Transplanting the Political Organ: “Our Bodies Belong to God” Reviewed
In Our Bodies Belong to God: Organ Transplants, Islam and the Struggle for Human Dignity in Egypt, anthropologist Sherine Hamdy explores the controversy surrounding the transplantation of body parts in Egypt. The book contributes to and further politicizes the vibrant body of literature on agency and social relationships activated by organ transplantation and the cultural forces that impact organ transfer and circulation (see Joralemon 1995; Scheper-Hughes 1996, 2000, 2004; Sharp 2006). Using fieldwork conducted in Mansoura, Tanta and Cairo between 2001-2007, Hamdy ‘examines the layers of social networks that have shaped and been shaped by Egypt’s organ transplant debate’ (p. 10) by engaging with patients, doctors, medical students, public figures, religious figures, patient’s families, organ procurers and providers. The fieldwork in Our Bodies Belong to God focuses primarily on the issue of kidney dialysis and transplant, but also includes a lengthy discussion of the history and reality of cornea transplant in Egypt, which attempts to parallel the dynamic debates around kidneys.
The inability of Egyptian biomedical authority to construct definitive positions on organ transplantation remains an active presence throughout the book, helping to set Hamdy’s research against a cultural background of general political and religious unrest. An overview of political and economic tensions in Egypt help to approach her main research questions: What does “our body belongs to God” mean? What is death and how is it defined in Egypt? How do patients in Egypt relate their health problems to political ecology? Is the organ donation question in Egypt a necessarily religious question? Hamdy smartly realizes that ‘by building on anthropologists’ scholarship and critiques of bioethics, [her] study makes the case for a bioethics rebound […] from its failed relationship with the social sciences’ (p. 8). This is particularly apt, given previous work on failed patient support in Egypt (see Inhorn 1994, 2003; Clark 2007), scholarship on Western bioethics’ inadequacy when transplanted elsewhere (see Fabrega 1990; Lieban 1990) and bioethics’ general abstraction from lived experience (see Kleinman 1995; Marshall & Koenig 2004). Hamdy takes up where much of this foundational writing left off, hoping to recast ethics as a ‘necessarily political project’ (p. 8) a move with potentially tangible effects on medical care and wellbeing in Egypt.
Hamdy’s multi-perspectival approach combined with a bioethics freed of disciplinary confines results in a rich pastiche of information, where the statement ‘our body belongs to God’ can mean more than Shaykh Sha’rawi (who publicly coined the statement) forbidding organ transplantation on the grounds that ‘the human body is the exclusive property of God’ (p. 122). Moreover, Hamdy finds that though the question directly addresses religious issues, that ‘differing positions on a practice such as organ transplantation may have less to do with their different approaches to Islamic legal tenets than with their views of the practice at hand and its relationship to state institutions’ (p. 131). The notion that ‘Our bodies belong to god,’ then, is individually mediated by ideas about the state, finance, benefit, risk, spirituality and experience.
There is considerable opposition in Egypt to acquiring organs from living donors; instead, cadaveric donors are preferable, even though the demand for cadaveric organs far outweighs the actual domestic supply. The preference for cadaveric organs in Egypt raises the question of what constitutes death again and again, with ‘fatwas and medical opinions [on brain death] swirled in circuits of doubt’ (p. 48). The state defers to medical opinion on medical issues, but the inability of the medical community in Egypt to agree on a definition of death has left this question institutionally unanswered. Hamdy concludes ‘the case of the brain-death debate in Egypt demonstrates the failure of the Egyptian state to deal productively with the plurality of voices that have emerged in assessing the status of brain-dead patients’ (p. 79), again reframing a medical issue as a political problem.
Hamdy’s discussion of how patients relate their experiences to the political economy in Egypt further develops organ transplantation as a political issue. Many of her informants expressed that widespread renal failure was in fact the result of toxins in the environment and that the state and subsequent state-related networks were aware of these conditions and chose not to address them because those that were most susceptible to renal failure were generally poor and in rural areas. Patients ‘formed communities out of a shared sense of vulnerability to a “failed state” and to corrupt and inadequate medical practice’ (p. 179), knowingly linking ‘the reasons for their poor health to broader social, environmental and global economic forces’ (p. 179) as a reaction against medical reductionism in clinics. These ‘political etiologies’ are how patients relate their lived experiences to the political economy in Egypt.
The most notable contribution of the book is that Hamdy has come to a position that leans slightly against developing a national program for organ transplantation. She sees the essentialist view of Islam as a hurdle to scientific progress held by transplant proponents as something of a red herring; instead, ‘transplant proponents have failed to adequately address the vulnerabilities of the poor and the specific problems that arise when transplantation is practiced in a sharply stratified society’ (p. 245). While a national transplant programme might advance medical practice in Egypt, it will ultimately reify systems that force the poor to ‘bear the brunt of risks and uncertain outcomes of high-technological medical interventions’ (p. 245). This is significant not only because it challenges growing Egyptian support for a potential organ program, but also because, pedagogically, Hamdy joins a growing number of contemporary medical anthropologists willing to take a firm stance on large and potentially divisive medical questions with political dimensions.
This book will primarily be of interest to medical anthropologists, as well as to scholars working in the medical humanities. Hamdy’s deft use of ethnography unites medical, political and transnational concerns, making the book an especially valuable blueprint for others conducting ethnographic fieldwork that aspires to both transdisciplinarity and real-world relevance. The applied implications of Our Bodies Belong to God on emerging studies in anthropology and the medical humanities that couple bioethics and political economic unrest are potentially widespread. She rightfully calls into question ‘the grand narrative that technoscience tells of itself [which] tends to elide questions about access, justice and overall benefit’ (p. 250), but also asks that medical questions—which are, even in Egypt, treated with a certain respect not awarded to other legislative realms—be reframed to address political and social inequality. Hamdy advocates for forward movement despite the messy intersections between medicine, Islam and governance that have resulted in a historical dearth of biomedical and religious consensus. By doing so, Hamdy makes room for the critical acknowledgement that Egyptian transplant policy and practice, where ‘near-permanent emergency-law status enables virtually unchecked power’ (p. 250), ultimately privileges the authoritarian state over the private citizen. This powerful realization lays bare the dangers of waiting for a standard position that may never come: populations remain vulnerable to policies that not only disappear widespread concerns like access and redress, but also ignore individual lived experience.
Reviewed by Emily Goldsher-Diamond, a Research Fellow at the Department of Media, Culture and Communication at New York University. Emily works on the intersections between technology, biomedicine and the body with a particular focus on prosthetics and amputation.
Correspondence to Emily Goldsher-Diamond.
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