Demarcating the dirty work: Canadian Fertility professionals' use of boundary-work in contentious egg donation

Making organ donation after circulatory death routine: Preserving patienthood and reproducing ways of dying in the intensive care unit

Controlled organ donation after circulatory death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction, there were debates about the ethics of DCD, including whether potential DCD donors receive end-of-life care which is in their best interests. Since this time, DCD has become a routine donor pathway in the NHS. In this article, we present findings from an ethnographic study examining the everyday practices of DCD in two English Trusts. Drawing on the concept of death brokering and Bea's (2020) call to consider organ donation as embedded and routine practice within health care, we look at how DCD is integrated into end-of-life care in intensive care units. We show how DCD is made routine at the end-of-life via the practices of health professionals who create an active separation between discussions about death and donation; reproduce usual ways of doing things in end-of-life care; and respect the distinction between patient/donor, dying and death. In doing so, we argue these function to preserve the patienthood of the potential donor, ensuring DCD operates as an integrated part, and culturally accepted form of, good end-of-life care for potential donors, their relatives, and health professionals alike.

Strategic In/Visibility of Turkish Egg Donors: Reproductive Labor, Secrecy, and Stigma in the Transnational Bioeconomy

Drawing on ethnographic fieldwork in a Northern Cypriot clinic, I examine how practices of secrecy function as strategic tools for invisibilization in the lived realities of Turkish egg donors engaged in an illicit, gendered, and stigmatized form of reproductive labor, both within and across national borders. Combining feminist studies of reproductive labor with an analysis of secrecy, stigma, and dirty work, I adopt a notion of secrecy as an embodied social practice to explore ethnographically how secrecy is integral to the bioavailability of Turkish egg donors. Secret practices enable these young women to intimately navigate gendered moral, health, socio-legal, and financial concerns within the challenging wider context of restrictive reproductive biopolitics, a legally ambigious cross-border biomedical market, fragile socio-economic conditions, and a heteropatriarchal sexual culture in Turkey. For Turkish egg donors, who opt for strategic invisibilization, moral and financial concerns sometimes override health and legal considerations. Secrecy sustains this transnational bioeconomy while simultaneously concealing its exploitative harms and risks.

A technical solution to a professional problem: The risk management functions of prognosticators in the context of prognostication post-cardiac arrest

Cardiac arrest (CA) is a major cause of mortality and morbidity globally. Two-thirds of deaths among patients admitted to intensive care units following out-of-hospital CA are due to neurological injury, with most as a consequence of withdrawing life-sustaining treatment, following prognostication of unfavorable neurological outcome. Given the ramifications of prognosis for patient outcome, post-cardiac arrest (P-CA) guidelines stress the importance of minimizing the risk of falsely pessimistic predictions. Although prognosticator use is advocated to this end, 100% accurate prognosticators remain elusive, therefore prognostication P-CA remains pervaded by uncertainty and risk. Bioethical discourse notwithstanding, when located within a wider socio-cultural context, prognostication can be seen to present risk and uncertainty challenges of a professional nature. Such challenges do not, however, subvert the medical profession's moral and ethical prognostication obligation. We interpret prognosticator use as an attempt to manage professional risk presented by prognostication P-CA and demonstrate how through performing "risk work," prognosticators serve professional functions, mediating tension between the professional duty to prognosticate, and risk presented. We draw on sociological analyses of risk and uncertainty, and the professions to explicate these (hitherto less enunciated) professional risk management functions of prognosticators. Accordingly, the use of prognosticators is conceived of as a professional response - a technical/scientific solution to the problem of professional risk, inherent within the P-CA prognostication process.