Spit is powerful stuff. As Kragh-Furbo and Tutton point out, it can disgust, it can cause offence, it can even (as we have seen acutely over the last 18 months) harbour and transmit disease. Spit, however, also holds promise. With the development of biotechnology over the 20th century, there’s now a the capacity to locate in spit the so-called building blocks of life (to employ the kind of rhetoric that Nelkin and Lindee in the DNA Mystique might describe as everyday ‘gene talk’). It’s because of this that when you register as a stem cell donor in the UK, you don’t even need to provide a blood sample. The registries can get everything they need to know about your genetic profile from just your spit. Enter, the flocked swab.
These swabs – you’ll likely have put one up your nose and down your throat to test for COVID in recent weeks – are used to collect cells from your cheek. The swab is packed, sent to a lab and typed, your genetic information stored on a database so you can be included in future searches for patients who need a stem cell transplant. During my current research project, Mix & Match, I spent lots of time at events where smaller charities register people using these swabs. It’s hard to imagine it now, but we’d peel where it says ‘peel here’, allow the registrant to take the swabs, rubbing their inner cheeks for up to three minutes with them. Then we might hold out an envelope, let the registrant slide their swabs into it, and post off the envelope to the registry.
They’re an interesting site for a lot of circulations. What’s to be done with all the single use plastics for example (think of all the lateral flow tests that need to be discarded after use)? The flow of human cells from the mouth, to the swab, via the post, into the lab, where the material is taken out of the swab and tissue-typed. The data, too – when a tissue-type is entered into a registry, and then searchable globally for patients who require transplants. The data may flow far further than the original cells on the swab ever did. And then, prhaps the most incredible flow of all: the cells from one human donated (because of that original decision to swab and register) perhaps even being flown to another country, to be transplanted into somebody else.
If organ donor cards work as semiotic objects signalling their carriers’ allegiance to the cause of ‘saving lives’, a host of other mediums circulate beside them to instil such a virtue of bodily giving in the first place. Take this booklet on blood donation disseminated by the Japanese Red Cross, for instance. Targeting primary and middle school students, who are yet ineligible to donate blood in Japan, the booklet conveys the alarming figures of falling blood donation rates among the younger generation, juxtaposed with the constant demand for blood transfusion. Cute fonts, bright pastel tone colours, and the manga characters cast blood donation as a children-friendly activity, possibly to dispel any fear associated with blood or needles (The pain and dislike of needles continue to rank the top self-reported reason of not donating blood among young people in the national blood donation consciousness surveys conducted by the Japanese Ministry of Health, Labour and Welfare!) The manga interspersed throughout the booklet ends with the two (phenotypically Japanese) protagonists declaring “We will also donate blood, when we turn sixteen!” The message here seems to be that becoming virtuous members of (Japanese) society means becoming donors. Or, put differently, growing up means being able to save lives by bodily giving to other citizens. While tissues like organs and blood circulate across bodies to ‘save lives’, the virtue of bodily giving also needs to be kept alive across generations through the circulations of objects like this booklet. What other things, images, virtues and affects are circulating here? Where do they end (what are the parameters of circulations)? Can we talk about the lives, afterlives and aborted lives of vital circulations?
Do you carry a donor card? In May 2020 organ donation law has changed in England, moving from consent to an opt-out system of organ donation based on presumed consent. The organ donation card suddenly looks like an obsolete object. Why carry a card, if one’s consent is presumed? The solution for those wishing to opt-out might be to carry a non-donor card? No such object exists so far, and one can surmise why not? Non-donor cards are in circulation in Japan, for instance. In England, opt-outs can be expressed via the online donor register only.
Yet NHSBT continues to encourage people to carry donor card. It is still valued, not as a form of consent, but as one of the relevant signs of one’s intention. Donor cards were never legally binding, but this does not mean they are legally, socially, culturally insignificant. There is a long tradition of public health messaging encouraging people to sign their donor card, and that carrying that signed card could save life. In reality, the card was always limited, and subdued by other mechanisms of certifying consent.
In recent years, in England and elsewhere, there is more open admission and discussion that to the same extent that consent forms do not represent consent, donor cards do not stand in for consent to donate. The emphasis in public health messaging has shifted in recent years to encouraging people to talk about organ donation with their family members. The most recent version of the organ donation card (they are still very much available, in circulation and encouraged) certifies not only the wish to donate, but that the card holder has spoken to their family. Tensions between family consent and individual consent are still at the heart of tensions in ICU and organ donation units. Is it time for a socio-legal history of organ donor cards?