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This chapter presents a global analysis of the phenomenon referred to as “transplant tourism.” It describes how patients with the financial capability procure organ transplants illegally from abroad. The globalization of organ and tissue markets highlights how the economic inequities that propelled Jesica and her family to travel to the United States in search of health care also encouraged other poor people of the world into selling their organs.

Following Jesica Santillan's death, the United Network for Organ Sharing (UNOS), the nonprofit organization that oversees the country's organ allocation network, reaffirmed its commitment to ensuring public confidence in the transplant system. This chapter examines the historical formation of UNOS and analyzes why public confidence is a paramount priority for transplant policymakers. It discusses the cultural-technical organization of matching, the efforts to promote organ donation, and the politics and economics of organ allocation. Overall, the chapter explores how the matching of available organs with worthy recipients has historically intersected with American debates over scarcity, abundance, fairness, equality, and public confidence.

This chapter analyzes whether the Santillan story fits into the larger politics of immigrant access to health care. It describes how the Santillan case highlighted and obscured central themes in immigration and health care in America with its ongoing tension between the contradictory impulses of sympathy and exclusion. The chapter also discusses access and rights to health care before 1986, the Immigrant Reform and Control Act of 1986 (IRCA) and the 1996 Welfare Reform, immigration and health care in North Carolina, eligibility for organ transplants, and the politics of charity and sympathy.

The events and commentary surrounding Jesica Santillan's case raised profound questions about the criteria used to justify her eligibility for organ transplantation and whether her citizenship should have had any bearing on whether she was eligible to access high-end technologies like transplant surgery. This chapter examines the extent to which “citizenship” is a morally relevant policy criterion in America for determining access to scarce resources. It also examines the place of humanitarianism, charity, and social philanthropy in shaping allocation and access in the American system.

This chapter investigates the growing trend in high-risk, high-technology experimental pediatric research in America and the problematic relationship between experimentation, transplantation, and children. After considering specific details Jesica Santillan's story, it turns to a more general discussion of experimental research in transplant medicine and the significant role occupied by children. Though transplantation is viewed as a miraculous procedure that helps prolong thousands of patients' lives, the chapter encourages the readers to ponder the ethical challenges posed by bringing children into the transplantation arena.

Jesica Santillan's botched transplant garnered intense media attention and fueled the ethical argument regarding the organ allocation system in the United States. With thousands of people on the waiting list, many people wondered why an illegal immigrant received organs from an American citizen so quickly. In this chapter, the different features of public ambivalence toward organ donation and transplantation are examined. It describes how the Santillan transplant emerged into the public sphere and how authors and commentators articulated the meaning of this case.

Jesica Santillan's death after a donor-recipient mismatch during transplantation shook people's confidence in transplant surgery and the organ donation system in the United States. This chapter sketches the process of organ transplantation relevant to understanding donor-recipient mismatches. It analyzes the dynamics of the transplant system, the manner in which a variety of factors surrounding organ transplantation play out in the conduct of patient care, and the complex biological, administrative, and social issues involved in allocation and determining compatibility between donor and recipients.

Tom Diflo is a clinical transplant surgeon who has performed almost 1,000 kidney, liver, and pancreas transplants in the United States. In this chapter, Dr. Diflo provides insight on the complexities and crucial aspects of transplantation. The chapter describes the buying and selling of organs, or “transplant tourism”, particularly the problem of Americans stepping outside the system and going abroad to purchase organs in the black and gray markets of other countries. The root cause analysis on the Jessica Santillan case at Duke University Medical Center and the changes they implemented are also examined.

This chapter examines the transplant error in the Jesica Santillan's case and the main actors in the story (from Duke University Medical Center to Carolina Donor Services, from the United Network for Organ Sharing (UNOS) to the surgeon Jim Jaggers) in order to frame our understanding of medical mistakes as individual, institutional, and system-wide phenomena. Jesica's story illustrates how stakeholders transform celebrated cases to provoke discussions in public arenas and use as dramatic examples of formulating policies to prevent and/or reduce medical errors and achieve patient safety. Focusing on the theoretical understandings of systems error, the chapter analyzes how this mistake was understood at the time and examines the steps taken by the Organ Procurement Organizations (OPOs) and Duke to reassure the public that the causes of this error had been discovered and fixed.

Jesica Santillan's second heart and lung transplant on February 21, 2003 became a controversial turning point that generated a wide range of problematic, uninformed, or widely speculative commentaries. This chapter focuses on the public and professional discussions about whether Jesica received special treatment. Critics observed that the second transplant brought the key issues of the case together: the problem of illegal immigration, questions about the appropriate use of scarce resources, preexisting debates over medical futility, and the proper remedies for medical error. The chapter examines how all these complex issues played off of one another as the public and professionals debated over Jesica's second transplant even as the issue of “second chances” took on vastly different meanings.

Focusing on the central ethical issue of Jesica Santillan's case, this chapter discusses the question of whether transplant organs were allocated justly. Specifically, it analyzes how notions of justice should, and should not influence organ matching and that organ allocation should be governed by the principles of “clinical justice”. The chapter also provides insight on the United Network for Organ Sharing (UNOS) policy and the ways in which issues of urgency, efficacy, equity, and the interests of small transplant centers are weighed in organ allocation.

This chapter describes how the mestizo author El Inca Garcilaso de la Vega concludes his account of Hernando de Soto's expedition to Florida with a tale of Floridians in Spain, whose displacement reflects the author's own distance from his Peruvian homeland since his early twenties. It traces La Florida's multiple crossings in order to explore the relationship between Garcilaso's strategies of self-authorization and his reworking of the motifs of captivity and exile. For Garcilaso, transplanted individuals such as captives and exiles are essential to transmitting accurate and useful knowledge across cultural borders, yet La Florida's final episode offers a negative example of such a mediating role. It becomes a narrative of a double crossing: a transatlantic round-trip and a duplicitous revenge.