Departing from three metaphors—the body as gift, resource, and commodity—the book explores the contemporary exchange of organs, tissues, and cells. Although the gift is the sanctioned metaphor for donating parts of the body, the underlying perspective from the side of states, authorities, and the medical establishment often seems to be that the body shall be understood as a resource. But medicine, as some of the contributors to this book show, is not sealed off from the market economy. Increasingly, therefore, body parts become commodities on legal as well as illegal markets.

The chapters of the book are arranged in a way that presents, one after the other, the three metaphors of the body, starting with the body as gift, proceeding by way of the body as resource, and ending in the body as commodity. Although all three metaphors as ways of conceptualizing and making use of the human body can be found throughout human history, the present drive of commercialization will increasingly force us to identify and scrutinize the way these metaphors are used. Not only in addressing the fascinating question of what kind of an object (subject) the human body is, but also in trying to decipher what interests lurk behind the use of the metaphors in question when claiming that human bodies, organs, tissues, and cells are gifts, resources or commodities. The ambition of this volume is to address and remedy the need of a hermeneutics not only of depth, but also of suspicion, in the case of organ transplantation and other medical technologies involving the transfer of human tissues and cells.

In this paper, changes in identity and selfhood experienced through organ transplantation are analyzed from a phenomenological point of view. The chief examples are heart and face transplants. Similarities and differences between the examples are fleshed out by way of identifying three layers of selfhood in which the procedures have effects: embodied selfhood, self-reflection, and social-narrative identity. Organ transplantation is tied to processes of alienation in the three layers of selfhood, first and foremost a bodily alienation experienced through illness or injury and in going through and recovering from the operation. However, in cases in which the organ in question is taken to harbor the identity of another person, because of its symbolic qualities (the heart) or its expressive qualities (the face), the alienation process may also involve the otherness of another person making itself, at least imaginatively, known.

Three metaphors appear to guide contemporary thinking about organ transplantation. Although the gift is the sanctioned metaphor for donating organs, the underlying perspective from the side of the state, authorities and the medical establishment often seems to be that the body shall rather be understood as a resource. The acute scarcity of organs, which generates a desperate demand in relation to a group of potential suppliers who are desperate to an equal extent, leads easily to the gift’s becoming, in reality, not only a resource, but also a commodity. In this paper, the claim is made that a successful explication of the gift metaphor in the case of organ transplantation and a complementary defence of the ethical primacy of the giving of organs need to be grounded in a philosophical anthropology which considers the implications of embodiment in a different and more substantial way than is generally the case in contemporary bioethics. I show that Heidegger’s phenomenology offers such an alternative, with the help of which we can understand why body parts could and, indeed, under certain circumstances, should be given to others in need, but yet are neither resources nor properties to be sold. The phenomenological exploration in question is tied to fundamental questions about what kind of relationship we have to our own bodies, as well as about what kind of relationship we have to each other as human beings sharing the same being-in-the-world as embodied creatures.

In this chapter I will attempt to develop a phenomenology of parts of the human body that have been removed from their site of origin but nevertheless preserve their “aliveness.” What happens when human body parts are stored in the medical laboratory and are even being transformed or cultivated there? How are we to view the ontological and ethical status of cells and organs that are being transplanted from one human body to another? Do these body parts preserve some kind of relationship to their source of origin: that is, the person from whom they have been retrieved? Do they belong to the person they originate from and, if so, in what way? What implications does this type of ownership have for ethical analysis? In some cases, at least, would the concept of sharing be more adequate in describing transfer of body parts between persons than the idea of a gift being made?

This paper investigates the question of what an organ is from a phenomenological perspective. Proceeding from the phenomenology of being-in-the-world developed by Heidegger in Being and Time and subsequent works, it compares the being of the organ with the being of the tool. It attempts to display similarities and differences between the embodied nature of the organs and the way tools of the world are handled. It explicates the way tools belong to the totalities of things of the world that are ready to use and the way organs belong to the totality of a bodily being able to be in this very world. In so doing, the paper argues that while the organ is in some respects similar to a bodily tool, this tool is nonetheless different from the tools of the world in being tied to the organism as a whole, which offers the founding ground of the being of the person. However, from a phenomenological point of view, the line between organs and tools cannot simply be drawn by determining what is inside and outside the physiological borders of the organism. We have, from the beginning of history, integrated technological devices (tools) in our being-in-the-world in ways that make them parts of ourselves rather than parts of the world (more organ- than tool-like), and also, more recently, have started to make our organs more tool-like by visualising, moving, manipulating, and controlling them through medical technology. In this paper, Heidegger’s analysis of organ, tool, and world-making is confronted with this development brought about by contemporary medical technology. It is argued that this development has, to a large extent, changed the phenomenology of the organ in making our bodies more similar to machines with parts that have certain functions and that can be exchanged. This development harbours the threat of instrumentalising our bodily being but also the possibility of curing or alleviating suffering brought about by diseases which disturb and destroy the normal functioning of our organs.