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Paper short abstract

Despite being regarded as the 'gift of life' organ donation unfolds in a polarised terrain influenced by apartheid-era racialised landscapes, institutional mistrust and unequal access, where hierarchies of bodily worth persist and western models clash with local moral understandings.

Paper long abstract

Despite organ donation and transplantation being regarded as a ‘gift of life’, power relations and exclusions of a racialised environment has affected this particular medical intervention in South Africa. This article offers a critical anthropological analysis of organ donation from apartheid-era structures to post-apartheid understandings of the low donor rates. Drawing on understandings of Foucauldian biopower, debates on personhood and African philosophies of Ubuntu, the paper argues that organ donation in South Africa, cannot simply be understood as a lifesaving medical progression but as a site of unequal power relations and disparities.

To show how these treatments are occurring in a fractured healthcare system where socially and historically produced hierarchies of bodily worth persist, this paper investigates the history of persistent low donor rates. These disparities give rise to contemporary expressions of ‘differential bio-value’ or a hierarchical assessment of the body’s worth.

The prevailing interpretations which argue that low consent rates are ‘cultural resistance’ are challenged in this paper. Rather, the hesitation and rejection grounded with the historical experiences of institutional distrust, which have been influenced by the racialised environments of the apartheid-era. This demonstrates how Western biomedical understandings clash with local moral worlds by discussing how varying conceptualisations of personhood, autonomy and bodily integrity frequently conflict with ideologies such as Ubuntu. Therefore, organ donation occurs in a polarised environment where the body is a contested site where historical injustices, moral dilemmas and institutional structural fractures can be resolved.

Keywords: organ donation, South Africa, personhood, anthropology, biopower, body