The economics of symbolic goods and the creation of a favorable environment for organ and tissue donation: an analysis of campaigns to promote organ and tissue donation

Abstract

This article aims to analyze which are the symbols that the National Transplant System (STN) produces to build a favorable environment for organ and tissue donation. The study is based on the analysis of symbolism in advertising discourses of Brazilian organizations that promote organ and tissue donation. A theoretical plan is presented to discuss the principles at the base of the economy of symbolic exchanges within a social logic. The article argues that this process stimulates altruistic behavior and aims to avoid the mercantile behavior around organ and tissue donation. In the empirical plan, a semiotic analysis in organ donation advertise campaigns was conducted, observing that public and private actors use a set of symbols aiming to establish subjective truths that stimulate the donation in opposition to mercantile behavior.

Keywords:
economics of symbolic goods; socioeconomics; organ and tissue donation; advertising campaigns

Resumo

A partir da análise dos simbolismos presentes nos discursos publicitários das organizações que atuam com doação e transplantação de órgãos e tecidos no Brasil, o estudo tem como objetivo analisar quais são os símbolos que o Sistema Nacional de Transplantes (STN) produz para a construção de um ambiente favorável à doação. Para isso, parte-se de um plano teórico que discute os princípios que estruturam uma economia das trocas simbólicas no interior de uma lógica social, que estimula o comportamento altruísta e procura evitar o comportamento mercantil desses bens raros. No seu plano empírico, a partir da análise semiótica, observa-se que os atores públicos e privados intervenientes atuam na elaboração de símbolos capazes de estabelecer verdades subjetivas que estimulam a doação, em oposição ao comportamento mercantil.

Palavras-chave:
economia de trocas simbólicas; socioeconomia; doação de órgãos e tecidos; campanhas publicitárias

Resumen

A partir del análisis de la simbología presente en los discursos publicitarios de las organizaciones que trabajan con la donación y el trasplante de órganos y tejidos en Brasil, esta investigación tiene como objetivo analizar cuáles son los símbolos que el Sistema Nacional de Trasplantes (STN) se utiliza para la construcción de un entorno favorable a la donación. Para esto, fue construido un plan teórico que analiza los principios que sustentan una economía de intercambios simbólicos dentro de una lógica social, que estimula el comportamiento altruista y busca evitar el comportamiento comercial de estos productos raros. En su nivel empírico, a partir de un análisis semiótico, se observa que actores públicos y privados actúan en la elaboración de símbolos capaces de establecer verdades subjetivas que fomentan la donación a diferencia de comportamiento comercial

Palabras clave:
economía de los bienes simbólicos; socioeconomía; donación de órganos y tejidos; campañas de publicidad.

1. Introduction

The development of science and technology in the XX century propelled the practice of transplantation of organs and tissues, creating a new form of commerce between humans. Considering commerce a transaction of economic goods, without the necessary use of money, defferent from a mercantile relationship, which is characterized by monetary exchange in a buying and selling environment. In the case of organ transplantation, donation assumes the role of the commercial base over which economic goods are exchanged through a complex and hybrid system that articulates donors, service providers (hospitals), regulatory agencies (State) and recipients, while dealing with considerable financial figures (Steiner, 2010).

Differently from the traditional donation, which follows a pattern where individuals donate goods directly to others (gifts or charity), post mortem organ donation is (1) made to an organization that employs technology and medical staff; (2) does not depend only on the intention of the individual, expressed in life, but is conditioned to the authorization of family members; (3) involves an anonymity regimen, in which donor and receptor do not meet, creating a system of social solidarity guided by an abstract moral benefit; (4) involves considerable symbolic complexity between the dimensions of life and death, such as the experience of grief, taboos, access to information and moral and religious codes (Duarte et al., 2002; Moraes and Massarollo, 2009; Roza et al., 2010; Pessoa et al., 2013).

Therefore, the rearing of an environment favorable to donation requires work in the symbolic level from the organizations involved in promoting and operating the organ donation system, aiming to create an exhortation economy. In other words, typifying the environment in which the donation occurs as an economy of symbolic exchange (Bourdieu, 1980, 1994, 1997), the organs can be understood as economic goods marked by a strong symbolism (life and death), because they operate under a dual truth — ambiguity between objective reality and subjective truth — their economic action is converted in social reality and produces perceivable and valuable social results (moral benefits) (Bourdieu, 1994).

The present study intends to understand the symbolic resources used for the creation of a favorable environment to post mortem organ donation. Thus, the discussion in this paper seeks to bring, in a broad sense, light into the discourse from the organizations that work with organ and tissues donation and transplants in Brazil and its implications in the creation of a market of symbolic goods. The interconnection between the market and social life is regarded as altering the forms of exchange in a diachronic mode — not only the market transforms social norms, but also social narratives transform the market transactions (Polanyi, 2000). The donation of organs and tissues is a rich ground for the analysis of those interconnections, because it involves at the same time social norms and contractual exchange (Steiner, 2008, 2010) and combines elements from culture (Zelizer, 1979, 2010). Granted this, it is possible to understand exchange scenarios different from those financially oriented, which have already been broadly explained by the theories of economic performativity (Helgesson and Kjellberg, 2013; Geiger, Kjellberg and Spencer, 2012). By emphasizing the symbolic exchange of goods, the importance of investigating the variety of arrangements that shape economic actions beyond those involving a direct trade of goods and money is underscored.

Based on those premises, the study applies a semiotic analysis of advertisement pieces used to promote organ donation recently broadcasted in Brazil by public and private agencies associated with the National System of Transplantations (Sistema Nacional de Transplantes — SNT). Advertisement pieces are recognized as cultural documents, as a form of presenting and understanding the world (Mick, 1986). Based on this assertion, advertisement discourse has been adopted as a valid element for the comprehension of the values that circulate in a society, given its power of fusion between the product announced and the representation of a culturally constituted world (McCracken, 2003). Therefore, semiotic analysis is used as methodological support regarding the construction of a market of symbolic goods for the donation of organs, through the study of advertisement pieces.

2. Theoretical fundaments

2.1 Symbolism and the creation of an environment favorable to donation

From an economic point of view, the pathway between the donation of an organ and its transplantation is significantly complex, given the need to articulate two different regulatory systems: while the donation is based on altruism and gratuity, the transplantation involves a significant financial sum - involving aspects such as staff remuneration, pathological exams and the technological costs (Steiner and Trespeuch, 2014).

From a social point of view, the singularity of this economic transaction resides on the condition that the availability of an organ that may potentially save or prolong a human life depends on the death or mutilation of another individual. Thereby, a moral debate emerges marked by the influence of culture and affectivity in economic transactions (Zelizer, 2010), considering that the organs are considered a morally questionable commodity, because their circulation affects the intimacy of individuals and threatens the public order, triggering discussions that divide the opinions of scientists, jurists and legislators (Radin, 1996).

Since Brazilian legislation prohibits the sale of organs as a method for increasing the offer, the public and private agencies that form the SNT seek to broaden the number of donors through advertisement campaigns that stimulate solidarity and social altruism, connecting economically oriented agents and regulatory actors of this commerce through the adoption of strategies that bring the donation of organs close to the construction of a “market of symbolic goods” (Bourdieu, 1980).

Pierre Bourdieu’s theory for the exchange of symbolic goods is employed in the interpretation of the economical exchanges as those trades organize and orient the social relations within a socially acceptable pattern in order to strengthen the bonds of altruism and solidarity. Inside this spectrum, emerges the matter of the social dispositions put into practice to build an environment favorable to donation, combining symbolic transactions and financial amounts allocated for the payment of the surgeries and transplantations.

Even though the “donation of organs” is a “gratuitous” exchange of economic goods, in opposition to monetary exchanges, those economic transactions are marked by symbolic exchanges capable of creating a hybrid system, in which donation coexists with economic practices (Steiner, 2012). In order to reach a deeper understanding of this dubious relationship between donation and economic exchanges it is necessary to rethink the tradition of the concepts of donation, altruism and social solidarity. While the sociological tradition on the subject of donation (Mauss, 1923; Malinowski, 1922) allows for understanding the “fabric of solidarity” in a given society, donation begins to occupy a prominent place in modern debates. This prominence takes place as donation is moved towards the primary dimension of social life and is guided by the bureaucratic and mercantile norms of utilitarian efficiency. Modern donation produces an innovation as it enables the “donation to strangers”, allowing individuals to escape the enclosed aspect of interpersonal relationships, characteristic of pre-modern societies (Steiner, 2015).

Modern donation is, therefore, a donation to the organization, referred to as organizational donation. The organizations are able to articulate previously atomized individuals. This condition significantly altered the social morphology of donation, since the modern atmosphere for donation needs organization to occur. The organization plays a twofold role: on one hand, it separates individuals to preserve their autonomy and, on the other hand, it connects them through fragile and ephemeral bonds to ensure donation. However, fragile bonds do not equate precarious bonds or lack of solidarity. For this reason, modern donation begins to be understood through the framework of a solidarity model that seeks for the autonomy of the individual in its attempt to escape the enclosed social relationships pattern, typical of archaic societies. The organization, thereby, presents itself as a condition for the possibility of the donation considering that the separation is created by the organization to enable the donation itself to take place.

In the same direction, to Bourdieu (1994), the symbolism present in the donation and in other economic transactions suggests that modern societies did not abandon symbolic exchanges, even within the context of instrumental rationality. His researches evidence that subjects such as symbolic violence, symbolic capital and symbolic exchange economy are inserted in this agenda, displaying how the symbolic dimension plays a central role inside modern social life (Bourdieu, 1994).

Following the Kantian tradition, that considers symbols as instruments for the understanding of the world, Bourdieu (1994) suggests that they are instruments for social integration with the power to build a social reality. The interpretation of the world provides a sense that is collectively shared, presuming the accordance between the participants, possible via the habitus, through its three basic principles: operating in an ambiguity between two truths (objective reality and subjective truth); converting economic action in symbols and, establishing social rewards in the form of moral values, such as prestige and reputation.

In this regard, economic transactions demonstrate the sharing of cultural perceptions and personal relations. Those shared comprehensions between people and their relational habits are socialized and guide people in the construction of a sense of what is or is not a good exchange, which, even perhaps incompletely, foments a redistribution system (Zelizer, 2010). Therefore, the key to understanding the redistribution systems resides in the fact that people and institutions apply symbolic-material distinctions that signal moral commitment and projects of value, as well as they build frontiers and connections between them and others. Therefore, from the perspective of the symbolic exchanges, the redistribution of symbolic goods may carefully involve individual economic strategies that organize symbols in order to build meaning and moral basis. Those aspects are observed in the SNT, especially the convergence between its organizational format and the observance of the regulatory landmark for the production of materials that create an environment favorable to the donation.

2.3 The National System of Transplantations (SNT) and the environment for organ donation in Brazil

Brazil holds the largest public program for transplantations in the world. From the entire amount of surgeries that take place in the country, 95% are disbursed by the Brazilian Unified Health System (SUS), involving over 1.376 medical staffs and annual spending surrounding one billion reais (Brazilian Health Ministry, 2015). Those resources are transferred to the public and private transplant health facilities in order to finance the treatment given to patients. The costs involved in each transplant are variable and encompass services such as examination, removal, implant, medications and post transplant treatment, including the logistic cost with airway transportation (Brazil, 2014). The State finances this system benefitting professionals, companies and users (donors and recipients), differently from other countries, such as the United States, where the patient (eventually through health insurance) directly affords all the costs involved in the transplantation.

The SNT is regulated by the Brazilian Healthcare Secretariat (SAS) and works via the Central for National Notification, Harvesting and Donation of Organs (CNNCDO), which commands the local Centers for Notification, Harvesting and Donation of Organs (CNDO), spread throughout 24 states and the Federal District. The system was instituted by Law 9.434/1997 — which also defined the regulatory landmark for the donation of organs and tissues. Besides creating a new concept, more centralized, for the organization and management of the system, and criminalizing organ buying and selling practices, one of its main innovations was the inclusion of the “presumed consent”. On its fourth article, the law affirms that, “except when manifested otherwise, under this law, the donation of organs, tissues or human body parts is presumed authorized for the purpose of transplantation or treatment post mortem” (Brazil, 2015:1).

However, the issuing of Law 9.434/1997 was polemic because it required non-donors to expressly declare their will in an identification document (ID Card or Driver’s License), which generated skepticism in the population, focusing on the expansion of the expressed refusal. The population did not welcome the legislation because it also formalized the presumed consent without the need to consult with the family members. The social reaction to the law influenced the immediate enactment of a Provisional Measure (number 1718/1998) that included the express authorization from family members for donation. This revise was confirmed by the approval of Law 10.211/2001 which once again empowered the family of the potential donor, creating a monopoly of the familial decision over individual intention. (Maynard et al., 2016).

A review over Brazilian legislation shows there was an attempt to normalize the public expectancies and the express prohibition of the organ market. In fact, the high financial costs involved in the transplantation, as well as the risk of prevalence of the economic power could stimulate the clandestine organ market. Mediated by moral and cultural aspects, the encouragement towards donation does not represent a rupture from postulates of the traditional bioethics while at the same time employs the relationship between the State and the private entities to create an environment favorable to the donation. The main instrument employed is the development of campaigns to create an exhortation economy, where symbols play a role on orienting altruistic practices and developing social solidarity (Steiner, 2102).

The ability to build a market for symbolic goods of organs and tissues relies on the competence of those institutions in properly utilizing the symbolic resources. Thus, the analysis of the symbolic constructs targeted by the advertisement campaigns of the organizations that work within the SNT evokes a subject capable of generating repercussions regarding the practices adopted to foment behaviors and postures loaded with taboos.

3. Method

The present survey employed a qualitative-interpretive approach through the identification of empirical categories that refer to the symbolic dimensions expressed in the advertisement campaigns for stimulating organ donation. Considering this an interpretive study, the subjectivity of the researcher pervades its development. However, it is possible to foster broadened reflections, free from hypothetical ties and to open the possibility of new discoveries exactly because of the use of subjectivity (Larkin, Watts and Clifton, 2006).

A research corpus was organized, composed by advertisement pieces, more specifically folders and banners, from the so-called “awareness-raising campaigns” for the donation of organs and tissues. The criteria for the selection of material observed two aspects: 1) currentness of the production — opting for campaigns broadcast between the years of 2011 and 2015, comprising a five year period, and 2) the character of the organization, namely, its legal and operational nature. On this matter, two different types of organizations directly involved with the SNT were considered: governmental (Health Ministry and State Health Secretariats) and private organizations (which aim to organize and to promote the donation of organs). Regarding the private organizations, this study collected campaigns from the Brazilian Association for Organ Transplantation (ABTO) (the only entity that maintains a regular flow of advertisement campaigns on the matter, capable of supplying a record for analysis). Overall, the research corpus was composed by 14 advertisement pieces identified.

Both the visual matrix, namely, the images presented in the pieces, and the verbal matrix, explanatory texts and slogans, were taken into consideration in building the research corpus. In order to analyze and interpret the corpus, a singular methodological path was taken, with the choice to use semiotic analysis (Halliday and Hassan, 1991) as a methodological tool and not as a theoretical-conceptual element. This distinction is deemed necessary because the market of symbolic goods, originated form economic sociology, is considered to have a greater capacity than semiology in theorization regarding organ donation.

The analysis process followed a specific script composed of three fundamental steps, following the guidelines of Santaella (2001). The first step consisted of a qualitative identification of the signifiers, namely, emphasizing the textual and visual matrix of each piece, highlighting the elements responsible for the first impression caused on the receiver. Despite the subjective character of the qualitative identification, Santaella (2001) underlines the fact that this initial interpretation happens through iconic resemblance, and has a tendency to have a more plain suggestive power. Therefore, the authors of the article chose to perform this step.

Stemming from the elements stressed in the first step, a second glance was adopted, geared towards the phenomena, attempting to build signification through the perceptual capacity of the researcher. To this end, the situational aspects of the pieces were taken into account, namely, the universe to which the sign belongs. For example, a heart might symbolize affection, but in the universe of a campaign for the donation of organs it also produces meaning as a human organ viable for donation. The second step took place through a triangulation between the three authors. After conducting the individual analyses, the individual analysis boards of each researcher were compared, seeking for unity in the interpretation.

Finally, through the identification of the regularities embodied by the signs, which worked as a guideline, symbolic conventionalization was pursued. The conventionalization is a culturally directed process and represents an interpretation of the recipient (Santaella, 2001). However, it demonstrates potential for a fluctuating analysis of the campaigns and their intention to influence inside the context in which the piece was developed. Thereby, this stage also involved a triangulation between the authors and a greater degree of abstraction, aiming to comprehend the signs of each campaign within the context and the intention of the transmitter as an actor in the construction of a market of symbolic goods.

4. Description of the research corpus

Figure 1 presents the advertisement pieces that composed the research corpus, describing both the textual and the visual matrix, taking into account the year of publication and the actor responsible for the piece

Figure 1
Textual and visual matrix of the research do corpus

5. The symbolical production surrounding organ donation

It was noticeable that in the campaigns to incentive organ donation several public and private organizations have been adopting similar discourses in the construction of significations surrounding organ donation. However, those discourses hold important differences in the symbols they transmit to the receivers. Those symbols may represent the construction of softer or stronger significances to incentive donation. In order to illustrate those significations, we initially present the campaigns held by the Brazilian Health Ministry, through the selection of three different pieces, presented in image 1.

In the poster for the 2013 campaign, from the Brazilian Health Ministry the picture shows a boy who received a heart transplant (Mateus Lazaretti) in front of a birthday cake with lit candles. On the top portion, the sentences: “Don’t let life fade away: be an organ donor, talk to your family”. A folder from the same campaign shows a girl, Nívea Alves, from the city of Fortaleza, also benefited by a heart transplant. Invoking the words from the previous piece, the material adds the following plea:

Leave your eyesight for the man who never saw the sunrise on the arms of his loved one. Leave your heart for the woman who lived to make her son’s heart happy. Leave your example and, most importantly, let your family know your desire to be a donor. Those who leave their best, let life flow on.

The federal campaigns present a few important protruding aspects for the understanding of the incentive for organ donation: in the first place, they operate in the life-death ambivalence and resort to the association between the words “life” and “donation”. The word donation is always present in all of the pieces, being linked to transplanted people who show health and happiness. The concept of happiness seems to permeate the communication from the Brazilian Health Ministry, while the connection between donation and happiness seems to incite in the receivers and idea of social altruism, in other words, through donation it is possible to make other people happy. In all the communications, the subjects portrayed show a smile, which is the evidence of the happiness they desire to portray. This portrait of happiness is a way of inciting the individual to project this feeling in advance, by making the decision to become an organ donor.

Image 1
Brazilian Health Ministry campaigns

The symbolism adopted by those communications to incentive the “purchase” of the organ donation, in the federal campaigns, shows an intention to develop in the potential donor the feeling of happiness to be performing an altruistic deed. Therefore, the discourse involves a happier and more joyful understanding of organ donation through the social benefit it can generate. By interpreting the discourse in the context of the sender it is possible to observe a strong intention to generate positive stimuli towards donation in life, attempting to stimulate the receiver to manifest the intention of being a donor.

In turn, the campaigns broadcast by the sate secretariats, evidenced in Figure 2, involve other symbolic representations to reach the same purpose of encouraging one to manifest in life being an organ donor.

Image 2
Campaigns from the State Health Secretariats

The piece shown in Image 2, clearly directed towards the potential donor, evidences the figure of the hero. The hero attempts to invoke feelings of overcoming, conquest and pursuit of social wellbeing through personal sacrifice. Also, the face of the donor is not displayed, portraying the fact that donation is something anonymous. The campaign from the state of Pernambuco, in partnership with the Children and Maternal Institute Prof. Fernando Figueira, also makes a synergetic use of the visual and textual aspects to stimulate a feeling of guilt in the audience. The poster shows a child (girl) apprehensive next to a dumpster, next to the following statement: “One of them is going to receive your organs. You decide which one.”. The discourse suggests, then, that not donating the organs is equivalent to throwing them in the trash. Thereby, the campaign seeks to momtivate the donation through a behavior that may be negative within the society, linked to waistfulness and not seizing the organs, which are something important not to be discarded.

Differently from the federal government campaigns, the State Health Secretariats try to cause impact through an “after-death” position, that is, the role of the donor after death, attempting to cause commotion in order o stimulate the organ donation. The communication from the state secretariats attempt to send to the individual a negative feeling of regret for not contributing to the social wellbeing and not aiding others. Those pieces appeal to the social element and to the feeling of belonging to a social group as a way to incentive organ donation.

Despite those advertisement pieces having a different appeal from those broadcast by the federal government, the tonic of both discourses is to stimulate the citizen to perform a social role as a donor and to warn about the importance of communicating relatives in order for the donation to take place.

Alongside public institutions, there also are private entities that produce advertisement campaigns to stimulate the donation of organs and tissues. Image 3 presents communication broadcast by private organizations.

Image 3
- Materialsfrom private organizations

ABTO is the private organization with the greatest number of campaigns to stimulate organ donation. The entity is a medical society, nonprofit, that seeks to stimulate, gather professionals and establish the norms for the donation of organ and tissues. Among their advertisement pieces, the “2013 Campaign for the donation of organs and tissues” uses a popular vocabulary, frequently seen in posters glued to lampposts in the streets, articulating the universes of popular beliefs, and magic and sacred rituals. The slogan “We bring your loved one back, but we depend on you: be an organ donor” attempts to evidence that donation allows for the life of a loved one to continue in the body of the person who receives the organ. This communication, directed at the families of potential donors, suggests a second conclusion that there is a strong emotional appeal for the donation of organs, creating emotional bonds between the families of the donors and the recipients. It is important to remember that Brazilian law prohibits the disclosure of data form the recipients to avoid those “emotional transferences” by the family.

The second piece from ABTO, also part of the 2013 campaign, presents the slogan “Be someone else’s heart”, along with the image of two overlapped people. While the person who makes a gesture of handing over (donation) the heart and a visual resource portrays a suit as clothing, the person receiving the donation wear white (representing life, contrasting black, usually associated with death, in western culture). The clothing of the recipient carries an ideal of youthfulness, conveying the image of someone who has an entire life ahead.

Looking at the institutional context, the idea in this material is oriented towards stimulating altruistic donation values. The campaigns seek to generate the idea that through the donation of organs people are acting fraternally and generously with other. In this case, the discourse does not assume a fomenting character (stimulating people to become donors), but actually seeks to instill in the audience the meaning of altruistic donation.

When analyzing the discourse adopted by the government and by entities dedicated to promoting organ donation, it is possible to observe that both utilize symbols and significances associated with altruism in the construction and stimulation of the commerce of organ donation. Despite the participation of pharmaceutical companies in the campaigns, jointly with social entities, the State plays a key role in the organization and operationalization of this commerce. The highlights empirical evidences are analyzed subsequently, in the light of the theoretical framework of the study.

5. Conceptual implications and for public policies

Reflecting on the results of this research, two main aspects emerged to illustrate the construction of a market of symbolic goods for the donation of organs and tissues in Brazil: (1) the campaigns wager on the concept of altruism in order to remove the idea of a market; and (2) symbols are proposed for the creating of an environment favorable to the donation.

Regarding the first aspect, the actors involved make an effort to stimulate the desire to donate without inciting a market behavior (utilitarian and mercantile) capable of destroying social order (Steiner and Trespeuch, 2013). In practical terms, the exhortation policies need to be inside the symbolic framework that formats solidarity and altruism, associating the organs with the strengthening of social bonds, while discouraging mercantile rationale.

For that matter, the common aspect between all of the pieces analyzed is the strategy to change the meaning of the economic action through “symbolic marks” that circumscribe its usage and function (Zelizer, 2005). In other words, the relationship between economic rationale as a donor and the influence of collective values and beliefs in social action create the characteristics of this specific type of commerce.

On this matter, it is important to highlight the fact that there is no buying and selling relationship between donor and recipients. What takes place is an exchange of symbolic goods (life and death). Therefore, organ and tissues donation involves the denial of financial mercantilization, but is similarly attached to the justification through a mechanism of trade. As exposed by Healy and Krawiec (2012) the donation of organs is not a merely financial exchange, but it does not constitute a gift. Therefore, the argument is that even in the commerce of symbolic goods, the price that is attributed to a good is taken into consideration. In the commerce of organs and tissues, it is interesting that the regulatory agencies establish valuation criteria in different ways, in order to build a behavior that is uninterested in financial payback, but based in other interests, such as altruistic gains that ensure the maintenance of an interest in donating.

Following this perspective, the pieces seem to reinforce the idea that the so-called “altruistic emotions” are more efficient than the market rationale to incentive the donation. Even when demanding a choice between donating or throwing the organ in the trash (implying that organ donation is between “throwing away” and “donating to someone”), the advertisement pieces suggest a moral choice, blaming the lack of altruism and suggesting the donation of feelings of compassion that surpasses the rationalistic approach. Those conclusions show clues to redefine also the understanding of “altruism of organ donation” (Moorlock, Ives and Draper, 2014), setting it apart from other forms of altruism seen in society and used as foundation for the formulation of public policies for encouraging donation. In this case, the results strengthen the notion that organ donation is a modern form of donation (Steiner, 2012; Steiner and Trespeuch, 2014), in which the manifestation of altruism emerges as an element of social binding and maintenance of reciprocity bonds. Hence, it is necessary to consider the specificity of the altruism that involves organ donation, instead of ascribing the moral challenge of its efficiency over this kind of donation. In other words, it is necessary to recreate forms of encouraging altruism form the specific characteristics of this kind of donation and the existing social conditionals rather than proposing market alternatives that might be proven inefficient in this kind of commerce.

All the symbolism present in the campaigns analyzed seeks to stimulate the desire to be a donor and ensure support to this decision from family members. This donor should act guided by altruism, generosity, solidarity, attempting to convert the practice of letting go of an organ into a valued and positive social action. One evidence is the fact that the subject of the sale of organs (legal or illegal) does not appear in the discourses. This “lack of appearance” contributes to show that the materials seek to motivate interest towards donation, while avoiding to incentive a purchasing desire. Noticeably the themes of sale or even trafficking of organs is not present in any of the statements, which allows to reinforce the idea of the altruistic practice versus financial profit. It is important to mention that this process is eased by having a central organization, capable of ensuring not only the identity, but also articulate action around the benchmarks of common symbolic orders, despite the sender of the message.

A second aspect evidenced by this study is the emergence and the structure of an economy of symbolic exchanges based on three basic principles: the symbols operate in the ambiguity between two truths: objective reality and the establishment of a new subjective truth; economic actions are converted into social reality through collectively accepted symbols and; the shared symbols stimulate the social behavior through valued moral benefits, such as prestige and reputation (Bourdieu, 1994).

The first principle of this economy of symbolic exchanges is evident in the group of pieces analyzed, as they clearly attempt to hide the objective reality of death, mutilation and, in a sense, body defilement, in exchange for a new subjective truth, specially oriented to the family of the donor: the prolonging of life through the act of the donation. According to the literature, the taboos and beliefs involving the relationship with the body after death are very strong and have a performative effect over the decision of family members regarding the body’s destination. It is against this subjective reality that a new subjective truth is built. Life and death play an important role in the emphasis given to life as a subjective truth, in the face of death and finitude, which presents itself as objective reality. The campaigns from SNT and the pieces form ABTO (“we bring your loved one back” and “be someone else’s life”) emphasize this idea by directing the communication to the family of the donor.

The second aspect, regarding how economic truths are converted into social realities through collectively accepted symbols, stimulates the altruistic economic action, as it demands an attitude from the potential donor. The example of this is in the piece that proposes a moral choice between donating an organ or discarding it, stimulating the idea of the rare value attributed to this good, and that wasting it would be economically irrational.

Finally, the third principle — that the symbols stimulate social behavior by offering moral benefits — was also evidenced, especially in the piece that presents the act of donating as heroic. By emphasizing the potential heroism in the donation of organs, the pieces clearly intend to communicate with the potential donor. Even though the chest of the donor shows a scarf, the social benefit of the donation is compensatory as it converts the subject of the action in a semi god, once he saves lives through his “almost invisible” mutilation. This result surpasses the notion of mere usefulness and proposes social status of good reputation and prestige to those who adhere to the practice.

6. Final considerations

Facing the purpose of analyzing which symbols are produced by the system to build an environment favorable to organ donation, the results contribute to an interdisciplinary discussion that involves aspects from communication and from public governance, from the theoretical lenses of sociologic economy.

Thereby, a more distinctive concept is able to evidence a broader form, regarding the relationship between donation and economy of symbolic exchanges. The government and the institutions connects to the transplantation system are the main actors in the construction of this commerce, acting towards debunking the topic to broaden the practice of donation, combining cultural and moral elements to build a favorable environment. The symbols, produced to be collectively shared, seek to stimulate the behavior of the donor through a set of strategies that support this form of economic transaction. In other words, the pieces wager in the performative capacity of the symbols within the perspective of creating and environment that stimulates and prizes organ donation.

The reflections presented in the study allow for the understanding of the mechanisms and their possible influence in the creation of an economy of symbolic goods in two respects: (1) reinstates the importance of symbolism in formatting social interactions, especially in the work to signify the economic exchanges within and order that is beneficial to social order; and (2) identifies the place of donation within the economic context showing the effort to create an environment favorable to donation, in opposition to the mercantile behavior.

Within the scope of public policies, it is perceivable that the intervening actors have been attempting to build an environment favorable to donation from the dialogic life-death perspective, reinforcing the symbols “life” and “death”. However, those symbols encounter a social reality of reduction of the space to think death and its relationship to life (Veras and Soares, 2016). The exploration of feelings alternative from the idea of life-death and from donation as an altruistic gesture would enable the construction of new symbolic references for organ donation. This path may be interesting to raise new donors, allowing for other symbolic constructions. Granted that, policy makers may have clarity regarding their audience (if the potential donor or the family of the potential donor) and which symbols can be utilized to encourage the occurrence of organ and tissues donation. In addition, the symbolic construction portrayed in the work may assist policy makers in understanding which symbolisms should be more connected to the stimulation of a donor behavior.

Nonetheless, new researches are suggested for contemplating other forms of communication, such as audio messages broadcast in the radio and televised communication. We believe that other communications may bring a more complete overview over the symbols utilized. Another important aspect to emphasize is that the communications were analyzed in the perspective of the sender, giving voice to the policy maker and enabling the understanding of the motivations and interests of the sender organizations through symbolic comprehension. Future studies may explore the perspective of the receivers, namely, exploiting how the subjects receive the communication and how they interpret and react to the symbols utilized. That would enable the construction of an analysis plan in a critical view of the intention of the public policies and the way those intentions are met by different audiences, allowing to qualify the strategies and the impact of the public policies. Finally, by giving the receivers a voice, future studies may also complement the perspective raised in this study regarding a donor behavior, form other theoretical perspectives to recognize new symbols and significances that the commerce of organs brings into circulation.

Morals and markets: the development of life insurance in the United States. New York: Columbia University Press, 1979.

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  {Translated version} Note: All quotes in English translated by this article’s translator.

Publication Dates

• Publication in this collection
  May-Jun 2018

History

• Received
  08 Oct 2016
• Accepted
  27 June 2017