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Last Best Gifts

Altruism and the Market for Human Blood and Organs

Last Best Gifts

Altruism and the Market for Human Blood and Organs

More than any other altruistic gesture, blood and organ donation exemplifies the true spirit of self-sacrifice. Donors literally give of themselves for no reward so that the life of an individual—often anonymous—may be spared. But as the demand for blood and organs has grown, the value of a system that depends solely on gifts has been called into question, and the possibility has surfaced that donors might be supplemented or replaced by paid suppliers.
Last Best Gifts offers a fresh perspective on this ethical dilemma by examining the social organization of blood and organ donation in Europe and the United States. Gifts of blood and organs are not given everywhere in the same way or to the same extent—contrasts that allow Kieran Healy to uncover the pivotal role that institutions play in fashioning the contexts for donations. Procurement organizations, he shows, sustain altruism by providing opportunities to give and by producing public accounts of what giving means. In the end, Healy suggests, successful systems rest on the fairness of the exchange, rather than the purity of a donor’s altruism or the size of a financial incentive.

200 pages | 3 maps, 11 line drawings, 5 tables | 6 x 9 | © 2006


Political Science: Public Policy

Sociology: Formal and Complex Organizations, Medical Sociology


"As an economic sociologist, Healy adds important dimensions to the intensifying debate over organ procurement."

Virginia Postrel | New York Times Book Review

“Exploring an issue usually left to philosophers and economists, Kieran Healy goes beyond ethical and economic debates and investigates the organizational and cultural contexts behind people’s motivations to donate ‘human goods.’ Whether enough of these much needed goods are provided depends less on potential donors’ altruistic motives than on the structure and practices of the organizations handling the donations. Elegantly argued and well-written, Last Best Gifts makes a landmark contribution to our understanding of the social foundation of the moral order of exchange.”--Jens Beckert, Max Planck Institute for the Study of Societies


Jens Beckert

“In Last Best Gifts, Kieran Healy offers a timely, sophisticated, and original analysis of the complex organizational terrain of blood and organ donation. In doing so, he unpacks the crucial role that organizations and institutions play in creating the contexts for, and the meanings of, giving. His analysis suggests that the relationship between gifts and commodities, between giving and selling, is more complex than many scholars acknowledge.”--Wendy Espeland, Northwestern University

Wendy Espeland

Table of Contents

List of Illustrations

1. Exchange in Human Goods

2. Making a Gift

3. The Logistics of Altruism

4. Collection Regimes and Donor Populations

5. Organizations and Obligations

6. Managing Gifts, Making Markets

Appendix: Data and Methods



Society for the Study of Social Problems: C. Wright Mills Award

Association for Research on Nonprofit Organizations and Voluntary Action (ARNOVA): Outstanding Book in Nonprofit & Voluntary Action Research

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