A Paradox of Presence: Time-constraints in the Organ Donation Approach following Brain Death in Contemporary Midwestern America

In the current American healthcare system, bereaved families of brain-dead patients are approached almost immediately following the diagnosis, often by nonprofit workers associated with organ procurement organizations (OPOs), to question if the family will authorize organ procurement. The intertwined histories of brain death and organ donation reveal how the implementation of new medical technologies often exists as a socio-political process, where institutional policies and social discourses reshape assumptions about the body's condition. In this thesis, I explore the experiences of the organ donation approach following brain death through interviews I conducted with donation specialists (DSes) at a Midwest OPO and family decision makers (FDMs). I examine the interviews through an analytic of 'presence' and temporality to understand how the 'active mode of presence' and language employed by the OPOs in the time-constrained approach for donation renders certain meanings about life, death, and the body's value perceptible, while other meanings become erased. I show that, in adhering to the rational-utilitarian philosophy upon which western biomedical intuitions operate, the professional work – trainings, actions, and language – employed by the OPO within the ICU dictate a specific, and sometimes contradictory, mode of presence that both creates the immediate moment and defines the body's social, moral, and economic value within the procurement process. Specifically, I elaborate on the contradictions imposed through language by proposing a new form of the 'transplant paradox' (Sharp 2006) not covered in previous research – the paradox of presence. Ultimately, I aim to elucidate how OPO professionals have substantial authority in mediating family's experiences of brain death to co-produce opinions of organ donation as a sensible outcome. Furthermore, I argue an analysis of temporality (Munn 1992) offers a unique entry point for investigating how meanings of life and death are coordinated and created within this contemporary Midwestern American OPO.