Feminist Theory

http://fty.sagepub.com Biomedicine, tissue transfer and intercorporeality

Catherine Waldby Feminist Theory 2002; 3; 239 DOI: 10.1177/146470002762491980 The online version of this article can be found at: http://fty.sagepub.com/cgi/content/abstract/3/3/239

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Biomedicine, tissue transfer and intercorporeality

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Feminist Theory Copyright 2002 SAGE Publications (London, Thousand Oaks, CA and New Delhi) vol. 3(3): 239254. [1464-7001 (200212) 3:3; 239254; 029158]

Catherine Waldby Brunel University

Abstract More and more areas of medicine involve subjects donating tissues to another blood, organs, bone marrow, sperm, ova and embryos can all be transferred from one person to another. Within the technical frameworks of biomedicine, such fragments are generally treated as detachable things, severed from social identity once they are removed from a particular body. However an abundant anthropological and sociological literature has found that, for donors and patients, human tissues are not impersonal. They retain some of the values of personhood and identity, and their incorporation often has complex effects on embodied identity. This article draws on feminist philosophy of the body to think through the implications of some of these practices. Specically, it draws on the idea of intercorporeality, wherein the body image is always the effect of embodied social relations. While this approach is highly productive for considering the stakes involved in tissue transfer, it is argued that the concept of body image has been too preoccupied with the register of the visual at the expense of introceptive data and health/illness events. Empirical data around organ transplant and sperm donation are used to demonstrate that the transfer of biological fragments involves a profound kind of intercorporeality, producing identications and disidentications between donors and recipients that play out simultaneously at the immunological, psychic and social levels. keywords body image, identity, organ transplant, sperm donation

As contemporary medicalized subjects, our experience of our bodies increasingly involves their potential for biotechnical fragmentation. New surgical and clinical practices enable the donation of new kinds of biological fragments to others and the reciprocal incorporation of others fragments. Since the mid-20th century, with the development of effective methods of blood transfusion, individuals have been able to donate a portion of their blood for transfusion into anothers body. Organ transplantation has been practised since the late 1950s when the renement of tissue typing, surgical techniques and immunological suppression allowed organ donors to be matched with compatible recipients (Fox and Swazey,
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1992). Now, in the early 21st century, more and more kinds of tissues can be removed from one body and incorporated into another. Sperm, ova and embryos can be donated, banked and transplanted for reproductive purposes, and foetal tissue can be introduced into the brains of people with degenerative conditions. The recent development of techniques for the propagation of human stem cell lines derived from embryos means that embryonic tissues may become the source for a whole new range of transplantable tissues sometime in the future (Waldby, 2002). The globalization of biomedical research and the commodication of tissue fragments have accelerated these systems of tissue exchange and continually broadened their scope. As Scheper-Hughes puts it, these systems are the product of an increasing commodication of the human body,
linked to the incredible expansion of possibilities through recent advances in biomedicine, transplant surgery, experimental genetic medicine, biotechnology and the science of genomics in tandem with the spread of global capitalism and the consequent speed at which patients, technologies, capital, bodies and organs can now be moved across the globe. (Scheper-Hughes, 2001: 3; emphasis in original)

These developments suggest that the experience of embodiment in First World economies will involve increasing participation in these new circuits of biological exchange. Our health and fertility are more likely to be owed to the therapeutic effects of anothers fragments organs, blood, ova, semen, embryos or stem cells. We in turn will be obliged to donate what fragments we can afford.1 Hence the meaning of such fragments, their signicance within various orders of bioethical, capital and community value, will be more and more at issue. Within the technical frameworks of biomedicine and the commodity frameworks of biotechnology capital, such fragments are generally treated as detachable things, biological entities that are severed from social and subjective identity once they are donated or removed from a particular body. That is, they are legally regarded as alienable available for transfer from the originator to others by donation or sale (Lock, 2002). Historically, the majority of tissues are made available by donation2 and, in the US, Canada, the UK and Australia, donors are legally precluded from claiming property rights to tissue once transfer has taken place (Rabinow, 1996). In this sense, the biological fragment is understood to no longer refer to the donor after donation.3 Despite the clarity of this commodity model for tissue transfer, an abundant anthropological and sociological literature testies to a quite different experience of tissue transfer among donors and recipients. For those whose fragments are directly involved, tissues retain the trace of their donor to a greater or lesser extent. Human tissues are not impersonal or affectively neutral; rather, they retain some of the values of personhood for many if not most donors and recipients. Hence, circuits of tissue exchange are not only technical and therapeutic, but also relational and social. To give an organ, blood, ova, embryos, sperm or cells is to be caught up in a
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social and embodied circuit in which the signicance of ones personhood imbues the fragment. To receive and incorporate anothers organs or tissues involves a complex modication of the recipients embodied identity, as the habitual equation between the limits of the body and the contours of the I is thrown into question. In this article, I want to bring together two literatures that do not often communicate, to try and better conceptualize the subjective and bioethical stakes involved in these expanding circuits of tissue exchange. I have already alluded to the rst the social scientic literature that documents and analyses the personal and meaningful nature of tissue exchange for the subjects involved. The second literature is that of feminist philosophies of the body. In particular, I want to utilize and build upon Gail Weisss theoretical term intercorporeality (Weiss, 1999) as a useful conceptual tool for considering the kinds of embodiment jeopardized and enabled by new tissue economies. As used by Weiss, intercorporeality implies that no form of human embodiment is discrete and self-identical. Rather, each persons experience of being embodied emerges from a eld of embodied relationships and continues to refer to, and be modied by, such a eld throughout life. Each subject is a site of intersection where various modes of embodiment play themselves out and relations with others are realized as forms of incorporation. Hence, the idea of intercorporeality contributes to a denaturalization of the relations between the limits of the body and the limits of the I understood as a discrete entity. In this regard, it may help to conceptualize that most literal kind of boundary confusion involved in tissue transfer. Moreover, the empirical literature around tissue transfer can, it seems to me, contribute to the complexity of intercorporeality as a theoretical tool. Weisss development of the term works predominantly with the logic of body images, understood as the primary media relating identity to the body. In this, she builds upon a philosophical tradition that tends to locate the phenomenology of embodiment in the tension between a private introceptivity and a public and social negotiation of ones body surface as appearance. In this article, I will argue that contemporary developments in biomedicine and biotechnology provoke a reconsideration of the signicance of introceptivity and visceral materiality as social and relational sites. Certainly the interior of the female body has long been marked in West European culture as a social site, a place of sexuality and maternity that involves the intersection and production of others. The advent of internal medicine in the late 19th century has opened the interior of both male and female bodies to various modes of sociotechnical inscription. The progress of medical technology throughout the 20th century has rendered the interior of the body increasingly available as a site of use, knowledge and exchange (Waldby, 2000). It seems likely that the social circuits generated by the exchange of biological fragments will become more widespread and signicant as biomedical techniques are rened, with implications for both bodies and bodies politic. The idea of intercorporeality will, I hope, provide me with a way to consider some of these implications. In what follows, I will investigate Weisss development of the term and test out its
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uses and limits as a mode of understanding the relationships that are formed through circuits of tissue exchange.

Intercorporeality
Weisss book Body Images: Embodiment as Intercorporeality (1999) is a feminist theoretical investigation into the constitution of the body image or imaginary anatomy (Gatens, 1996), the image(s) or models that the subject develops of their own body as a condition of being in the world. Her study builds upon what is now a well-established eld in feminist philosophy of the body. Feminist theorists such as Elizabeth Grosz, Moira Gatens, Iris Young and Judith Butler have investigated the ways that living bodies incorporate and naturalize norms and ideas about gender, health, sexuality and identity. The idea of the imaginary anatomy or body image is one of the major methodological strategies in this area of investigation. Weisss particular contribution to this eld is to reread the foundational body image studies (Freud, Lacan, Head, Schilder, Merleau-Ponty) and subsequent feminist studies in order to tease out the dynamics of intercorporeality. She foregrounds the intersubjective nature of the body image and its conditions of emergence:
Rather than view the body image as a cohesive, coherent phenomenon that operates in a fairly uniform way in our everyday existence . . . I argue . . . for a multiplicity of body images . . . copresent in any given individual, and which are themselves constructed through a series of corporeal exchanges that take place both within and outside of specic bodies. (Weiss, 1999: 2)

For Weiss, the body image is always expressive of a history of interrelationships, a site informed by engagement with others, and it is this that guides her rereading of the literature. The foundational literature on the body image can be found in psychoanalytic and neuropsychological work around child development, cerebral traumas and neurological conditions. Within this literature, accounts of the body image vary as to its mode of development, its dynamics and their complexity. What they have in common is the notion that functional subjects operate with an imagined and internalized map of their own bodies, a corporeal schema that helps to coordinate experience, location and modes of relationship to others. The development of a body image is fundamental to our spatial orientation to the world, a dynamic map of the relationship between our bodies and external things that allows us to navigate in space without conscious attention. The body image informs us from moment to moment and in a largely unthematised way, how our body is positioned in space relative to the people, objects and environment around us (Weiss, 1999: 9). In the phenomenological and psychoanalytic work of Freud, Lacan, Merleau-Ponty and Schilder, the body image is also the site for the emergence of subjectivity. For Freud (1914), the infant establishes the foundations of selfhood through the development of the body ego, a psychical mapping of its own body that allows it to make fundamental subject/object
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distinctions between its own boundaries and the ux of perceptual events that engulf it. The body ego allows the organization of previously disorganized perception by creating the initial conditions for a unied body image, which facilitates the coordination of sense data, motor activity and communication. The establishment of the body ego takes place through what Grosz (1994: 32) describes as the stabilisation of the circulation of libido in the childs body, as the child invests and psychically maps various parts of its anatomy. Weisss interest in this process lies in the relational dynamics between infant body and maternal care that allow such a stabilization and self-investment to take place. The mothers nursing and interactions with the infant form the precondition for its investment in itself and for the emergence of a workable body ego. The mothers care maps the infants body through touch, feeding and warmth while the mother forms the rst object with which the infant can identify its rst ego ideal, in Freuds terms. Weiss observes:
Primary narcissism . . . never involves an infants unmediated relationship with his or her body, but from the start implies a complex series of interactions between the infant and others. . . . The image the infant forms of his/her body through primary narcissistic investments in different bodily zones or regions will already reect the inuences of others . . . long before the infant can recognise her/himself or others as discrete entities. (Weiss, 1999: 16)

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This account of the body ego implies a process precipitated by touch, nurture, physical intimacy and skin contact, but other psychoanalytic and phenomenological accounts of the early emergence of the body image tend to locate it in the order of vision and visuality. The very term body image locates the phenomenon under discussion in the realm of the specular: To develop a body image is to develop an image of my body as visible to others (Weiss, 1999: 33). Visual perception is so crucial in the development of the body image because of the tension that emerges between the childs inner and outer world. At a certain point, the child learns that the introceptive experience of its body the body lived from the inside can be coupled with its body experienced as spectacle, seen from the outside, by itself in the mirror and by others as object. Weiss, referring to Lacans mirror stage account of the body image, comments that:
The specular image offers the child a new perspective not only on her/his own body and her/his being-for-others but simultaneously allows the child to project her/himself outside of her/his body into the specular image and, correspondingly, into the bodies of others. . . . It is the latter . . . that provides the ground for strong identications with others, identications that expand the parameters of the body image and accomplish its transition from an introceptive, fragmented experience of the body to a social gestalt. (Weiss, 1999: 13)

The essentially social nature of the body image, its intercorporeality, derives, on this account, from its location in visual space. The subject is simultaneously alive to itself as point of view, introceptive and proprioceptive experience, and alive to others as spectacle, as object. The body image emerges out of this tension, as the subject becomes subject by internalizing and dealing with the fact of being visible and, hence, available for
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others as projective surface. It emerges from a play of identication and disidentication with others, and from the projection and introjection of the body images and part images of others. Desire, love, care, hatred, neglect and other modes of relationship are negotiated in part through a shifting internalization and externalization of body image relations what Schilder calls body-image intercourse (Weiss, 1999: 33). Moreover, the body images location in the domain of the visual opens it out to the multifarious forces of visual culture and representation, particularly representations of the body in medicine, fashion, cinema and the like. Body images as lived gestalt communicate with body images elaborated in the wider social order. For Weiss, it is this location in the order of images that prevents the development of the body image being simply a private affair. She writes:
Given that the body image responds directly to subtle physiological and emotional changes in our bodies, it may seem as if the body image should be characterised as a personal or even private phenomenon. . . . And yet the body image intercourse that Schilder describes, implies that body images are in continual interaction with one another, participating in a mutually constitutive corporeal dialogue that dees solipsistic analysis. . . . Through . . . processes of introjection, projection, and identication, the body image continually incorporates and expels its own body (parts), other bodies and other body images. (Weiss, 1999: 33)

Physiology, trauma and body image

Weisss account of the intercorporeal body image is highly nuanced and dynamic. She presents a complex picture of a psychosomatic agency or process that is never static. The contours and constituents of any persons body image develop out of a network of images and relations. It can be neither completed nor stabilized; it is always subject to perturbation, transformation and fragmentation, according to the kinds of corporeal exchanges that take place. In this dynamism, the idea of intercorporeality presents a useful way to understand the kinds of destabilizations of self that are often involved in various kinds of tissue transfer, described later in this article. The introduction of matter from anothers body into ones own is the most literal kind of intercorporeality and, as we shall see, it frequently precipitates quite compelling dynamics of introjection and projection, identication and disidentication, between recipient and donor. This is despite the fact that donor and recipient rarely meet face to face. Nevertheless, Weisss development of the idea of intercorporeality tends to binarize the body in a way that limits its deployment in analysing the area of tissue transfer or medical practices more generally as modes of intercorporeality. That is, while repeatedly acknowledging that physiology and the processes of health and illness contribute to the formation of the body image, the intercorporeality of the body image, its essentially communicative nature, derives, for Weiss, from its location in an economy of images and visible surfaces. This location is, of course, intrinsic to the notion of the body image as image. The visceral interior, on the other hand, remains dark and mute, excluded from social communication or exchange
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except insofar as its evidence must be socially managed according to the protocols of the abject. While it may contribute to the formation of the body image from moment to moment, Weiss tends to cast its contribution as presocial. There is, however, an important moment in her text where she considers the case of pregnancy as an instance in which the visceral interior serves as a site of intercorporeality. Weiss draws on her own experience of pregnancy and on Youngs (1990) rst person phenomenological account of being pregnant to consider the particular material relationship between pregnant woman and foetus as an instance of co-embodiment. The pregnant woman must negotiate the tension between the habitual sense that whatever is contained within ones bodily boundaries is self and the introceptive evidence of another life within. Foetal life partakes of otherness even though it is not autonomous. Young writes:
The pregnant subject . . . is decentred, split, or doubled in several ways. She experiences her body as herself and not herself. Its inner movements belong to another being, yet they are not other, because her body boundaries shift and because her bodily self-location is located in her trunk as well as in her head. (cited in Weiss, 1999: 52)

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The senses of interior and exterior body lose their distinctiveness; the externality of the inside, as Young puts it. In pregnancy I literally do not have a rm sense of where my body ends and the world begins (Weiss, 1999: 52). The interior is no longer marked out as a space of physiological self-possession in contrast to the socially marked and shared surface of the body. Pregnancy marks the interior of the body as a place of intersection with others the foetus, the sexual partner who helped conceive the child, the medical personnel who monitor and manage the pregnancy, and the family and friends who take a proprietal interest. This confusion of budding body-within-body is intercorporeal in the crucial double sense that it involves both a material confusion of bodies, a material indeterminacy and that it makes a relationship in this case, motherhood, fatherhood and kinship. As we will see, biomedical intercorporeality also has this double sense. A material confusion of bodies through the exchange of fragments produces various kinds of relationality, both weak and strong. Taken overall, Weisss concept of intercorporeality succumbs to a certain ocularcentrism. This is unsurprising given the privileged and problematic relationship between women and images of women in a culture increasingly organized through visualization and the production of image as desire. At the same time, her work around pregnancy points to other possible ways of working the term. Both pregnancy and biotechnical innovations involve the enrolment of the visceral interior in various forms of productive social exchange. Both involve the erosion of distinctions between inside and outside and the rendering of the visceral interior as continuous with social surface, a place for the negotiation of relationship. In what follows, I will consider some accounts of tissue transfer according to the logic of an intercorporeality that refuses to consider the organic interior as excluded from exchange.
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Transplantation and fragmentation

Tissue transfer is a broad term encompassing a range of different medical practices. Some are traumatic, involving specialized and difcult kinds of internal surgery like whole organ transplant. A liver transplant, for example, involves between ve and seven hours of surgery and a highly specialized team. At the other end of the spectrum, sperm donation and articial insemination involve minimal or no trauma for the participants. The semen is transferred using the bodys own conduits and an intermediary set of institutional and clinical procedures. These two instances of tissue transfer, quite different in their details, nevertheless create forms of material exchange that play out as modes of intercorporeality. I will draw on studies of participants in both of these forms of transfer to explain what I mean. People diagnosed with end-stage disease awaiting organ transplant evince a dramatic change in their relationship with their visceral interior. This space becomes highly invested, sensitized and fragmented. For the healthy person, living life in the silence of the organs as Canguilhem (1994) puts it, the interior is not physically mapped in any degree of detail. There is little introceptive data provided by healthy organs aside from the beat of the heart, the swell of the breath and the gurgle of digestion to indicate location or function. Few healthy people have a precise sense of the location of their liver or pancreas, for example. For the person awaiting transplant, however, the diagnosis and experience of organ degeneration and failure, prior to the transplant, create an interior rift. The homogeneity of the bodys interior, its apparently given relation as a space of the self that supports the living processes, is disrupted by the diagnosis of organ damage and the symptoms or sensations that may have preceded this diagnosis for some time, as Francisco Varela writes about his liver disease and subsequent transplant:
Ive got a foreign liver inside me . . . [yet] my old liver was already foreign; it was gradually becoming alien as it ceased to function, corroded by cirrhosis, with no other than a suspended irrigation of islands of cells, which are then left to decay and wither away. Years before the transplant, during a biopsy the surgeon came to see me: I saw your liver, it looks very sick, you must do something about it. The statement made this silent organ suddenly un-me, threatening and already designated to be put at a distance in the economy of the bodys self. (Varela, 2001: 2623)

Hence, for the patient awaiting transplant, the bodys interior is psychically reorganized, divided into a threatened self and the degenerate organ that threatens self. This threat must be endured until surgical intervention can rid the body of this malign presence and replace it with the benevolent tissues of another, the donor. In the case of whole organ transplants, organs are usually procured from people who have been declared brain dead and who have signed donor cards. The families of donors under many medical systems have the right to override the wishes of the donor. Often the most important motivation for a grieving family to allow their loved ones organs to be taken is the
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sense that the donors identity is transferred with the organ and continues in some sense in the body of the recipient (Fox and Swazey, 1992; Lock, 2002). For the recipient of anonymous organ donation too, the organ is often personied, bringing with it some trace of the donor. This can play out in a number of different idiosyncratic ways. Many, if not most, recipients are intensely curious about the donor and will develop complex fantasies about them and an intense sense of linkage. Varela describes his overwhelming curiosity about the anonymous donor whose liver he receives and his drive to imagine them:
I arrived in the hospital after the crucial phone call stating that a donor had been found for me . . . the nurses at the reception, professional and kind, let out Its coming from Marseilles, its an organ in excellent condition. This mere suggestion is like the skeleton onto which the imagination unleashes [its] full contents. (I see a young motorcyclist sprawled next to the AutoRoute. . . . One of a thousand scenarios that go through my mind. I will never know.) . . . In the early temporality of the experience the social imaginary link is intense and gripping . . . I found myself spontaneously desiring a reciprocity, to seal a pact with the anonymous donor. (Varela, 2001: 2667)

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Some of the recipients interviewed by Lock (2002) several years after a transplant state that they still think about the donor every day and wonder about them. One woman, a nurse, worries that her kidney donor was a child who had died:
It took me a long time to get used to the idea of having someone elses kidney inside me, even though I am a nurse. Now Im just thankful, but it still comes back in ashes, like a daydream sometimes, wondering, wondering who it is. (Lock, 2002: 324)

Other recipients feel an intense identication with the unknown donor and guilt towards the donor or their family. Fox and Swazey (1992) describe the case of a man in his early twenties who received the kidney of a young girl killed in a car accident. He tells them:
When certain of my friends learned I had received a kidney from a little girl, they made jokes about it, saying that maybe Id get back the youth and virility that I hadnt had for a long time. This so upset and disgusted me that I broke off all relations with these people. . . . But there was another patient, a woman who received a kidney at the same time that I did from the same little girl. We have become brother and sister. (Fox and Swazey, 1992: 36)

He also relates his intense sense of guilt towards the imagined mother of the little girl, whom he dreams about:
In my dream, I see this woman, all dressed in black, with a black veil over her face. She is crying, and she has reproach in her eyes. I try to communicate with her, to console her, but I cant. Because there is a pane of glass between her and me: a pane just like the one that was in the isolation room where I was hospitalised during the rst days after the transplant. (Fox and Swazey, 1992: 41)

Clearly, for this man, his new kidney aligns him with the imagined person of the young girl in an intense and protective way. Other organ recipients develop an intensely personied relation with the organ itself.
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Rosengarten (2001) describes cases where transplant patients fear that they will be invaded or overwhelmed by the presence of an organ as a possibly malign representative of the donor. In one such case, an African American man who distrusts white people receives a kidney donated by a white woman. He experiences the kidney as hostile and fears that it will reject him or damage him in some way. Lock (2002) observes that it is common for organ recipients to worry about the gender, ethnicity, skin colour, personality and social status of their donors, concerned that they may be overtaken by the identity associated with the organ. Others consider the new organ to have a semi-discrete and separate identity that is accommodated within their bodies. Some of Locks female interviewees refer to the organ as a kind of foetal life. Here they clearly draw on the experience of pregnancy so eloquently described by Young (1990) as a sense of semiautonomous life within, both myself and not myself:
I still think of it [kidney and liver transplant from a single donor] as a different person inside me. . . . Is not all of me, and its not all this other person either. . . .You know, sometimes I feel as if Im pregnant, as if Im giving birth to somebody. I dont know what it is really, but theres another life inside of me, and Im actually storing this life, and it makes me feel fantastic. Its weird, I constantly think of that other person, the donor. (Lock, 2002: 323)

Another interviewee states:

Oh yes [the kidney is] part of me its me, its me. I even call it my baby! I take so much care, I feel protective, its a really special part of me. You know, at rst, when I went through periods of [immunological] rejection, I would pray about it. . . . I felt I must be responsible for this other persons kidney. (Lock, 2002: 324)

Clearly, in each of these cases the organ recipient has been compelled to reorient their sense of embodied identity, to stretch, double or split it in some kind of way. The don, the given organ, is not a neutral and detachable anatomical component, but rather a fragment that partakes of the identity of the donor. The material incorporation of the organ involves a powerful identication or disidentication with the donor, a major adjustment of the selfs composition and structure. Self here works in a double sense that further complicates these psychosomatic struggles (Rosengarten, 2001).4 In immunology, self describes the signature antigenicity of each individuals tissues, the macromolecules that sit on the cell surface of tissues and allow the bodys immune system to recognize these tissues as the bodys own. If these molecules are different from others found in the body, the immune system cells will begin to attack the tissue, reading it as pathogenic. Hence, as every immunology textbook will tell you, the immune system marks the limits and boundaries of the body, demarcating the biological self from non-self (Waldby, 1996). All organ transplantation, except when an organ has been donated by an identical twin, provokes a massive immunological reaction. This reaction is controlled by the administration of powerful immunosuppressive drugs that effectively disable the bodys ability to tell the immunological self from non-self. Varela describes his own immunological reaction to his liver transplant:
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The body-technologies to address rejection are absurdly simple: disable the ongoing process of identity, weaken the links between components of the organism. Immunosuppression is, to date, the inescapable lot of transplantation. One starts by special suppressive drugs and massive doses of corticoid. . . . As the rejection does not yield, the treatment mounts one step . . . the entire repertoire of immune cells is massively eliminated by a slow injection. (As I felt the effect coming in a few minutes, my whole body was swept by uncontrollable shaking, like an alien possession that left me [who?] in a limbo of non-existence; looking steadily into my wifes face the only reference point in a disappearing quagmire.) Complete immunosuppression does stop the rejection, but now simply being in the world is a potential intrusion, as the temporality of my somatic identity has been erased for a few days. . . . In time the body is allowed to reconstitute; I recover my assurance of my daily embodiment, as the immunosuppression is milder. This becomes a life condition. (Varela, 2001: 264)

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This crisis of the immune system is also, necessarily, a crisis of the recipients relation to the organ and the complexity of its incorporation. The new organ intrudes into a space that is simultaneously immunological and psychical self so that the reactions of the immune system cannot be affectively or psychically neutral. A transplant unit psychiatrist interviewed by Lock (2002) argues that patients who cannot nd a compromise with their new organ, a way to live with the identity transformations it induces, are at much higher risk of immunological rejection. Conversely, the routine rejections experienced immediately after transplant provoke doubts about the psychic relation to the organ, he claims. In the most serious cases, the organ may remain unincorporable, rejected by both the immunological and psychic selves. In successful transplants, the organ is functionally incorporated yet, as the interview excerpts above clearly show, it will always bear the trace of its origins in another. The recipient must take immunosuppressive drugs for the rest of their lives, a constant reminder that their internal milieu is shared with fragments of anothers body. A successful transplant involves an immunological and psychical accommodation of this other body, but the organ recipient can never forget that their sometimes precarious state of health is owed to an uncertain compromise between their body and anothers. Hence the organ recipient is involved in the most direct and literal form of intercorporeality. Their capacity to live at all depends on a profound confusion between their body and anothers.

Sperm donation and intercorporeality

Organ donation has a number of features that distinguish it from other kinds of tissue donation and that tend to exacerbate the intercorporeal dramas involved in tissue transfer. First, it works on a one-to-one or oneto-few ratio. That is, one organ donor gives their organs to one or a small number of recipients. The relationship is temporally direct: the organ is removed from one body and transplanted into anothers within the minimum possible time. Second, donors generally have to die in order for the recipient to receive the organ. While kidney donation from a living donor is becoming more common, almost all organs are procured from
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bodies declared brain dead, often after car or sporting accidents that damage the head but leave the major organs intact. Organ recipients are generally aware that their new organ has been obtained in circumstances that involve the death of the donor and devastation for their families. They themselves are, by denition, ill and on the verge of death and hope that the new organ will prolong their lives and improve their health. Hence, organ donation is, generally speaking, more personal, more traumatic and involves more guilt and gratitude than other kinds of tissue donation although, of course, the experience around various kinds of tissue transfer is highly variable. Nevertheless, other more benign kinds of tissue transfer also produce modes of intercorporeality. While space prevents me from systematically comparing all the modes of tissue transfer, I will briey describe a study of sperm donors and recipients (Tober, 2001) that suggests that less traumatic and weaker forms of intercorporeality are also in play here. Tober examines the ways that donated semen is attributed with various social powers and works as a mediator of relations between donor and recipient. She argues that women who purchase sperm treat it as a synecdoche for the donor. That is, they select sperm from donors whose characteristics resemble those they would look for in a partner the same ethnicity and education level, preferably good-looking and with a high income. Sperm is understood to be a kind of tissue that transmits such qualities to the resulting offspring:
The sperm-banking industry and the market for sperm are both heavily inuenced by the notion that some traits social or physical are more desirable than others, and that these traits reside in the sperm. Semen is a vehicle for the transmission of genetic material; as such, various complex meanings biological, evolutionary, historical, cultural, political, technological, sexual intersect at this particular site. . . . Culturally held perceptions of (and preoccupations with) genetics, with sperm as a transmitter of genetic material, shape the ways in which potential donors are screened and their semen sold. . . . The semen donor, then, is viewed as the prototype for the child that will be produced by his sperm. (Tober, 2001: 138)

It is evident, therefore, that semen (like whole organs) is a substance that refers back to the identity of the donor and carries aspects of this identity with it when it is used by the woman for insemination. Hence, to accept someones donated semen is to enter into a relationship with them, despite the commodity model that predominates in this kind of tissue transfer.5 Tober comments that the buying, banking and selling of semen imply that the relation between donor and recipient is simply the anonymous relation of producer and consumer, yet the social relations of fatherhood reassert themselves:
First, the donor who provides semen for a womans child becomes the subject of fantasy and fetish some sort of relationship exists at least in the realm of the imagination and certainly in the realm of the biological should a child be conceived. . . . Second, the recipient may, at some point, have some sort of contact with the semen donor who often has the option of entering into a social relationship with the offspring as the childs biological father, albeit a limited one. (2001: 1401)
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One of the women interviewed by Tober described her fantasies about her donor and future child: [She would] daydream about standing with her mythical daughter and her mythical donor, together at her mythical daughters graduation (2001: 142). So it is evident that, like organ donation, the incorporation of donated sperm produces intercorporeal effects. Semen donation does not, on Tobers account at least, precipitate the kind of profound destabilizations of the body ego that are evident in organ donation. Semen is a renewable substance; it is produced (by young men at least) with little effort and no pain and is incorporated by the woman with fairly minimal technological intervention. Moreover, it is incorporated not to save the life of the recipient, but to enable the production of another life, a child. Nevertheless, the transfer of seminal tissue clearly compels modes of relationship that echo in an attenuated form the kind of profound intercorporeality of the sexual relationship, even if donor and recipient never meet.

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Conclusion: biomedical intercorporeality

The idea of intercorporeality expresses ways we are indebted to and mutually implicated with each other. The intercorporeal nature of selfhood suggests the contextual vulnerability and non-autonomy of personhood, the openness of each person to another. It is evident from my account that the sharing of bodily matter compels particularly direct experiences of intercorporeality. Biological exchange is also a kind of social exchange. Participants experience forms of bodily relationship and indebtedness and sometimes a complex psychosomatic confusion of selves. In this regard, biomedically engineered intercorporeality maps itself on to those much older expressions of the social powers of shared bodily matter: kinship relations based on sexual relations and consanguinity. The term consanguinity here is highly expressive family relations based on the 19thcentury trope of shared blood now replaced by the trope of shared genes. The strong intercorporeality engendered by organ exchange, in particular, often seems to resemble kinship relations. Donor families who meet with recipients often form family-like relations, held together by a sense of mutual indebtedness and obligation that can, as Fox and Swazey (1992) report, become intense and oppressive. For these reasons, biotechnically-mediated intercorporeality creates new circuits of relationship in ways that are often neither anticipated nor recognized by medical researchers or liberal bioethicists devoted to the defence of an autonomous self. Participation in circuits of tissue transfer risks identity and selfhood, although this is not in itself a bad thing. Weisss notion of intercorporeality suggests that the coherence of selfhood is constantly risked, fractured and transformed by virtue of the fact of being embodied. However, it is important to recognize that particular technical congurations and procedures within tissue transfer (is the material donated or sold? can it be banked? how is eligibility for a donation and transplantation decided?, and so on) set out the terms of the relational networks that any practice of tissue transfer will create. Hence, these
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procedural and technical congurations require bioethical attention to take account of the force of intercorporeality as a salient experience of participation in such networks and to intervene to make the experience tolerable and productive. So, for example, I would agree with Locks (2002) suggestion that the sacrice and feelings of indebtedness produced by organ donation could be communalized: It may well be appropriate to . . . increase recognition of donors and perhaps to bring donor families and recipients together more frequently, not to establish personal ties but to celebrate the social good that emanates from organ donation (Lock, 2002: 373). If stem cell technologies prove to be sources of transplantable tissue, such communalized relationships may well be appropriate among embryo donors and tissue recipients, particularly as a single embryo will form the starting point for numerous self-renewing cell lines that may provide tissue for many patients. Currently in the UK, a stem cell bank is being set up to collectivize donated embryonic tissue for therapeutic research, a step taken in part to reassure embryo donors that their gift will contribute to a social good and not merely to the protability of patentable medical research. Tissue transfer procedures also require attention because sharp hierarchies of risk, bodily danger and illness can very easily be created, particularly as circuits are globalized and marketized. Marketization tends to redistribute tissues organs, blood and cells from the poor who accept payment for their bodily substance to the rich who can afford to pay for the health these substances may bring. This is the ugliest face of intercorporeality. The bodies of the strong can cannibalize those of the weak, assimilating them without regard. There is abundant evidence that such unjust modes of incorporation are well established (Scheper-Hughes, 2001) and that Third World bodies are being used to supplement those of the First World. This, therefore, is ultimately what is at stake in biomedical circuits of intercorporeality: power relations are played out as economies of tissue transfer. If feminist philosophy of the body limits itself to considerations of image economies, it is unable to understand such stakes or formulate ways to work towards intercorporeal justice.

Acknowledgements
A version of this article was given at the Gender Talks Seminar, University of Geneva, 46 April 2002. I would like to thank Anna Gough-Yates, Marsha Rosengarten, Susan Squire and Elizabeth Wilson for helpful comments on earlier drafts of this article.

Notes
1. The globalization and commodication of fragments carry with them the spectre of the worlds poor selling their fragments to the worlds wealthy and there is strong evidence that this practice is becoming more common (Scheper-Hughes, 2001). 2. Sperm being a persistent exception (Tober, 2001). In the US, more kinds of
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tissues (for example, ova) are marketized, although there is strong social resistance to the idea of a market in human organs (Fox and Swazey, 1992). 3. However, as Lock (2001) observes, hospitals and organ donation campaigns routinely utilize a personalized rhetoric around human organs, asking people to make their organs a gift of life and so forth. 4. I am indebted to Rosengarten (2001) for this important idea and to many conversations I have had with the author regarding immunology, materiality and embodiment. 5. Sperm donation is unusual in that donors are almost always paid and sperm is generally purchased, even in countries like the UK that consistently refuse to marketize other forms of tissue donation.

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Waldby, C. (2002) Stem Cells, Tissue Cultures and the Production of Biovalue, Health 6(3): 30523. Weiss, G. (1999) Body Images: Embodiment as Intercorporeality. London and New York: Routledge. Young, I. (1990) Throwing Like a Girl and Other Essays in Feminist Philosophy and Social Theory. Bloomington and Indianapolis: Indiana University Press. Catherine Waldby is Reader in Sociology and Communications and the Director of the Centre for Research in Innovation, Culture and Technology at Brunel University, London. She is also Adjunct Associate Professor at the National Centre in HIV Social Research, University of New South Wales, Sydney. She is the author of AIDS and the Body Politic (Routledge, 1996), The Visible Human Project (Routledge, 2000) and numerous articles about science, technology and the body. She is currently researching blood donation systems, tissue banks and human stem cell technologies. Address: Department of Human Sciences, Brunel University, London UB8 3PH, UK. Email: catherine.waldby@brunel.ac.uk

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