Theoretical resources regarding the creation of objects and orientations in ideology and material practice are drawn on to develop an original, theoretical account of organ transplantation. This analytical lens is then used to advance understanding of the social relations that enable and inhibit the exchange of kidneys for transplantation. The argument is that customary claims about how to increase organ donation, set within an altruism versus market framework, deflect attention from a significant variable: the legitimacy and limits of removing kidneys from their owners – in other words, alienability. Two sets of rules are revealed, with one set, the rules of altruism, requiring and eliciting public engagement, and the other set, the rules of alienability, being pushed by experts within their realm of authority. Both sets of rules demarcate boundary lines through a fundamental tension between recipients, intermediaries and donors that is demonstrated to be imbalanced by a recipient-centric orientation. As a result, public discourse is focused on a small set of variables and distanced from a far more complex set of dynamics predominantly emerging from the relationality of donors and recipients.
Seeing the deflection of attention challenges both the legitimacy of conventional wisdom about transplantation, especially as it informs public policy, and the common view of a complete distinction differentiating altruism from capitalist modes of body part exchange. It also raises new questions about persuasion and public knowledge that trouble altruism, and shows how efforts to alleviate the suffering of some, (potential) recipients, has largely unintentionally led to a structured forgetting of the suffering of others, (potential) donors. This is demonstrated for both deceased donation and living donation using a case study of one organ, the kidney, in one jurisdiction, Ontario, Canada, from 2000 to 2014, with a focus on donors and intermediaries.