veinglory: exploring processes of blood transfer between persons

8/9/2019 Veinglory: Exploring processes of blood transfer between persons

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VEINGLORY: EXPLORING PROCESSES OF BLOOD

TRANSFER BETWEEN PERSONS

Jacob Copeman

University of Cambridge

This article examines processes involved in blood donation and ‘blood management’ inan anthropological light. It claims that blood management is not restricted to the pro-cedures that medical professionals employ on blood outside of bodies, but that ‘manage-ment’ practice is enforced by donors themselves onto their own internal bodily processes.It suggests that donation and transfusion centre on issues of time-management and pro-duction; concepts of temporal synchrony and investment are employed to explore theimplications of this dimension of blood donation. By way of a comparison with gift-giving amongst Jains in India, this article argues for an ‘overlapping’ of – and dependencybetween – different economies within blood-banking processes. In examining the general

processes involved in blood donation, it aims to provide the groundwork for future com-parative analyses of blood-banking processes.

In a lecture given at a Beijing conference in 2004 on the global promotionof voluntary blood donation C.Th. Smit Sibinga, a leading figure in transfu-sion medicine, exhorted donor recruiters to equip themselves with proper ‘vein to vein chain understanding’. In the anthropological context, there havebeen several significant articles that have probed political and kinshipeconomies of blood donation (notably, Cohen 2001;Weston 2001).1 I suggest

that a sustained attempt to acquire an anthropologically hued ‘vein to veinchain understanding’ might enable us to enrich these analyses and take themfurther. Accordingly, this article pursues a general anthropology of ‘bloodeconomies’ which seeks to constitute a solid grounding for future compara-tive anthropological analyses of blood donation practices. Though the articlesreferred to do not altogether elide the question of material processes, their focus is squarely on political utilization of acts of donation, indeed a vital areaof inquiry, but an area that would benefit from interrogation of what isactually being co-opted, or pushed into service, for particular political or

ideological ‘projects’.The aim of this article is to document and interpret the raw materials from

which these projects are moulded and to present a set of general featuresagainst which particularities of specific blood collection systems can be juxtaposed (Strong 2002: 405). For this purpose materials deriving both fromthe English National Blood Service (part of the National Health Service,henceforth NBS) and from fieldwork in Delhi during 2003-4 are scrutinized.Interviews with professionals in the Scottish National Blood Transfusion

© Royal Anthropological Institute 2005. J. Roy. anthrop. Inst. (N.S.) 11, 465-485



donation and management. Laidlaw draws on Derrida’s phenomenologicalaccount of gift-giving (1992) in which the ‘free’ gift is declared to be impos-sible as a result of its inability to fulfil certain critical conditions:

A. There cannot be reciprocity, return, or any sense of a cycle in a giftwhich is defined as free.

B. Recognition of the gift as a gift must therefore be avoided on the partof the recipient, otherwise debt and obligation must surface.

C. Recognition must also be avoided by the donor because such a recog-nition can only pass into self-praise, a symbolic return of ‘the value of what he thinks he has given’ (Derrida 1992: 14).

D. Gifts can only be conceptualized as part of a cycle that renders the freegift impossible, and therefore for a gift to exist it cannot exist (Laidlaw2000: 621).

Laidlaw, however, uses Derrida’s ‘impossible’ conditions to argue convincinglythat lay Jains do indeed engage in something closely approximating a free giftin the form of a transfer of alms to Indian Jain renouncers.

It would clearly be inadmissible to treat blood-gifts in India, Britain, or elsewhere as ‘free’ insofar as government officials and medical professionalsquoted in the media and in recruitment literature exhort the general publicto ‘give’. To take just one example, the principal slogan of the NBS is ‘DoSomething Amazing: Give Blood’. Depictions such as these that recognizeblood donation as gift-giving are contrary to two of Derrida’s conditions (Band C). Additionally, gratefulness suggests a return, which contravenes theother two conditions (A and D). Laidlaw’s arguments, however, have impor-tant implications for the analysis of blood-gifts in terms of identification andstorage. In regard to the question of gift-recognition, Laidlaw shows thatthough, in the case of alms transfer among Jains, there is a movement of foodbetween two separate parties (from lay to renouncer Jains), it is ‘as if ’ therehas not been. Donors do not see the food offering being consumed, the food

was not especially produced for the renouncers but distributed from a total-ity prepared by and for lay families, and the amount given is so small as notto be missed. Significantly, the contributions of different donors are mergedby the renouncers, and thus depersonalized such that ‘they need not, inDerrida’s terms, recognize the gift as a gift’ (Laidlaw 2000: 623).These are allstrategies to reduce personal indebtedness and obligation, and thus to avoidcycles of return.

Though the gift is not denied outright either in blood-giving or in Jainpractice, its substance and location are unclear; there is structured ambiguity.

The alignment between blood-giving and Jain practice becomes clearer onexamining the physicality of blood donation; though there is undoubtedlytransfer of fluids between persons, blood’s ‘automatic’ replenishment systemmeans that soon after donation it is ‘as if ’ the gift has not been given.‘Haemopoiesis’ is the name given by the medical profession to the produc-tion mechanism that resides within blood (Starr 1998: 212). Blood donationand repeated giving depend on this self-reproducing quality of blood since,in a matter of weeks after donation, the process of replenishment means that

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it is ‘as if ’ the donation had never taken place (and hence the ‘gift’ can berepeated). Annette Weiner (1992) uses the phrase ‘keeping-while-giving’ in adifferent context,3 but it is also apposite for our purposes.

Particularities of Jain and blood donation practices correspond at other points. Renouncers are forbidden to express thanks or pleasure on receipt of the food. In those blood management regimes in which blood is procuredfrom non-remunerated donors, recipients of blood similarly do not directlythank donors because the blood service mediates between them; they do notmeet. There are many generalized expressions of gratefulness; these can befound especially in The Donor magazine. Published by the NBS and sent toblood donors and recipients, it contains the ‘inspiring’ stories of what trans-fusions have enabled for families and individual adults and children; there arehumorous items, popular science items about ‘secrets in the blood’, andnumerous articles that thank donors. One letter to The Donor from a trans-fusion recipient expresses thanks to all B-type donors (National Blood Service2003a: 12). A letter I received from the NBS thanks me for donating ‘onbehalf of everyone who has ever had a blood transfusion’ (my emphasis). Per-sonalized specificity is not evinced. General, abstract expressions of thankful-ness are deployed by the NBS marketing team as an aspect of ‘ethical publicity’(Cohen 2001: 9), but just as the personal food-substance of lay Jains is madeanonymous and undifferentiated by the renouncers through mixing, so are theNBS’s expressions of gratitude directed at a mixed assortment of anonymousdonors via The Donor magazine, leaflets, and their website. Additionally,Laidlaw asserts that ‘identification of the other as the beneficiary of one’slargesse’ is prevented in the Jain practices that he documents because ‘donorscould not see their gift being enjoyed, for it is no longer there as such’ (2000:623). The voluntary blood donor is similarly not able to witness the benefi-cial effects of his or her contribution to the medical well-being of others.However, in an interview with a former manager of blood donation sessionsat the Scottish Blood Service, I was told that there is a balance to be struckin the release of information to donors about the recipients of their blood.

People like to know that they have helped specific people, but there aredangers in revealing too much information:

There are people who come along to give donor-specific platelets when they’ve got amatch of platelets for someone, and so we might contact you and say, we need plateletsof this specific type and would you mind coming along? You can say the person’s name,but generally you would say, that’s great, we’ve got a wee baby here who needs this …The only thing is you also have to be careful with that because if they’re coming backregularly to give to this person and the person then dies … there’s a sense of somethingnot working I guess … You have to be careful … we might say we’ve had a sick baby

and he used up thirty units of blood so it’s great that you’ve come in today because that’sreally had an effect on our blood stores.

Doctors and blood service professionals take the view that small gestures of individuation have their motivational uses, but that care must be exercised.Hints of personalization, however, are not the same thing as seeing thegift enjoyed, and in this sense the blood donor’s experience and that of lay Jains correspond. The analogy in respect of individuation can be takenfurther. When Laidlaw says that ‘it [the gift] is no longer there as such’, he is

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referring to the fact that the renouncers’ mixing of food received from dif-ferent households ‘effectively subsumes each family’s individual offering’ (2000:623).

This leads to the next key issue in the analysis of gift management, that of the storage and mixing of blood. By way of a centrifuge machine, a proce-dure is performed on the ‘whole’ blood which has been taken directly fromeach individual so that its multiple components become separated from eachother. It is, as it were, a machinic revelation of the concatenation of elementsin the substance’s composition. The implications of this procedure are dis-cussed later in more detail; what should be emphasized here is that this sepa-ration of ‘whole’ blood takes place because of the accepted medical principlethat (like corporate de-merger) the sum of its parts is worth more than thewhole taken together. Some of these parts are kept individually and some aremixed with other parts of the same type deriving from other persons. Toreturn to the ex-blood service employee:

The red cells are stored individually, the platelets individually, and the plasma is all mixedtogether and then put into bags.4 So if you need a blood transfusion you need to getone specific for your blood type, and it’s the same for platelets … but if you need plasma

you can get it from anywhere and all together.

Different degrees of individuation are necessary according to the bloodproduct required by the body in need, and this is reflected in the storageprocedure.

To reiterate, the case is not being made for blood-gifts as ‘free’ or ‘pure’;the aim here is to indicate the presence of this type of economy, along withother types, in these practices. Later I demonstrate the systematic connectionsbetween them. The question of storage and mixing has implications for theways in which the transfusion might be viewed or experienced by the recipi-ent or for an imagined donor-recipient relationship. An NBS leaflet titled Dosomething amazing today reports the case of Tim Wood, a leukaemia patient,

who survives today as a result of receiving ‘more than 75 units of blood and250 units of plasma, which equates to at least 1000 donors’ (2003b: 8). Therecipient of a plasma transfusion receives a recombined whole, a substanceconcocted from similarly divided parts from the veins of many. It is quitea different thing to conceive of a transfusion made up from many peopleas opposed to one person. Laidlaw shows how undifferentiated substanceprevents personal recognition, forestalling debt and obligation. Non-differentiation in storage and transfusion procedure similarly introduces ele-ments of an analogous ‘free’ gift in blood donation.

And yet there is simultaneously an opposite tendency within storage pro-cedure. Plasma is mixed, but red cells and platelets are stored and transfusedindividually. The NBS barcodes donations to track the stages through whichthey pass in their journey of spatio-temporal co-ordination with needy veins.Prior to donation, swiping of the cards issued to donors also provides theservice with readily accessible information about the donor’s donation historyand circumstances.There are thus alternations of perspective in blood-bankingprocedure that accord with what Wagner identifies in a different context(Melanesia) as ‘successive grouping of individuals and individuation of groups’

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(1991: 171).Another apt analogy is contained in Hart’s treatises on the moderncharacter of money (1986, 1999), in which he finds that ‘anonymous’ moneyhas multiple principles of individuation concurrently built into it; the new hi-

tech donor cards are, of course, analogous with the credit cards that he deploysas an example of monetary individuation.The necessity for Jain renouncers to mix and depersonalize the food they

receive derives from the important issue of safety or, more precisely, of reli-gious safety: ‘Reciprocal relations between lay Jains and renouncers … wouldpreclude the transcendence of temporal causal relations … and the achieve-ment of unending spiritual perfection (moksha)’ (Laidlaw 2000: 626). Corre-sponding to, though inverting this, the issue is also one of safety in bloodstorage, but it is the movement to individuation that seeks to guarantee thisphysical safety of the body rather than, as in the Jain case, a movement to mixand thereby extinguish donor personality. A recent article in The Sunday Times(2003) declares that the NBS has agreed to import blood from the UnitedStates for British children in need of transfusions in order to cut the risk of CJD infection, a disease held to be more prevalent in British blood. A Con-servative Party politician is there cited expressing concern that ‘older patientsrequiring blood transfusions will not have access to the screened Americanblood, which will come from individually identifiable donors rather thanpooled stocks’. The mixing together of plasma is defined by the former employee of the Scottish Blood Transfusion Service whom I interviewed asbeing problematic for the same reasons. High ‘identifiability’ of blood isequated with safety:

The problem with plasma is that it is pooled – a hundred, a thousand donations even – are put in a big vat and it’s all mixed up and then it’s put into bags and then it’s frozenand then it’s used for albumin for burns or used as a volume-filler rather than red cellsthemselves … so if someone’s losing a lot of blood, and you don’t have a lot to givethem, you can give them a couple of transfusions, and you can give them plasma for volume. But the problem is that that plasma will have hundreds of different people’splasma in it, instead of just one person’s.

Economy and efficiency

‘Identifiability’, however, is not necessarily congruent with optimal ‘efficiency’and the need to ‘maximize’ the utility of the substance. ‘Rational’ usage isstressed in the language of blood management as contained in medical liter-ature and displayed on the NBS website.5 ‘Promoting rational blood usage’ isa key tenet of the Indian government’s recent National Blood Policy (India,

Ministry of Health and Welfare 2003). In order for ‘rational’ usage to occur,according to these sources, components of blood from one person sometimesneed to be combined with components of blood from other persons. I nowexamine blood management as a system of rationality, or, more specifically, of rational maximization, a system that looks upon the substance it manages asbeing of very special value and hence worth treating ‘economically’. Cen-trifuge and fractionation procedures have already been alluded to. It is theseprocedures that exemplify the system of rational maximization in blood

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management. In the 1950s the key pioneer of modern blood managementpractices, Dr Edwin Cohn, conducted research on blood and proteins at theHarvard Medical School and came to the conclusion, crucial for future devel-

opments in transfusion medicine, that it was wasteful to administer blood topatients in its whole form (Starr 1998: 211).A far greater ‘use-value’ could be yielded by isolating the different cellular constituents of the undifferentiatedliquid. He called this new approach ‘component therapy’ or ‘blood economy’(Starr 1998: 211). Douglas Starr explains that the situation up until Cohn’swork had been that if one had four units of blood, four people could betreated (assuming that they each needed one unit). If a division is performed(via a centrifuge machine) into red cells and plasma, it becomes possible totreat four people with the red cells and two with the plasma. Plasma can simi-larly be subdivided (fractionated) by separation into albumin, gamma globu-lin, and another component identified as Fraction 1 (1998: 212). Starr concludes that, by the late 1950s, the efficiency of blood usage had risen by600 per cent relative to the foregoing decade. A colleague of Cohn’s, Charles Janeway, stated at the time that ‘for the first time real economy in the use of blood becomes possible’ (1998: 212).

The NBS website declares that whole blood ‘is your blood in its naturalstate, and something we very rarely use. It’s much more useful to us to haveit separated into components’ (my emphasis).6 This means, of course, that whatthe donor gives is on most occasions not what the recipient receives.As treat-ments promoting ‘blood economy’ and efficiency, centrifugal separation andfractionation make explicit the need to avoid wastage in dealing with such aprecious fluid. This also reveals that blood transfusion should not be thoughtof as ‘whole’-blood transfer between persons, vein to vein, as it were. For sepa-rated components in many cases (plasma, most often) need to be recombinedwith similarly separated components deriving from other ‘whole’-bloodextractions in order for ‘rational usage’ to occur.

The movement from donor’s vein to recipient’s vein resulting from theseintervening treatment procedures is from a single, ‘whole’ substance (what is

extracted) to a substance that is simultaneously singular and multiple (what istransfused). To rephrase, the ‘whole’ substance that is extracted is revealed tobe multiple through the divisions performed upon it by the centrifugemachine; certain divisions (though not all – red cells, for example, are kept‘individually’) are then added to other divisions of the same kind derivingfrom other persons such that the recombination of fluids from multiplepersons re-creates a ‘singular substance’, multiply composed.What results is amore ‘self-similar product at every level of minification and magnification’(Gell 1998: 137), a form of unity composed via the pooling of products gath-

ered from many.These procedures potentially create a multiplicity at both ends of the move-

ment from donor to recipient since the singular donation stemming from oneperson will have multiple beneficiaries, and the singularly defined beneficiarymay receive a product deriving from multiple donors.This multiplicity at bothends of the chain may appear paradoxical because at the level of substance-donated and substance-received these are also ‘whole’ or singular fluids.Luhmann’s unitas multiplex (1990: 68), ‘a unity that is a unity only as a

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multiplicity’ (Pottage 2001: 130), is thus a useful tool for describing theseapparent paradoxes.7

I suggest that altruism (insofar as it relates to ‘free gifts’) and commodity

logic (insofar as it relates to maximization of a resource configured as scarce)are present here as dependent variables. Parry has outlined a similar proposi-tion. He argues that ‘an ideology of the “pure gift” is most likely to occur inhighly differentiated societies with an advanced division of labour’ for ‘[w]ithrenewed ideological stress on the autonomy of the market go renewed pleasfor philanthropy to assume the responsibilities it denies’ (1986: 466-7, 469).For Parry the commodity economy is a condition for the existence of ‘dis-interested’ giving. In the processes under discussion, these economy featuresare mutually enabling. The rationalizing procedure of centrifuging maximizesaltruism through gift-splitting, and if ‘commodity logic’ here expands andinflates altruism in maximizing it, the fruits of ‘altruism’ conversely enable acertain pristine commodity production, equivalent to what Gell terms amodern technological ‘magic-standard’, that is, ‘ideal “costless” production’(1999: 185n) – the conjuring of several units from one (the singularly offeredgift technologically imbued with multiple beneficiaries).

The feature of elements deriving from ostensibly different economiesproving to be mutually structuring continues in the following discussion of time-management. Blood is necessarily processed within a temporal economyof blood management that also has connotations of time (and commodity)production. It is to these temporal implications that I now turn.

Time ‘of ’ and time ‘in’

Blood-banking is a system of co-ordinating and matching properly codedblood with similarly coded bodies in need. It is a system of synchrony inwhich the elements to be synchronized are not durable and thus are depen-dent upon the correct temporal as well as spatial co-ordination of each to theother (body and disembodied blood). As a ‘whole’ substance, blood movesthrough our veins in accordance with the speed of the pulsing heart but, whenextracted and separated into its constituent elements, each component takeson a different temporality. For example, red cells have a thirty-day refriger-ated shelf life, platelets just five days, while plasma can be frozen and keptindefinitely.The centrifuge process therefore separates ‘whole’ blood not onlyinto its constituent components but also into different temporalities. The factthat the shelf life of red cells, the principal component of blood, expires after thirty days creates a time-management problem for blood services. An

employee of the Scottish service told me that the service must take accountof blood expiration and seasonal variations in donor numbers, which further complicates the already complex need to synchronize blood input and bloodoutput:

The difficulty is getting the balance because we don’t want to have a shortage, and neither do we want to be destroying people’s blood, not using it. It’s a fine balance to get becauseif we’ve lots of donors coming in this week because they’re on holiday, and then thenext week we don’t have as many, well in a month’s time that will [be] reflect[ed] … so

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we try and keep it at an even keel. One of the reasons we send out cards to donors inEdinburgh is to try and have some control over the amounts on the shelves, because wedon’t want too much either.

A further key dimension of the issue of time-management is therefore theblood bank’s proper management of the temporal relation between gatheringand dispersal. Blood-banking institutions that must gather blood in a properlymanaged temporal relation to their concurrent dispersal of it are designed, likethe veins of designated donors, to be subtracted from. As with donors, theremust be constant replenishment in order for the ideal shape to be regained – ‘the unity of an ideal configuration’ (Derrida 1996: 3). Like the haemopoi-etic production mechanism within blood that creates an a posteriori bodilysurplus ‘as if ’ the blood had not been extracted or given, the bank must ideallyreceive inputted blood in the same instant as it outputs, ‘as if ’ it has not beensubtracted from. In this way blood bank and blood substance are analogues of one another. Rather than parallel, unconnected analogues, however, it wouldbe more accurate to define blood bank and blood substance in terms of anessential relationship between different levels of a system. The bank’s contin-ued viability through replenishment of stocks is crucially dependent onhaemopoietic replenishment of substance. Of course, the blood bank cannotever capture the precise ideal of input and output alignment, and incom-pleteness is therefore built into its structure. Since it constantly disperses itmust constantly gather, and, as such a system of inputs and outputs, it followsthat blood banks are dependent on replacement and repetition.

This discussion of the temporal organization of gift management hasanthropological precursors in Pierre Bourdieu (1977), Alfred Gell (1992), andMarilyn Strathern (1991).Their accounts, like mine, have tended to focus onthe time of the gift.8 I believe that there are grounds, regarding blood dona-tion, for a discussion of the time in the gift.Though Gell’s assertion that timeis not a substance but a measure or dimension (1992: 213) logically entailsthat blood is not a measure or dimension but a substance, blood transfusions

do facilitate the possibility of the continuation of something that is measuredby time, that is, life. If this is accepted, then we can assert that transfusions of blood produce, as their principal effect, the continuation of experiential life-time . The experiential time resulting from transfusions is thus a form of timewhich more than any other is ‘contingent on the significance of death’(Greenhouse 1996: 21).There is, though, a unique aspect to the time ‘in’ blooddonation: people’s time, according to employees in the Scottish service, is seenas the service’s prime competitor (thus making people take the time to donatea prime imperative) and this creates an investment equation. A donor must

give some of his or her time to donate, and this acts like a share, ideally cre-ating substantial experiential time for the recipient. It is not being claimedthat the times located at each end of the equation are of the same order.Rather, a conversion of temporalities takes place, an instantiation of Gell’senvisioning of the possibility of ‘analogic transfers between different “orders”of temporality’ (1992: 316).

The time that results from the gift is stressed repeatedly by recipients andtheir families. The Donor magazine contains a letter from the daughter of atransfusion recipient:

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In August, my father, then 86, was suddenly diagnosed with advanced bladder cancer. Heopted for an operation, and to my surprise received six pints of blood. Unfortunately heonly lived for two more days, but the blood gave him and our family precious extra time ,and made him feel better (2003a: 12, my emphasis).

The word ‘extra’ is critical here. It points towards two aspects of the dona-tion’s effects. First, ‘extra’ means additional: more time than that expected was‘created’ or made experientially possible through incorporation of the blood-gift. Secondly, ‘extra’ also means ‘situated outside’, as in ‘extra-corporeal’meaning ‘outside of the body’, and, as the letter-writer makes clear, this ‘extra’time was experienced differently as being particularly ‘precious’. Blood incor-poration thus creates ‘extra’ time in the senses of both ‘additional’ and ‘differ-ent’ (because more appreciated). As I have pointed out elsewhere (Copeman2004: 130), it is time that, on the experiential level of the person, would nototherwise have been.

In an article entitled ‘The precious gift of time’ (National Blood Service2003a: 16) readers of The Donor are told that for people who are dying it isthe quality of experiential time that is the principal benefit of transfusion,enabling precious ‘family’ time for people who must adjust to definite futureloss.The article quotes the view of a community nurse that ‘these vital trans-fusions give patients a better quality of life. It gives them the energy and abilityto enjoy this precious, final time with their families’ (2003a: 16). The articlecontinues: ‘But this time is often a gift that only blood can provide’.The caseof Edmund Proctor, an optometrist, is described. His rare and terminal bonemarrow disease meant he could not produce blood; his disease would havemeant death soon after initial diagnosis if it were not for the three units of blood he received every two weeks.The narrative continues:‘[T]he extra yearsof life [that] blood gave him was a very precious gift’. The article ends witha plea from Edmund’s family that highlights the investment equation whichhas been alluded to: ‘[I]t costs nothing to be a blood donor, only your time,and one day your family and friends may find themselves in a similar situa-tion, relying on blood to give them some more time’ (2003a: 16). ‘Extra’ time

is experienced not only by the recipient, whose experiential lifetime isextended, but also by the recipient’s family members, who receive the effectsof transfusion’s provision of ‘extra’ time through being able to savour contin-uing precious moments with their ill relative.

The donor thus gives his or her own time in order for others to receivetime. The above examples concerned terminally ill patients where, thoughtime-received was indeed far greater than time-given, the principal effect wasattenuation of terminal disease rather than cure.The investment equation canbe far more dramatic, however, as in the case of a foetus receiving a curative

transfusion, giving it ‘pre-life’ within the womb as well as subsequent full-life(‘Saving life before birth’, National Blood Service 2003a: 11). Imagining childrecipients is to construct one’s donation in terms of temporal ‘best-value’, andthe fact that children are key to the ‘enchantment’ processes in donor elicita-tion that I refer to below is suggested by the prevalence of their pictorial rep-resentation in recruitment materials.

It should be emphasized that both time-input and time-output are revealedas critically important in these narratives, where the ‘enlarged’ output is seen

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to stem, via an intervening accrual, from the more modest input. The Scot-tish employee mentioned above spoke of people’s time as ‘our big competi-tor’, indicating the difficulties experienced by the service in ‘capturing’

people’s time to donate:

Sundays used to be very, very busy sessions, but that’s changed because people don’t havetime to sit and wait for an hour – they used to sit and blether with their friend for awhile, it was a community thing – but now the shops are open on Sundays, and DIYalso made a difference.

It is harder now to ‘capture’ people’s time and new strategies must be sought:‘One of the things the [Scottish] blood service does now is go out to people

– workplaces and so on’. People’s time must be captured, ‘enrolled’ for invest-ment, so that more experiential time will result for recipients.

Derrida (1997: 123) suggests a connection between the present as givenand the present as tense. It is true in our case that the present given by donorscan be equated with the present tense received by recipients. Consider a pho-tograph of a small child excitedly observing her birthday cake (a promotionalposter designed by the Association of Voluntary Blood Donors, West Bengal).The caption reads: ‘This is me … I am a normal 6 year old, but I live because100s have given the blood which flows in my veins. Make our todays possi-

ble by donating blood’ (my emphasis). The cake stands for the accumulationof time that transfusions have facilitated, the birthday is celebrated in a todayextending into a tomorrow.Varying temporal extensions have been ‘enabled’by donated blood. Recruitment materials that configure donors as saviours of experiential presents and futures, and of pasts allowed to happen, base their claims quite firmly on an understanding of donation’s real effects and areaccurate in suggesting that blood is the material analogue of a dimension(temporality).

Temporal investment

The investment relation is once more evident in a poster designed by theBlood Bank Society of Chandigargh (north India). Beside a photograph of anewborn baby are the words, ‘I thought I had no time to give blood until Iheld a baby with no time left without it’.A blood bank in the southern Indianstate of Karnataka employs the slogan, ‘a little of your time means life for someone’.9 The investment takes the form of a translation from a time-given

into an increased and experientially modified time-received. And therein, Isuggest, lies the nucleus of a certain enchantment that recruiters attempt toelicit from prospective donors. It is notable that the real temporal effects of donation and ensuing processes of treatment are capitalized upon by recruitersas a means of recruitment-by-enchantment. In its appeal to maximization andinvestment, it is enchantment founded upon a commodity logic of time as ascarce resource subject to techniques of maximization (‘capital is time’ declaredBohm-Bawerk [cited in Gell 1992: 178]).

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In Gell’s formulation (1999: 167), enchantment is achieved by objects intheir necessary referral to the technical means of their coming into being. Inreferring to prior dexterity, objects objectify past action whilst in their present-

ness they render that action ‘in progress’. However, in the main, the virtuos-ity that is objectified is consigned to imaginings of its creation in the past.Blood donation reverses this technology of enchantment; it is enchantmentwith a ‘futurial orientation’ (J. Weiner 1999: 250).The task of recruiters is toenchant prospective donors in regard to a set of procedures that they have thepower to set in motion, and for which they are configured as being ultimatelyresponsible. The doctor or technician might refer to donors merely as pro-viders of ‘starting material’ (Faber 2004), but recruiters construct donors astemporal facilitators with near magical powers. ‘Save Future [sic ]. DonateBlood’, says one poster in a Delhi hospital. ‘Save Time. Give Blood’, declaresa donation-inspired bhajan (devotional song) used in Delhi’s elicitation cam-paign. The everyday ‘saving’ of ‘time’, an expression that explicitly subjects‘time’ to economy, is here conveyed in enchanted terms that underline justwhat a donor is capable of enacting – insuperable temporal economy.

Exertion of temporal control – even of formation – suggests the next phaseof enchantment, that of donors as divine agents of creation. One poem of donation-elicitation, delivered by a trainee doctor at a symposium held inDelhi to promote voluntary donation, declares,‘You are a human being already/ For a few minutes you can be god of creation [brahmatv ]’ (my emphasis). Bea donor and be ‘the source of life next to God’, instructs promotional litera-ture designed by Delhi-based NGO Safe Blood.An Indian video presentationon donation declares of a patient, ailing on a hospital bed, ‘the doctors cannotsave him unless his lost blood is replaced. Unbelievable, but true – only youcan save him.You could see him live again’. Donors are thus agents of resur-rection, with the patient figured in this presentation as already dead. The lan-guage of resurrection is more subtly present in an address given at the Beijingconference, already mentioned, by a Chinese woman who had received atransfusion after blood loss while giving birth: ‘It is the millions of donors

who gave me hope, who gave me a second life’. The already dead patient isbrought back to life from death by donor gods.The ‘second life’ that she men-tions, we ought to insist, is a second lifetime .10

These constructions of the donor from the United Kingdom, India, andChina – while responding to and formulating profoundly different socialsystems – all nevertheless share an affinity in reifying donors as temporal inter-ventionists who partake of an enchanting and futurially oriented economy of time ‘production’. I do not claim that donors think of themselves as particu-larly divine or creative but that an idiom of temporal enchantment is engaged

by campaigners in the hope of recruitment-by-enchantment.A final example,however, suggests that donors are quite capable, in certain circumstances, of yielding to the temporality of donation. Sharlene Lachance of Canadian BloodServices told me that her service has organized a small group of Baby UnitDonors (BUDS), recruited to support neo-natal units:

‘BUDS’ blood is collected in a pack that has little mini packs attached to it, so that wecan separate that unit into four mini units – because little babies don’t need so muchblood, and as soon as you go into a large bag you contaminate the rest to take some

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out. Once opened, you can’t use the rest of the blood bag. So by diverting it into smallmini packs, we can help that many more babies. When you take a little blood samplefrom babies, because their blood volume is really not very great, you have to replenishthe blood you take out for sampling.We’ve explained it all to them and they understand

why they’re donating blood, so when they have to cancel because of personal illness,they have visions of all these little babies waiting for this blood transfusion that they’renot going to get because we had to cancel their appointment.They’re an extremely com-mitted group of donors. When I meet them they say, ‘You know, I’m a baby donor’ – they’re very proud of that.

This technical ‘closed system’ produces several interesting social effects. Thevisibility of the number of recipients, represented by mini bags, paradoxicallyserves to personalize the process, an explicitly non-specific donation – splitinto parts before the donor’s eyes11 – acutely specifying the reality of thegift’s future dissemination.The resolutely rational purpose of maximizing sub-stance use-value by preventing wastage occurring from donation into onlyone blood bag helps generate a committed group of donors. I suggest that aconception of temporal best-value underpins this commitment. For not onlyis it made explicit that four beneficiaries will result from a single donation, itis also manifest that those beneficiaries will be newborn babies – those withthe most future time to lose. Number and age of beneficiaries each have impli-cations for the time ‘in’ the gift. In this case, information on each aspect isavailable to donors; it draws the investment equation up close, enchanting

them.

Sharing and recurrence

In temporal investment it is significant that the person who ‘invests’ differsfrom the person who reaps the benefits of the expanded temporal share: thereis a division between donors, who must give ‘ten minutes’, and recipients, whoget the enchantingly expanded profit accrued on those ‘ten minute’ temporal

investments.The process hinges on the logic of rational maximization, calcu-lation, and reified efficiency for, along with fractionation and centrifugal effi-ciency measures that ‘economize’ blood and protect against wastage, there isinvestment of temporal ‘capital’. What makes blood donation procedures anintriguing interweaving of economic forms, however, is the interdigitation of these ‘commodity’ features with qualities of a free gift economy (in a systemicsense each ‘enables’ the other, cf. Parry 1986). In the particular instance of temporal investment under discussion, there is a further complicating ‘overlap’of forms stemming from the critical separation between investor and recipi-

ent of investment. There is a return on the time given (invested) by donorsbut the recipient of the ‘profit’ garnered from the investment differs, with thereturn not going to the initial investor but getting redirected. It is onlythrough this redirection of return that concepts of altruism can becomegermane (giving and not seeking reward). The recipient of the investment isnot the investor; the investment is made for others. We can speak thereforeof ‘approximate altruism’.There is maximization, but not for the purposes of individualistic accumulation. ‘Altruism’ is maximized through the interdigita-tion of different economic forms.

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The ‘sharing’ of blood thus occurs through its treatment as a ‘share’.A sharerefers both to the individual’s contribution to a company’s capital and to theportion of detached property or capital that the contribution entitles the indi-

vidual to receive. The blood share, as I have stated, is redirected as a result of the division between investor and recipient of investment. This observationinvites the drawing of a parallel with recent analyses of hunter-gatherer com-munities. The extraction of blood from veins in order that it may be sharedwith those suffering a deficit does not stem from an objective surplus that lieswithin healthy bodies waiting to be ‘redistributed’ into other, more needyveins.The surplus is created a posteriori , after the fact of blood’s removal, as aresult of the haemopoietic replenishment mechanism discussed above.This isthe point of alignment between some hunter-gatherer communities’ ideasabout sharing and the procedures of blood donation. It is through extractionand sharing that blood proliferates and creates ‘plenty’. According to BarbaraBodenhorn, Iñupiat whalers in Alaska see the souls of animals and humans asconnected over time and space on a continuum.The whalers declare that ‘theanimal carcass … must be treated correctly – by sharing its meat. If this isdone, the animals will return to give of themselves again’ (1989: 5). NuritBird-David (1992) generalizes this tendency to various hunter-gatherer com-munities, including the Nayaka of South India, the Batek of Malaysia, and theMbuti of (then) Zaïre. In her formulation, hunter-gatherers engage with their environment ‘as if they were in a sharing relationship’ (1992: 31), with sharingensuring recurrence. However, in Bird-David’s account, it is not the resourcesthemselves that are principally valued, but the system that shares out theseresources. Blood, however, is valued as a life-saving resource, which of neces-sity ‘recurs’ and reproduces itself directly as a result of its removal for sharingpurposes.

Replenishment in time

Marilyn Strathern has declared in relation to blood and semen donation that‘the circulation of gifts does not create distinct kinds of persons’ (1997: 302,emphasis removed). However, with reference to the sharing and recurrenceargument presented above, I suggest that the particular replenishment struc-tures of blood donation might problematize her claim because, though theremay be anonymity written into donation treatment procedures (an anonymityequated by Strathern with commodity production), the haemopoietic pro-duction mechanism within donors’ veins, essential for repeat donation, createsa space for the ‘distinct’ persons that Strathern’s analysis appears to preclude.

Necessary enforcement of bodily creativity inhabits procedures of blood dona-tion, and this is a creativity which, since it is enforced directly as a result of a decision on the part of donors, renders donors more distinct from com-modity production than Strathern would have them.

Strathern suggests that semen is an alienable body-product ‘because of thepossibility of its being produced without being elicited by another person’(1997: 300). It is because of a lack of intentionality on either side of the equa-tion, Strathern implies, that distinct kinds of person are not produced by these

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kinds of gifts. ‘Indeed the person who purchases a present to give to a friendsimply puts in reverse the same process which makes it possible for him/her to donate body substance to a blood bank, cadaver to science’ (1997: 302).

There are two central observations here: (1) because not intentionally pro-duced or directly elicited by others, substances such as blood and semen arealienable, and (2) since the giving of blood and semen are thereby renderedactions similarly mundane to the giving of a commodity purchase, circulationof such gifts does not presuppose distinct types of person.These are undeni-ably valid points. A convincing analogy is suggested between the anonymityof bodily production and the anonymity of commodity purchase. However,since the second observation follows from the first, if the first can be dis-proved with regard to blood donation, the second would automatically be ren-dered problematic, and we would be able to refer to persons distinct fromstraightforward commodity production. One could say simply that if oneresponds to injunctions to ‘Do Something Amazing’ and give blood, one hasmade a choice and become the kind of person who makes those choices.However, a more effective critique can be offered than this.

One can assert simply that the blood of the (voluntary) blood donor is dif-ferent; it is not anonymously produced. Not only is it elicited by blood-banking institutions, it is produced by the donor as a direct result of theseelicitations. Intentionality thus exists on both sides. Strathern is correct thatblood ‘becomes part of a store on which others can draw’, but she also con-tends that it is an ‘anonymously-produced object’ (1997: 302). She is not alonein this view. Ricoeur writes that ‘it is extraordinary that life functions in mewithout me … It is a wisdom of movement: the circulation of my blood andthe beating of my heart do not depend on me’ (1966: 418). Derrida, in‘Haematology’ (n.d.), describes his own medical experiences in passive terms:‘[A] crural vein expelled my blood outside … leaving me nothing more to do… It’s me but I’m no longer there, for nothing, for nobody’.This assumptionof the anonymity of blood’s production is problematic in regard to blooddonation because, although centrifugal and testing procedures might

‘anonymize’ the substance and although blood is ‘anonymously’ produced inthe womb and in childhood – that is, at stages in which the option to makea decision in respect of donation is absent – as soon as we donate, creativityis enforced by us upon our blood. Decisions to donate of necessity revivifythe haemopoietic production mechanism. Blood replacement in the veins of the donor, soon after donation, occurs precisely as a result of the donation;replenishment results from that donor’s action for others. This goes back tothe special kind of surplus involved in blood donation, a surplus that is notobjective but produced a posteriori through its extraction for sharing. Replen-

ishment enables future donations so that one can forge a ‘career’. The pro-duction process is enrolled, managed, and forced into creativity by the decisionto give and is therefore not anonymous. Blood donation entails a gift that isnot anonymously produced, indeed, that is produced for and elicited by others,and whose transfer stems from the desire to be the kind of person who makessuch transfers. As such, blood extraction and replenishment are processesthrough which are fashioned persons who cannot straightforwardly be assimi-lated to anthropological characterizations of commodity production. The

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donor subjects to control what at first glance appear to be processes thatcannot be deliberated, weighed, or subjected to nuance – in short, that appear automatic. The ‘automatic’ is supplemented by direction and intention; the

actions of donation are enabling structures that enclose a space for the ethicalagency that Strathern’s analysis would disallow.

Conclusion

An array of interpretative models has surfaced in this discussion of themultidimensional economy of blood management. There have, however,been omissions: there has been discussion neither of the set of tests adminis-tered on blood for transfusion-transmitted infections like malaria and AIDS,nor of apheresis procedures in which the donor becomes a kind of self-circuitof donation whereby blood is drawn from the donor, centrifuged so thatcertain components can be siphoned off for usage elsewhere, withthe remainder being returned (transfused) to the donor. Nor has therebeen space for discussion of autologous ‘risk-reduction’ measures in whichthe patient serves as his or her own donor, typically receiving, duringplanned surgery, blood previously extracted from him or her for the purpose.Promissory narratives of universal human relatedness to be achievedthrough blood transfer between persons (‘Let us be blood brothers’ is apopular Indian slogan; ‘donation is an introduction to love … we’re beginningto realize the chance it gives us for loving relationships, that we are allbrothers and sisters’, says the director of a Delhi blood bank) might bethreatened by the increasing prevalence of this technology of the singular donor-recipient.

This has been a description and analysis of a modal and mobile constella-tion of practices and knowledges, transnational in distribution, but also situa-tionally enacted in particular instances. Economies of blood management defysingular explanation. Intimations of the free gift facilitate the thinly veiled

commodity logic of temporal investment, but the share that is invested isinvested and maximized for others (the temporal commodity infused withrationalized altruism).The haemopoietic production mechanism, too, facilitatesa gift that, in the manner of its giving, cannot be reduced to commodityformulations, although commodity formulations are present in theseprocesses. It is thus difficult to extricate the ‘altruism’ of sharing from the‘commodity logic’ of the share; one could say they are ‘entangled’ (Thomas1991). Like the sharing that ensures recurrence in hunter-gatherer communi-ties, blood’s extraction produces it afresh as a result of haemopoietic replen-

ishment. It is this mechanism that leads to questioning of previous analysesproclaiming that donors invisibly and anonymously produce this vital bodysubstance. Internal functioning is directed and ‘managed’ by the donor, for whom a posteriori replenishment – in the same instant – is for themselves andfor others.

When considered in relation to family-replacement donation (donationfor someone) – the norm in many countries – non-remunerated donation(donation for anyone) reveals itself as both materially and emotionally abstracted.That is, the donation for a specific person that characterizes replacement

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or directed donation is ‘centrifuged’ in the voluntary system; there is amovement away from a centre and the gift is for m/any. Centrifuge technol-ogy would seem to facilitate the centrifuge of economic forms, for a gift

split into multiple parts can hardly be directed toward a specific person.

12

InIndia and in other countries struggling to replace replacement with voluntarydonation, it is not difficult to trace a movement from material specificity toabstraction. Future research in this area needs to address the ways in whichcentrifugal blood donation trajectories from one person to m/any are beingachieved in large part through specifying imaginary recipients and hencethrough the simultaneous inclusion of a centripetal trajectory from manypersons to one (imagined) person (a religious leader, perhaps, or a politician).The directed donation thus remains but moves into another dimensionwithin material abstraction, the emotional image of a ‘someone’ substitutingfor what had previously been a real ‘someone’ (the actual recipient). Futureresearch needs to explore how the materially ‘anonymous’ structures of voluntary donation become an imaginative canvas for specificity withinabstraction.

Afterword: the time of transfusion

By way of an afterword I return to the part of the argument that refers tothe allocation, measurement, and spending of time. I have proposed that tem-porality – its organization and production – is a key ingredient, imperative,and effect of a set of life-saving material processes. I finish by indicating thegrounds for future exploration of the relationships between time and transfu-sion by demonstrating that the temporal effects of blood donation might bemore multiple than I have so far suggested.

In this article the focus has been on donors and recipients, with the perhapsmyopic presumption that the donor takes time out, and the recipient, as itwere, takes time in. However, at a donation camp in Delhi in 2004 an infor-

mant told me, ‘I just wanted a nap of sleep – it is relief from work, I get sostressed; I needed a nap in the afternoon!’ The time of extraction is consid-ered here a gift to the donor, rather than the donor giving his or her owntime. Conversely, at a recent talk given by a British person who has the blooddisorder thalassemia – a condition which requires transfusions as often as everytwo weeks in order to bolster haemoglobin levels – it was declared of the dis-order that ‘it is burdensome, it is time consuming. I waste time having bloodtests. My time is also wasted waiting for the blood to come through’. Rou-tinized transfusion – or what the temporal investment formula might term

regular temporal input – is here considered, understandably, as a burden onthe time of the recipient. Here, akin to the donor, the recipient takes timeout, albeit to take time in.

These inversions of my descriptive metaphors suggest that my analysis mighthave invested too heavily in simple and discrete give-and-take distinctions.Further ethnography may well produce different, more apposite, interpreta-tions but the examples that I have just cited nevertheless, indeed crucially, pro-claim the necessity of sustained temporal interrogation when it comes to thesepractices.

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If I have just indicated that temporal give and take should not so readilybe singularly assigned to either donor or recipient, I finish with a citationfrom a contribution to the Oxford handbook of clinical medicine , exquisitely titled

‘On the taking of blood and of holidays’, which further emphasizes the mul-tiplicity of these procedures’ temporal effects – that donors and recipient arenot the only ones to ‘receive time’:

[T]he most menial of our [doctors’] tasks: the act of taking blood … [W]hat is specialabout taking blood is that for once we are being given something valuable by the patient.13

What is this wealth? The answer is time . For while the blood is flowing into our tube,we cannot be disturbed. We are excused from answering our bleeps, and from makingpolite conversation (a few grunts in reply to patients’ enquiries about the colour of their blood is quite sufficient) … Thinking of this sacred time as a sort of hypnotic holiday isexcellent … During this time, allow your own mind to coalesce into a more peacefulorder if you can, and let William Blake help you in the task of furnishing your mind tobanish objectivity, for he knew some truths about haematology unknown to strictly ratio-nal practitioners of this art:

The Microscope knows not of this nor the Telescope: they alter The ratio of the Spectator’s Organs but leave objects untouch’dFor every space larger than a red globule of Man’s bloodIs visionary, and it is created by the Hammer of Los;And every space smaller than a Globule of Man’s blood opensInto eternity of which this vegetable Earth is but a shadow.The red Globule is the unwearied Sun by Los createdTo measure Time and Space to mortal Men …(Longmore, Wilkinson & Török 2001: 625)14

NOTES

My thanks to Thomas Strong, Olivier Allard, and Emma Reisz for their valuable commentson this article, and to the referees for careful readings. Input from Bettina Göbels is also muchappreciated. I am grateful to the Economic and Social Research Council for financial

assistance.1 Simpson’s recent interesting article, ‘Impossible gifts’ (2004), which includes a section onblood donation in Sri Lanka, appeared well after the writing of the present article and it is notpossible to consider its implications here.

2 For a fuller account of asceticism within the Shvetambar Jain community see Laidlaw’sRiches and renunciation (1995).

3 In focusing on the paradox of ‘keeping-while-giving’ in Trobriand settings, Weiner soughtto displace the centrality of the ‘norm of reciprocity’ as the central issue of social life in theregion.

4 Platelets are disk-like structures which are the foundation of clots (Starr 1998: 211).Plasma is the colourless coagulable part of blood in which the fat-globules float (OED ) –

usually frozen after extraction and centrifuge, it becomes known as Fresh Frozen Plasma (FFP).Red cells contain haemoglobin, which helps carry oxygen from the lungs to other parts of thebody. Red cells also collect carbon dioxide waste, moving it to the lungs for expulsion (Ray2003).

5 http://www.blood.co.uk.6 http://www.blood.co.uk/pages/e17compn.html. For a key anthropological treatment of medical

professionals’ efforts to prevent bodily wastage, see Gordon (2000).7 Jackson (2002) records instances of (organ) donations between strangers leading to imag-

ined relationships of reciprocity. The system of rational maximization through splittingdescribed here would appear to frustrate even such limited attempts to ‘imagine’ the giving or

482 JACOB COPEMAN

http://www.blood.co.uk/

http://www.blood.co.uk/pages/e17compn.html

http://www.blood.co.uk/pages/e17compn.html

http://www.blood.co.uk/



receiving personality. Not only is the donation split, it is recombined with parts from similarlysplit donations; the donor is rendered several times more unidentifiable.

8 For example, Bourdieu observes that ‘if it is not to constitute an insult, the counter-giftmust be deferred and different , because the immediate return of an exactly identical object

clearly amounts to a refusal’ (1977: 5, emphasis his). Strathern similarly highlights the timingof exchange in regard to semen transmission among Baruya cult members in Melanesia:‘Donor and recipient are rendered distinct by their place (their time) in the sequence’ (1991:203).

9 http://www.udupipages.com/health/blood.html.10 For a critical perspective on resurrection narratives in the realm of organ transplantation,

see Scheper-Hughes (2004: 59).11 This produces an interesting analogy and contrast with centrifugal blood separation in

which the blood is split away from the eyes of the donor, in the laboratory of the blood bank.In centrifugal separation, the gift is qualitatively split, whereas in the instance of BUDS, wheredonors attain vision of gift-splitting into separate bags, the separation is quantitative. It is at the

very least intriguing that visual knowledge of separation and maximization procedures can affectdonors so profoundly.There thus appears an ‘affective’ difference between known and unknownsplitting.

12 The various multiplications of component separation (multiplications through materialdivision) are a focus of my current research. In countries where blood is sold, not only is thesubstance ‘multiplied’ via its separation, the price is too – one donation can produce four saleable items.

13 Doctors often problematically conflate donor and patient, which is mistaken unless thedonation is autologous – the patient giving for his or her own later use. Donors do not reallyfit into doctors’ categories.

14 The poem is ‘Milton’.

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Don de soi : une exploration des opérations entourant ledon du sang

Résumé

L’auteur étudie ici les opérations liées au don du sang et à sa « gestion » dans une perspec-tive anthropologique. Il affirme que cette gestion ne se limite pas aux opérations réaliséespar les professionnels de la santé pour manipuler le sang à l’extérieur du corps humain, maisque ces pratiques de « gestion » sont incorporées par les donneurs dans leurs propres proces-sus physiologiques. Il suggère que le don et la transfusion sont centrés sur les questions demaîtrise du temps et de production, et emploie les concepts de synchronie et d’investisse-

ment pour rendre compte des implications de cette dimension du don de sang. Par unecomparaison avec la tradition du don chez les Jaïns indiens, l’auteur émet l’idée d’un« recoupement » et d’une interdépendance de différentes économies dans le fonctionnementdes banques du sang. Par cet examen des processus généraux liés au don du sang, l’auteur cherche à jeter les bases de futures analyses comparatives de ces opérations.

Jacob Copeman is a member of the Cambridge University Department of Social Anthropol-ogy. He is currently finishing a study of the religious, economic, and kinship aspects of blooddonation in India.

Department of Social Anthropology, University of Cambridge, Cambridge CB2 3RF, UK.

[email protected]

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veinglory: exploring processes of blood transfer between persons

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