive the child,the medical personnel who monitor and manage the pregnancy, and thefamily and friends who take a proprietal interest. This confusion ofbudding body-within-body is intercorporeal in the crucial double sensethat it involves both a material confusion of bodies, a material indetermi-nacy and that it makes a relationship – in this case, motherhood, father-hood and kinship. As we will see, biomedical intercorporeality also hasthis double sense. A material confusion of bodies through the exchange offragments produces various kinds of relationality, both weak and strong.

Taken overall, Weiss’s concept of intercorporeality succumbs to a certainocularcentrism. This is unsurprising given the privileged and problematicrelationship between women and images of women in a culture increas-ingly organized through visualization and the production of image asdesire. At the same time, her work around pregnancy points to otherpossible ways of working the term. Both pregnancy and biotechnical inno-vations involve the enrolment of the visceral interior in various forms ofproductive social exchange. Both involve the erosion of distinctionsbetween inside and outside and the rendering of the visceral interior ascontinuous with social surface, a place for the negotiation of relationship.In what follows, I will consider some accounts of tissue transfer accordingto the logic of an intercorporeality that refuses to consider the organicinterior as excluded from exchange.





Transplantation and fragmentation

Tissue transfer is a broad term encompassing a range of different medicalpractices. Some are traumatic, involving specialized and difficult kinds ofinternal surgery like whole organ transplant. A liver transplant, forexample, involves between five and seven hours of surgery and a highlyspecialized team. At the other end of the spectrum, sperm donation andartificial insemination involve minimal or no trauma for the participants.The semen is transferred using the body’s own conduits and an inter-mediary set of institutional and clinical procedures. These two instancesof tissue transfer, quite different in their details, nevertheless create formsof material exchange that play out as modes of intercorporeality. I will drawon studies of participants in both of these forms of transfer to explain whatI mean.

People diagnosed with end-stage disease awaiting organ transplantevince a dramatic change in their relationship with their visceral interior.This space becomes highly invested, sensitized and fragmented. For thehealthy person, living life in ‘the silence of the organs’ as Canguilhem(1994) puts it, the interior is not physically mapped in any degree of detail.There is little introceptive data provided by healthy organs aside from thebeat of the heart, the swell of the breath and the gurgle of digestion toindicate location or function. Few healthy people have a precise sense ofthe location of their liver or pancreas, for example. For the person awaitingtransplant, however, the diagnosis and experience of organ degenerationand failure, prior to the transplant, create an interior rift. The homogene-ity of the body’s interior, its apparently given relation as a space of the selfthat supports the living processes, is disrupted by the diagnosis of organdamage and the symptoms or sensations that may have preceded this diag-nosis for some time, as Francisco Varela writes about his liver disease andsubsequent transplant:

I’ve got a foreign liver inside me . . . [yet] my old liver was already foreign; it wasgradually becoming alien as it ceased to function, corroded by cirrhosis, with noother than a suspended irrigation of islands of cells, which are then left to decayand wither away. Years before the transplant, during a biopsy the surgeon cameto see me: ‘I saw your liver, it looks very sick, you must do something about it.’The statement made this silent organ suddenly un-me, threatening and alreadydesignated to be put at a distance in the economy of the body’s self. (Varela, 2001:262–3)

Hence, for the patient awaiting transplant, the body’s interior is psychicallyreorganized, divided into a threatened self and the degenerate organ thatthreatens self. This threat must be endured until surgical intervention canrid the body of this malign presence and replace it with the benevolenttissues of another, the donor.

In the case of whole organ transplants, organs are usually procured frompeople who have been declared brain dead and who have signed donorcards. The families of donors under many medical systems have the rightto override the wishes of the donor. Often the most important motivationfor a grieving family to allow their loved one’s organs to be taken is the





sense that the donor’s identity is transferred with the organ and continuesin some sense in the body of the recipient (Fox and Swazey, 1992; Lock,2002). For the recipient of anonymous organ donation too, the organ isoften personified, bringing with it some trace of the donor. This can playout in a number of different idiosyncratic ways. Many, if not most, recipi-ents are intensely curious about the donor and will develop complexfantasies about them and an intense sense of linkage. Varela describes hisoverwhelming curiosity about the anonymous donor whose liver hereceives and his drive to imagine them:

I arrived in the hospital after the crucial phone call stating that a donor had beenfound for me . . . the nurses at the reception, professional and kind, let out ‘It’scoming from Marseilles, it’s an organ in excellent condition’. This mere sugges-tion is like the skeleton onto which the imagination unleashes [its] full contents.(I see a young motorcyclist sprawled next to the AutoRoute. . . . One of a thousandscenarios that go through my mind. I will never know.) . . . In the early tempo-rality of the experience the social imaginary link is intense and gripping . . . Ifound myself spontaneously desiring a reciprocity, to seal a pact with the anony-mous donor. (Varela, 2001: 266–7)

Some of the recipients interviewed by Lock (2002) several years after atransplant state that they still think about the donor every day and wonderabout them. One woman, a nurse, worries that her kidney donor was a childwho had died:

It took me a long time to get used to the idea of having someone else’s kidneyinside me, even though I am a nurse. Now I’m just thankful, but it still comes backin flashes, like a daydream sometimes, wondering, wondering who it is. (Lock,2002: 324)

Other recipients feel an intense identification with the unknown donor andguilt towards the donor or their family. Fox and Swazey (1992) describe thecase of a man in his early twenties who received the kidney of a young girlkilled in a car accident. He tells them:

When certain of my friends learned I had received a kidney from a little girl, theymade jokes about it, saying that maybe I’d get back the youth and virility that Ihadn’t had for a long time. This so upset and disgusted me that I broke off allrelations with these people. . . . But there was another patient, a woman whoreceived a kidney at the same time that I did from the same little girl. We havebecome brother and sister. (Fox and Swazey, 1992: 36)

He also relates his intense sense of guilt towards the imagined mother ofthe little girl, whom he dreams about:

In my dream, I see this woman, all dressed in black, with a black veil over herface. She is crying, and she has reproach in her eyes. I try to communicate withher, to console her, but I can’t. Because there is a pane of glass between her andme: a pane just like the one that was in the isolation room where I was hospi-talised during the first days after the transplant. (Fox and Swazey, 1992: 41)

Clearly, for this man, his new kidney aligns him with the imaginedperson of the young girl in an intense and protective way. Other organrecipients develop an intensely personified relation with the organ itself.





Rosengarten (2001) describes cases where transplant patients fear that theywill be invaded or overwhelmed by the presence of an organ as a possiblymalign representative of the donor. In one such case, an African Americanman who distrusts white people receives a kidney donated by a whitewoman. He experiences the kidney as hostile and fears that it will rejecthim or damage him in some way. Lock (2002) observes that it is commonfor organ recipients to worry about the gender, ethnicity, skin colour,personality and social status of their donors, concerned that they may beovertaken by the identity associated with the organ. Others consider thenew organ to have a semi-discrete and separate identity that is accommo-dated within their bodies. Some of Lock’s female interviewees refer to theorgan as a kind of foetal life. Here they clearly draw on the experience ofpregnancy so eloquently described by Young (1990) as a sense of semi-autonomous life within, both myself and not myself:

I still think of it [kidney and liver transplant from a single donor] as a differentperson inside me. . . . Is not all of me, and it’s not all this other personeither. . . .You know, sometimes I feel as if I’m pregnant, as if I’m giving birth tosomebody. I don’t know what it is really, but there’s another life inside of me, andI’m actually storing this life, and it makes me feel fantastic. It’s weird, I constantlythink of that other person, the donor. (Lock, 2002: 323)

Another interviewee states:

Oh yes [the kidney is] part of me – it’s me, it’s me. I even call it my baby! I takeso much care, I feel protective, it’s a really special part of me. You know, at first,when I went through periods of [immunological] rejection, I would pray about it.. . . I felt I must be responsible for this other person’s kidney. (Lock, 2002: 324)

Clearly, in each of these cases the organ recipient has been compelled toreorient their sense of embodied identity, to stretch, double or split it insome kind of way. The don, the given organ, is not a neutral and detach-able anatomical component, but rather a fragment that partakes of theidentity of the donor. The material incorporation of the organ involves apowerful identification or disidentification with the donor, a major adjust-ment of the self’s composition and structure.

‘Self’ here works in a double sense that further complicates these psycho-somatic struggles (Rosengarten, 2001).4 In immunology, ‘self’ describes thesignature antigenicity of each individual’s tissues, the macromolecules thatsit on the cell surface of tissues and allow the body’s immune system torecognize these tissues as the body’s own. If these molecules are differentfrom others found in the body, the immune system cells will begin to attackthe tissue, reading it as pathogenic. Hence, as every immunology textbookwill tell you, the immune system marks the limits and boundaries of thebody, demarcating the biological self from non-self (Waldby, 1996). Allorgan transplantation, except when an organ has been donated by an iden-tical twin, provokes a massive immunological reaction. This reaction iscontrolled by the administration of powerful immunosuppressive drugsthat effectively disable the body’s ability to tell the immunological self fromnon-self. Varela describes his own immunological reaction to his livertransplant:





The body-technologies to address rejection are absurdly simple: disable theongoing process of identity, weaken the links between components of theorganism. Immunosuppression is, to date, the inescapable lot of transplantation.One starts by special suppressive drugs and massive doses of corticoid. . . . As therejection does not yield, the treatment mounts one step . . . the entire repertoireof immune cells is massively eliminated by a slow injection. (As I felt the effectcoming in a few minutes, my whole body was swept by uncontrollable shaking,like an alien possession that left me [who?] in a limbo of non-existence; lookingsteadily into my wife’s face the only reference point in a disappearing quagmire.)Complete immunosuppression does stop the rejection, but now simply being inthe world is a potential intrusion, as the temporality of my somatic identity hasbeen erased for a few days. . . . In time the body is allowed to reconstitute; Irecover my assurance of my daily embodiment, as the immunosuppression ismilder. This becomes a life condition. (Varela, 2001: 264)

This crisis of the immune system is also, necessarily, a crisis of therecipient’s relation to the organ and the complexity of its incorporation.The new organ intrudes into a space that is simultaneously immunologicaland psychical self so that the reactions of the immune system cannot beaffectively or psychically neutral. A transplant unit psychiatrist inter-viewed by Lock (2002) argues that patients who cannot find a compromisewith their new organ, a way to live with the identity transformations itinduces, are at much higher risk of immunological rejection. Conversely,the routine rejections experienced immediately after transplant provokedoubts about the psychic relation to the organ, he claims. In the mostserious cases, the organ may remain unincorporable, rejected by both theimmunological and psychic selves. In successful transplants, the organ isfunctionally incorporated yet, as the interview excerpts above clearly show,it will always bear the trace of its origins in another. The recipient musttake immunosuppressive drugs for the rest of their lives, a constantreminder that their internal milieu is shared with fragments of another’sbody. A successful transplant involves an immunological and psychicalaccommodation of this other body, but the organ recipient can never forgetthat their sometimes precarious state of health is owed to an uncertaincompromise between their body and another’s. Hence the organ recipientis involved in the most direct and literal form of intercorporeality. Theircapacity to live at all depends on a profound confusion between their bodyand another’s.

Sperm donation and intercorporeality

Organ donation has a number of features that distinguish it from otherkinds of tissue donation and that tend to exacerbate the intercorporealdramas involved in tissue transfer. First, it works on a one-to-one or one-to-few ratio. That is, one organ donor gives their organs to one or a smallnumber of recipients. The relationship is temporally direct: the organ isremoved from one body and transplanted into another’s within theminimum possible time. Second, donors generally have to die in order forthe recipient to receive the organ. While kidney donation from a livingdonor is becoming more common, almost all organs are procured from





bodies declared brain dead, often after car or sporting accidents thatdamage the head but leave the major organs intact. Organ recipients aregenerally aware that their new organ has been obtained in circumstancesthat involve the death of the donor and devastation for their families. Theythemselves are, by definition, ill and on the verge of death and hope thatthe new organ will prolong their lives and improve their health. Hence,organ donation is, generally speaking, more personal, more traumatic andinvolves more guilt and gratitude than other kinds of tissue donationalthough, of course, the experience around various kinds of tissue transferis highly variable. Nevertheless, other more benign kinds of tissue transferalso produce modes of intercorporeality. While space prevents me fromsystematically comparing all the modes of tissue transfer, I will brieflydescribe a study of sperm donors and recipients (Tober, 2001) that suggeststhat less traumatic and weaker forms of intercorporeality are also in playhere.

Tober examines the ways that donated semen is attributed with varioussocial powers and works as a mediator of relations between donor andrecipient. She argues that women who purchase sperm treat it as a synec-doche for the donor. That is, they select sperm from donors whose charac-teristics resemble those they would look for in a partner – the sameethnicity and education level, preferably good-looking and with a highincome. Sperm is understood to be a kind of tissue that transmits suchqualities to the resulting offspring:

The sperm-banking industry and the market for sperm are both heavily influencedby the notion that some traits – social or physical – are more desirable than others,and that these traits reside in the sperm. Semen is a vehicle for the transmission ofgenetic material; as such, various complex meanings – biological, evolutionary,historical, cultural, political, technological, sexual – intersect at this particularsite. . . . Culturally held perceptions of (and preoccupations with) genetics, withsperm as a transmitter of genetic material, shape the ways in which potential donorsare screened and their semen sold. . . . The semen donor, then, is viewed as theprototype for the child that will be produced by his sperm. (Tober, 2001: 138)

It is evident, therefore, that semen (like whole organs) is a substance thatrefers back to the identity of the donor and carries aspects of this identitywith it when it is used by the woman for insemination. Hence, to acceptsomeone’s donated semen is to enter into a relationship with them, despitethe commodity model that predominates in this kind of tissue transfer.5

Tober comments that the buying, banking and selling of semen imply thatthe relation between donor and recipient is simply the anonymous relationof producer and consumer, yet the social relations of fatherhood reassertthemselves:

First, the donor who provides semen for a woman’s child becomes the subject offantasy and fetish – some sort of relationship exists at least in the realm of theimagination and certainly in the realm of the biological should a child beconceived. . . . Second, the recipient may, at some point, have some sort of contactwith the semen donor who often has the option of entering into a social relation-ship with the offspring as the child’s biological father, albeit a limited one. (2001:140–1)





One of the women interviewed by Tober described her fantasies about herdonor and future child: ‘[She would] daydream about standing with hermythical daughter and her mythical donor, together at her mythicaldaughter’s graduation’ (2001: 142). So it is evident that, like organdonation, the incorporation of donated sperm produces intercorporealeffects. Semen donation does not, on Tober’s account at least, precipitatethe kind of profound destabilizations of the body ego that are evident inorgan donation. Semen is a renewable substance; it is produced (by youngmen at least) with little effort and no pain and is incorporated by thewoman with fairly minimal technological intervention. Moreover, it isincorporated not to save the life of the recipient, but to enable the produc-tion of another life, a child. Nevertheless, the transfer of seminal tissueclearly compels modes of relationship that echo in an attenuated form thekind of profound intercorporeality of the sexual relationship, even if donorand recipient never meet.

Conclusion: biomedical intercorporeality

The idea of intercorporeality expresses ways we are indebted to andmutually implicated with each other. The intercorporeal nature of selfhoodsuggests the contextual vulnerability and non-autonomy of personhood,the openness of each person to another. It is evident from my account thatthe sharing of bodily matter compels particularly direct experiences ofintercorporeality. Biological exchange is also a kind of social exchange.Participants experience forms of bodily relationship and indebtedness andsometimes a complex psychosomatic confusion of selves. In this regard,biomedically engineered intercorporeality maps itself on to those mucholder expressions of the social powers of shared bodily matter: kinshiprelations based on sexual relations and consanguinity. The term ‘consan-guinity’ here is highly expressive – family relations based on the 19th-century trope of shared blood now replaced by the trope of shared genes.The strong intercorporeality engendered by organ exchange, in particular,often seems to resemble kinship relations. Donor families who meet withrecipients often form family-like relations, held together by a sense ofmutual indebtedness and obligation that can, as Fox and Swazey (1992)report, become intense and oppressive.

For these reasons, biotechnically-mediated intercorporeality createsnew circuits of relationship in ways that are often neither anticipated norrecognized by medical researchers or liberal bioethicists devoted to thedefence of an autonomous self. Participation in circuits of tissue transferrisks identity and selfhood, although this is not in itself a bad thing.Weiss’s notion of intercorporeality suggests that the coherence of selfhoodis constantly risked, fractured and transformed by virtue of the fact ofbeing embodied. However, it is important to recognize that particular tech-nical configurations and procedures within tissue transfer (is the materialdonated or sold? can it be banked? how is eligibility for a donation andtransplantation decided?, and so on) set out the terms of the relationalnetworks that any practice of tissue transfer will create. Hence, these





procedural and technical configurations require bioethical attention totake account of the force of intercorporeality as a salient experience ofparticipation in such networks and to intervene to make the experiencetolerable and productive. So, for example, I would agree with Lock’s(2002) suggestion that the sacrifice and feelings of indebtedness producedby organ donation could be communalized: ‘It may well be appropriate to. . . increase recognition of donors and perhaps to bring donor families andrecipients together more frequently, not to establish personal ties but tocelebrate the social good that emanates from organ donation’ (Lock, 2002:373). If stem cell technologies prove to be sources of transplantable tissue,such communalized relationships may well be appropriate among embryodonors and tissue recipients, particularly as a single embryo will form thestarting point for numerous self-renewing cell lines that may providetissue for many patients. Currently in the UK, a stem cell bank is being setup to collectivize donated embryonic tissue for therapeutic research, astep taken in part to reassure embryo donors that their gift will contributeto a social good and not merely to the profitability of patentable medicalresearch.

Tissue transfer procedures also require attention because sharp hierar-chies of risk, bodily danger and illness can very easily be created, particu-larly as circuits are globalized and marketized. Marketization tends toredistribute tissues – organs, blood and cells – from the poor who acceptpayment for their bodily substance to the rich who can afford to pay for thehealth these substances may bring. This is the ugliest face of intercorpore-ality. The bodies of the strong can cannibalize those of the weak, assimi-lating them without regard. There is abundant evidence that such unjustmodes of incorporation are well established (Scheper-Hughes, 2001) andthat Third World bodies are being used to supplement those of the FirstWorld. This, therefore, is ultimately what is at stake in biomedical circuitsof intercorporeality: power relations are played out as economies of tissuetransfer. If feminist philosophy of the body limits itself to considerationsof image economies, it is unable to understand such stakes or formulateways to work towards intercorporeal justice.

AcknowledgementsA version of this article was given at the Gender Talks Seminar, University ofGeneva, 4–6 April 2002. I would like to thank Anna Gough-Yates, MarshaRosengarten, Susan Squire and Elizabeth Wilson for helpful comments onearlier drafts of this article.

Notes1. The globalization and commodification of fragments carry with them the

spectre of the world’s poor selling their fragments to the world’s wealthyand there is strong evidence that this practice is becoming more common(Scheper-Hughes, 2001).

2. Sperm being a persistent exception (Tober, 2001). In the US, more kinds of





tissues (for example, ova) are marketized, although there is strong socialresistance to the idea of a market in human organs (Fox and Swazey, 1992).

3. However, as Lock (2001) observes, hospitals and organ donation campaignsroutinely utilize a personalized rhetoric around human organs, askingpeople to make their organs a gift of life and so forth.

4. I am indebted to Rosengarten (2001) for this important idea and to manyconversations I have had with the author regarding immunology,materiality and embodiment.

5. Sperm donation is unusual in that ‘donors’ are almost always paid andsperm is generally purchased, even in countries like the UK thatconsistently refuse to marketize other forms of tissue donation.

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Catherine Waldby is Reader in Sociology and Communications and theDirector of the Centre for Research in Innovation, Culture and Technology atBrunel University, London. She is also Adjunct Associate Professor at theNational Centre in HIV Social Research, University of New South Wales,Sydney. She is the author of AIDS and the Body Politic (Routledge, 1996), TheVisible Human Project (Routledge, 2000) and numerous articles about science,technology and the body. She is currently researching blood donationsystems, tissue banks and human stem cell technologies.

Address: Department of Human Sciences, Brunel University, London UB83PH, UK. Email: [email protected]





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1.2.13 Biomedicine, Tissue Transfer and Intercorporeality - Waldby