Symbolically dense and ethically contentious, organ transplantation has proven good to think with across an increasingly diverse range of settings. Preoccupying much of this literature are the complex and shifting relations among body, self, and society emergent in transplantation as well as the new forms of bodily commodification thus made possible. The view from Israel, shaped by a distinctive politicomoral economy of sacrificial bodies and national identity, has much to contribute here, not least because of Israel’s policy (only recently discontinued) of providing national health care coverage for transplants purchased abroad. In Organ Donation and Transplantation: Body Organs as an Exchangeable Socio-Cultural Resource, Orit Ben-David offers a welcome exploration of the social life of this biotechnology in Israel.

Ben-David’s central concern is with the exchange relations structuring organ transplantation, and she aims to both elucidate and increase organ transfer by examining the sociocultural dynamics in which it is enmeshed in Israel. Significantly, her analysis, which draws on ethnographic research conducted over more than a decade in Tel Aviv, is restricted to transplantation with cadaveric donors and to the Jewish Israeli population.

Ben-David begins by tracing out the trajectories and forms of exchange elaborated among three key groups in transplantation: medical personnel, transplant candidates and recipients, and donor families. She is rightly interested in complicating the common focus on relations between donor and recipient and pays particular attention to the mediating (and prestige-garnering) role of the medical team interposed between them. Ben-David next painstakingly reviews various social exchange theories, rejecting the widely employed gift model as inaccurate and instead drawing a distinction between two systems of exchange: the “concrete” transfer of the actual organ and the “abstract” transfer of death for life. Having laid this conceptual groundwork, she goes on to explore the sociocultural understandings of the body, life, and death that underpin these two exchange types. Parsing out the perceptions of various groups, Ben-David links physicians and transplant recipients together as espousing a strictly mechanical view of the body and a “biological–technical” understanding of death, which resists the notion of a second life conferred through the act of donation. In contrast, she finds donor families and the Israeli media trafficking in more symbolic associations of the physical body with (potentially perduring) identity and emphasizing donor “immortality” achieved through memory and in the transplanted organs. Far from creating contradictions, she argues that it is precisely these differently held perceptions that engage diverse constituencies in transplantation and thus enable its enactment.

Ben-David concludes her analysis by examining some of the wider cultural values animating (and sometimes inhibiting) the exchange of human organs in Israel, particularly notions of altruism, individualization, and nationalism. Intriguingly, she contrasts the deaths and social identities of cadaveric donors (a high proportion of whom appear to be suicides) with other kinds of socially significant deaths in Israel. Soldiers and terrorism victims rarely serve as organ donors, Ben-David argues, at least partly because their deaths are already regarded as heroic and socially meaningful. For those who die excluded from the social body, however, (and here she includes both suicides and recent immigrants), she sees organ donation as providing a powerful means of social reincorporation and resignification.

Ultimately, Ben-David offers a timely and engaging foray into transplantation as practiced and experienced in Israel, although the overall picture is often familiar to existing work and sometimes oversimplified in the service of diagrammatic clarity. A more deeply ethnographic sensibility could have made this a more singular contribution, for the ethnographic material often feels sparse and somewhat undigested. Generalizations made about life-and-death beliefs, for instance, could have been usefully nuanced by more attention to the particular performative conditions and power relations structuring statements made by physicians giving public presentations or by desperate transplant-seeking patients. Yet tantalizing ethnographic tidbits do emerge throughout. In one, a woman is forced to accept an unwanted kidney transplant by the threat of removal from dialysis (p. 95). In another, the minister of health promotes organ donation in a speech to university students by noting that it “would save the nation a great deal of money” (p. 143). And in yet another, organ donation is posited as offering non-Jewish Israelis a potential way around the difficulties they often experience in obtaining burial sites (p. 103). Evoked by such moments is the rich (but not yet fully realized) potential for the ethnographic lens of Israel to refract critical new insights into the practices, possibilities, and implications of transplantation—and, in turn, for transplantation to serve as a revealing analytic lens into emergent assemblages of body, self, and state in Israel.
[tables, references, index.]