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From The CriticsReviewer: Steven J. Squires, B.S., M.Ed., M.A. (Saint Louis University)
Description: Dr. Farhat Moazam's book is an ethnography concentrating on the religious and social dimensions involved in kidney transplantation in a Pakistani institute located in Karachi. The central figures in the book are the patients at this institute, their families, and the healthcare professionals providing assistance.
Purpose: Responding to a deficit in the literature regarding the non-medical aspects of living donation, the book seeks to be an accessible resource for a broad group of healthcare professionals, social scientists, ethicists, and laypersons. This multidisciplinary book engages questions surrounding a variety of topics, including decision-making and distributive justice. The author succeeds in her aim of acknowledging and clearly defining non-medical aspects of live organ donation. She is especially skillful in her ability to bring this conversation to a practical level while demonstrating the complexity of ethical dilemmas in this community.
Audience: The book is both eloquent and linguistically adept, introducing the reader to potentially new words and concepts in Urdu. Dr. Moazam is an ideal person to pen this work as she is a practicing pediatric surgeon in Pakistan as well as in the U.S. and has an MA in bioethics from the University of Virginia. This background makes her an excellent mediator between medicine and ethics, as well as between Pakistani and Western culture.
Features: The author explores Pakistani culture and the political, social, and religious dynamics affecting kidney transplantation. Her interviews and observations include significant attention to key healthcare professionals at the institute, potential donors and recipients, and their families. The author emphasizes gatekeeping, micro-allocation strategies, and persuasive techniques, all in the context of kidney donation. Her attention to the local standard of feminism is refreshing. The book would benefit from more explicit links between common Pakistani medical customs and bioethical concepts in Pakistan and the West. For instance, it is not clear if suggesting the discontinuation of dialysis to influence family member organ donation is coercive in Pakistani culture, much less by Western standards.
Assessment: "This is a superb and insightful ethnography, with a wide appeal. It is highly useful for those with interests in the fields of healthcare, bioethics, or culture. More specifically, this book closely examines gender roles, feminism, family dynamics, gatekeeping, and persuasion. It is comparable to, and of the same high caliber, as Anne Fadiman's The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (Farrar, Straus and Giroux, 1997).