To Share or not to Share? Institutional Exchange of Cadaver Kidneys in Denmark

Kidney transplantations are about exchanges. Grafts are moved from dead bodies to living ones in return for gratitude and meaning; between friends and family members out of, or in hope of, affection; and between strangers for philanthropic or pecuniary reasons. These exchanges raise legal, psychological, ethical, and philosophical questions, and kidney transplantations owe their high visibility as much to the ongoing debates about these issues as to their therapeutic qualities. Consequently, exchanges like these have received much attention from scholars, stressing how kidney transplantations, along with other kinds of organ transplantations, involve society in a unique way. Renée Fox and Judith Swazey, pioneers in the sociological study of kidney transplantations, asserted in 1978 that the importance of renal replacement therapies ‘‘lies as much in their social and cultural significance as in their medical and surgical value’’, thus announcing a broad perspective on the significance of kidney transplantations that continues to dominate nonmedical research in the field to this day. But kidney transplantations also involve exchanges on a different level. Jeffrey Prottas reminds us that ‘‘before they go to patients, organs go to transplant teams and hospitals’’. Doctors and transplant centres involved at this level hold strong vested interests in how organs are distributed, and exchanges at the institutional level are thus potentially as problematic as exchanges on a broader societal level. Prottas identifies two different ways of allocating organs for transplantation. In the first case, organs are distributed according to general criteria accepted by a group of transplant centres and are offered to the most suitable recipient within the network of cooperating centres. In such a system, clinicians in local hospitals have little formal influence on the allocation of grafts, and authority lies primarily with regional or national organ allocation agencies. In the second