Situating the practice of organ donation in familial, cultural, and political context.

This article provides a discussion of the factors that have contributed in recent years to the assertion that there is a growing shortage of organs for transplant. Findings from ethnographic research carried out in 3 settings--the United States, Japan, and Mexico--are then presented to demonstrate that factors other than low education levels, irrationality, or a lack of generosity are at work when individuals make decisions about organ donation. In all 3 sites, it is clear that both the donation and receiving of organs are based on moral positions and felt obligations concerning appropriate behavior among close relatives and that the ideal of autonomous choice is not readily applicable. Culturally informed expectations are at work in all 3 sites, and in Japan and Mexico, social and political dimensions additionally come into play. We argue that a better accounting is called for of the familial, cultural, and political contexts within which organ transfer takes place.