Bulletin of the History of Medicine

Over the past twenty years medical anthropologist Lesley A. Sharp has contributed much to our understanding of the phenomenon of organ transplantation. This is a field of knowledge that anthropologists and sociologists have made their own, with important contributions including Renée Fox and Judith P. Swazey’s Courage to Fail and Spare Parts, Margaret Lock’s Twice Dead, and Sharp’s own Strange Harvest.¹ More recently, historians have examined transplantation’s longer history, notably Susan Lederer, Thomas Schlich, and Ayesha Nathoo.²

In The Transplant Imaginary, Sharp focuses on two experimental forms of contemporary transplantation, concentrating in the main on the period from the 1990s to the present and drawing on research she carried out in the United States, Canada, the United Kingdom, Australia, and New Zealand. Here, Sharp extends her consideration of transplantation’s moral world by attending to the troubled phenomena of xenotransplantation (grafting nonhuman animals’ organs into human bodies) and the development and use of mechanical parts such as artificial hearts. Both these experimental forms of organ replacement are rationalized as being driven by the well-publicized dearth of available human organs to transplant. [End Page 840]

The transplant enterprise has always been imbued with moral complexity, involving as it does considerations about the worth of particular lives, how death should be understood, whether organs should enter recipient bodies as gifts or commodities, and so on. Indeed, as Sharp explores in The Transplant Imaginary, transplantation deals with what it means to be human in a world in which diseased body parts can be cut out and replaced with foreign material that has been removed from other, purpose-bred sentient beings and by goods manufactured in a bioengineering facility. Yet the moral aspects of these developments have often been shunted to the margins of concern, while attention has instead focused on more mundane matters such as organ shortages and how best to increase supplies.

Sharp has unearthed the moral convictions held by people working in these two experimental fields. She argues that moral values transcend the constricted realm of bioethics with its “strident set of four principles” of autonomy, nonmaleficence, beneficence, and justice (p. 35). Through a series of ethnographic encounters with individual scientists, bioengineers and others, Sharp rather seeks to “identify and decipher individuals’ experiences, the personal values embedded in their narratives, and, more broadly, the richness of moral thinking in everyday laboratory life within specialized branches of science” (p. 176).

Importantly, Sharp argues that both xenotransplantation and bioengineering are forms of experimental science that manage to elide the immediate moral concerns that imbue them because the outcome of their work is displaced into the future. This orientation makes concerns about, for example, the morality of vivisection, the creation of hybrid bodies, and cross-species infections appear to be less urgent, and renders current failures as lessons from which to learn while moving forward on a worthwhile pursuit. Yet such temporality is itself “an inescapable moral presence that permeates experimental actions, thoughts and aspirations” (p. 151). It remains morally salient that this work affects sentient beings, including when a transplant is deemed a “success” even if the recipient dies soon after the operation, or the graft survives for only a short time (p. 167).

Sharp marries a panoramic consideration of her subject matter with a close examination at the micro level of how particular scientists rationalize their work. This enables her to perceive differences in how individuals who are engaged in a common project think about what they do. There are many nice examples in the book. Primates, once the animal of choice as “donors” in xenotransplantation, have become too morally challenging and costly to use for that purpose. As Sharp explores, pigs are now considered to be “ideal matches for human bodies” (p. 50). Unlike primates, they are thought to be expendable. As one of Sharp’s interviewees...