Citizenship, Identity, Blood Donation

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DOI: 10.1177/1357034X05052464
2005 11: 113 Body & Society
Kylie Valentine
Citizenship, Identity, Blood Donation
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KYLIE VALENTINE
Blood donation has long been known as a public act of altruism. Indeed, Richard
Titmusss well-known analysis of donation in the 1970s argued that it is a
uniquely altruistic practice. Outside the obligations and reciprocities that char-
acterize Mausss gift system, and untainted by the strictures of the market, blood
donation remains proof against the philistine resurrection of economic man
(Titmuss, 1997: 60). This description of donation as a public gift can also be seen
in the campaigns and advertisements of blood collection systems. Blood banks in
Australia, as elsewhere, appeal to the goodwill and generosity of the public in
recruiting donors, and implicitly or explicitly identify donation as an act of
altruism more valuable than any other. Blood is described as the most precious
gift in these campaigns, privileging blood donation over the donation of any
other resource.
The more recent history of blood donation in Australia and elsewhere reveals
both an apparent prescience in Titmusss work and inadequacies in his guring
of blood as a circulatable, universal substance. Titmuss warned against the
commodication of donation, arguing that offering incentives to donors could
encourage dishonesty about their health status and lead to contamination in the
blood supply. Since his death, blood banks have become subject to risks beyond
anything Titmuss envisioned. Yet the contamination of Australian and other
blood banks with hepatitis C (HCV) and HIV occurred in precisely the
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conditions Titmuss recommended: donors were unpaid volunteers telling the
truth.
These contaminations, and later fears that blood supplies could become
contaminated with vCJD, have led to changes with regard to the publics invited
to donate blood. Voluntary donation has also been codied and made subject to
sanction. Titmuss writes that blood donation is unique among social gift trans-
actions because the goodness of the gift depends in part on the honesty of the
giver (1997: 127). The HIV and HCV contamination of blood supplies led to all
Australian states enacting legislation criminalizing false or misleading declar-
ations on the part of blood donors. These days, the altruistic motives behind the
donation of blood are more important than ever, but the nature of this altruism
has changed. The conditions of blood donation remain truth-telling and altruism,
but new truths need to be told, and the consequences of not telling them are
newly severe. At stake is not only the moral obligation to give to strangers, but
to give correctly.
While altruism remains important to voluntary donation, these events present
a disruption to hitherto useful models of donation and altruism. My aim here is
to present a new model of donation that accounts for it as both a public and
private act. Working from studies of blood donation as public altruism, I also
want to argue that Jeffrey Weekss guring of the sexual citizen offers a useful
means for discussing the importance of intimate practices and the embodied self
to public spaces. Blood donation, traditionally analysed in terms of its public
functions, emerges in the light of this analysis as the practice of an embodied self.
Especially interesting here are the ways in which this nexus of private and public
is known and negotiated by those with particular interests in the sphere of
donation: donors, those for whom donation is proscribed, those who receive
donated blood through transfusions or other medical procedures.
Weeks puts forward sexual citizenship as a corrective to limitations of
earlier notions of citizenship. He argues that sexuality needs to be included in
understandings of what makes the citizen and makes up the public sphere
(1998: 39). Weekss work extends feminist scrutiny of the often invisible
gendered constructions behind liberal models of the citizen, and is indebted to
feminist scholarship on the state, law and rights. This debt is acknowledged, as
is the influence of another separate but connected field of scholarship, social
movement studies. Also concerned with the state and claims made on the state,
some social movement scholars foreground new categories of identity, and new
modes of public activity. Based on practices of everyday life, and recognizing
hitherto unregarded markers of identity such as dress, demeanour and speech,
social movement studies examines the ways that individual and collective
114

Body and Society Vol. 11 No. 2
identities are formed and claims are made from those identities (Johnston et al.,
1992).
Feminism and the gay and lesbian movements are central to Weekss analysis
and social movement studies. A particular enactment of this mobilization can be
seen in the events surrounding the exclusion of gay men from blood donation in
New South Wales, Australia, in 1983. Mark Cortiula (2001) provides an account
of this exclusion, which was decided by the director of the NSW blood bank after
he attended a seminar on the possible spread of AIDS through blood trans-
fusions. The decision to declare a no-gay donation policy was sudden and
poorly explained. There was no consultation with community leaders around
this decision, which was instead announced in the media even before many blood
bank staff knew of it. It provoked an angry reaction from the gay community,
already mobilized around campaigns to decriminalize homosexuality and alert to
the homophobic meanings of phrases describing AIDS then in use such as gay
plague. Activist groups including the Gay Rights Lobby and the Sydney Gay
Solidarity Group organized much of the subsequent protest. Activists argued
that in the (then) absence of compelling evidence linking homosexuality and the
spread of AIDS through transfusion, the exclusion of gay men from donating
represented a slur against them. Gay men picketed the Clarence Street blood-
bank in Sydney, and handed out leaets accusing the director of bigotry
(Cortiula, 2001: 2079). The mobilization of gay men around these events was an
example of new realms of political claim-making and demands for recognition.
Blood donation was constituted during these events as not simply an act of
altruism, but as a participatory space of belonging. Exclusion from this space
became not simply an abstention from a specic act of charity, but the denial of
full participation in civil practices.
In this case, donation was politicized in a claim for recognition and belonging
by gay men. Donating here was constituted as a public sphere to which Weeks
sexual minorities claimed belonging. Homosexuality functioned as an identity
category in both the naming of a public newly forbidden to donate and in the
reaction of that public. Beyond these specic events, it is possible to examine
donation as a civil sphere in which the particularity of blood is crucial. Since
1983, other groups of people have been precluded from donating in Australia.
The Australian Red Cross Blood Service, for example, advertises on its website
that healthy people who are aged between 16 and 70 and weigh over 45 kilos are
eligible to donate, with two provisos. First, anyone who spent a cumulative
period of six months or more in the United Kingdom between 1 January 1980
and 31 December 1996 cannot be accepted as blood donors until further notice
(Australian Red Cross Blood Service, 2003). Second, unspecied guidelines also

115
need to be met: these refer to the ineligibility of injecting drug users to ever
donate, and the ineligibility of those having sex with an injecting drug user
(IDU), a gay or bisexual man, or a prostitute, to donate until 12 months have
elapsed since that sexual contact. Those with a history of residence in the UK are
thus classied as temporarily ineligible, and specied as such. The ineligibility of
other people, which is in some cases permanent, is incorporated into the category
of protective guidelines. Some identity categories, such as injecting drug users,
are used in other domains; some, like ex-UK residents, were devised especially
for this purpose. No one in good health is specically precluded from donation,
although actual eligibility for donation is much narrower than that.
Blood donation, then, remains a public practice at the same time that certain
kinds of public are precluded from it. Blood becomes Titmusss public, circu-
latable substance while retaining traces of intimate practices and identities.
Blood may no longer be seen as the origin and distillation of individual charac-
ter, but it still bears the imprint of intimate practices who weve had sex with
and what that sex was, what drugs weve taken, what food weve eaten and is
capable of carrying that imprint to another person. This kind of double
movement, whereby donating is represented as available to any healthy person
at the same time that signicant numbers of people are rendered ineligible to
donate, is not unique to blood donation. However, the signicance of altruism
to blood donating suggests some interesting questions. Blood donation has
become a strictly dened and nite civil sphere which promises an identity of
altruism and belonging to those who participate. What then is particular to the
body of the blood donor, and how are the civic practices of this body different
from those of non-donors? How do the dangers of contaminated blood supplies
inect understandings of donation as a civic practice? Who is the citizen consti-
tuted by the practice of or abstention from blood donation, and in what public
sphere?
It is this nal question that is considered in this article, or, more specically,
the question of exclusion from blood donation. Understanding donating as a civil
practice is useful in part because citizenship is always exclusionary. Benedict
Andersons famous imagined communities are nations with borders that set
limits on who can belong to those communities, and contests in the name of
citizenship have included contests over those entitled to make claims as citizens
(1983: 16). I am concerned here to examine some of the assumptions behind
the imagining of the citizen-as-blood-donor, and some of the ways that under-
standing of that category affects those who cannot assume it themselves. The
imaginative production of blood donation as a practice available to anyone who
ts the category of citizen conrms the importance of the intimate and embodied
116

self to the public sphere, but it also re-inscribes the boundaries of civic belong-
ing and exclusion.
This article is based on interviews conducted for a study on blood awareness
and hepatitis C prevention.
1
The following two sections will examine the
responses of interview participants to questions about blood donation includ-
ing questions about the imagined impact on blood donating if payments were
offered to donors, and how participants might feel about receiving blood in
conditions where donors are paid. The section following that, Exclusion,
examines representations of drug users as blood donors: representations that
reect both the attribution of moral derangement to drug users and the exclusion
of some drug users from donating.
Charity
The altruism of blood donation has been compared to other altruistic practices,
especially the donation of labour or money. When asked about similarities
between blood donation and charitable donation, a number of responses across
all categories placed these practices as proximate. However, about as many
responses again from donors, recipients and IDUs nominated blood donation
as not just different from, but more than charity, either in terms of the value of
the resource donated, or the effort of the donor, or both.
2
A few of these spoke
to the difculty of the process of donating for example, Bill (IDU): Its such
a personal, intrusive thing again. A hard thing to do physically. It can be distress-
ing and it can be unpleasant. A few others spoke to the exactness of the exchange
between donor and recipient: you can actually save someones life. Directly
(Jane, IDU). In one instance, blood donation was contrasted with the political
environment of social welfare charities: Like money can only do so much. Its
like putting money in a bucket for the homeless, its solving a temporary issue
and theres a whole lot of social, political obligations behind that (Trudy, donor).
Most, however, privileged blood over other forms of giving because of the
substance itself. Responses to other questions in the interview, around incorpor-
ation of blood into the body after transfusion, and whether blood in some sense
still belongs to the donor after donation, did not reveal any strong proprietorial
or symbolic attachment to blood (Waldby et al., 2004). Here, however, blood is
represented as something other than a disembodied resource, and donation of it
as something better, stronger (Jane, IDU) than other altruistic acts. Fiona, a
blood recipient: I dont think its the same as giving money to charity, anyone
can give money. When you give blood, its not like more, but its like they care.
Bob, a donor: Blood donating youre actually giving a bit of yourself literally. I

117
mean its human tissue, stuff that youre donating. So again, I think it is a bit
special. Several responses contrast blood donation with other acts of charity
with a description of giving blood as giving the self. Ryan, a donor: But when
you give blood youre giving away something of yourself, your own blood, so
its more personal to you. Like its part of you that youre giving away.
These responses correspond to the language employed in recruitment and
advertising campaigns of blood banks. In contrast to money or other gifts, blood
is seen as an urgent, immediate, life-saving gift. This may be attributed in part to
scepticism over the uses to which other resources may be put by social welfare
charities, and perhaps to the difference in cultural meanings between medical
emergencies and, say, poverty. Yet the value given to blood donation here reveals
an investment in blood and the donation of it that is not always shown in other
responses. Most responses nominate blood donation as equivalent to or more
signicant than charitable donations; in contrast, only a small number of
responses put forward blood donation as easier than other donations, because
of the relatively short time commitment involved and, in one case, absence of
contact with the recipient. The fact that blood is the most precious gift only
under specic conditions, that money or other resources are far more valuable
and possibly life-saving under different conditions, and that blood is used for
ongoing, routine procedures as well as in emergencies, is not visible in the
majority of responses, which reveal meanings invested in blood donation beyond
the instrumental. While blood is not sacralized, a strong sense of donation as
giving the self, in contrast to the donation of impersonal resources, is evident
here.
These discussions of blood donation disclose it as both a public act and an
intimate practice. Outside considerations of the social or cultural meanings
invested in blood sui generis, blood donation can be considered in the light of
theoretical models of the embodied subject and analyses that demand recognition
of corporeality as important to selfhood. Like many other interventions, the
process of donation itself disrupts any interpretation of the donors body as a
closed system. It pierces the skin, introduces the technical apparatus of collection
into seemingly enclosed circulation systems. An act of the embodied citizen,
blood donation makes literal the place of the private self in the public space of
the blood bank, of the public uses of the private body.
Blood donation also concretizes the specificity as well as the commonality
of the donating bodies. A repeated, universally applied series of bureaucratic
and clinical procedures, the implementation of criteria for donation is nonethe-
less necessarily individual and personalized, and is experienced as such by
donors.
118

But Im always conscious of when Im walking down the hallway that the nurse in that booth
is going to nd something on my le that is some kind of ag that theres something wrong.
I dont know why. I have no idea why I think like that, because there is nothing wrong with
me but theres always that little nagging thing in the background that theyre going to say sorry
Sally you cant give blood today . . . are they going to say oh Im sorry youve just been
penalized youve got to leave. (Sally, donor)
The specicities of the donating body are integral to the donating process
conducted by the blood bank, and are felt as such by the donor. Blood is par-
ticularized even as it becomes part of an anonymous pool of disembodied
resources; the body and intimate practices of the donor are subject to scrutiny
even as that body is presented as public.
3
The Donor as Anyone
Prompted to discuss the real or imagined motives for donation, some donors and
non-donors nominated reasons of self-interest as well as altruism, such as
imagined or anticipated receipt of blood by the donor. Both donors and non-
donors, reecting Healys (2000) argument that attention should be paid to
systems of blood collection as well as individual impulses, also proposed a kind
of absent motivation behind the practice of real or imagined donation, including
habit or family tradition. However, in most responses donors were discussed in
moral terms: either positive (for example just to help other people, be a good
boy scout) or very positive (for example very compassionate, friendly, lovely,
good, generally wonderful people, legend). These correspond roughly to the
two main representations of blood donation above as either more valuable than
other kinds of donation, or as similar to other kinds of donation.
Blood donation is seen, then, either as an act conrming or enabling member-
ship of a collective identity; or as the practice of an individual with a greater sense
of altruism than others with that collective identity. In the main, donors are
discussed by donors and non-donors in language invoking moral superiority,
rather than, say, membership of a different community, or attachment to a
different identity. Donors are seen as more caring, compassionate, and generous
than non-donors, and blood as equally available, or even more available, as a gift
than money or other resources. The universality of blood is implicitly, and some-
times explicitly, equated with a universal possibility of donating it. Kelvin, non-
donor: I mean they could be anybody or anywhere. Just saying citizens, it
doesnt mean male, female or otherwise. Colour, creed or anything.
Imaginative representations of donors as anonymous and divested of race and
other markers of individual identity recall Titmusss argument that blood is a

119
bond that links men and women in the world so closely and intimately that every
difference of colour, religious belief and cultural heritage is insignicant beside
it (1997: 61). But blood is not a universally donatable substance, which is both
Titmusss point and a highly visible outcome of recent history. This history
reveals that while all blood regarded as unsuitable for donation is regarded, from
the point of view of blood banks at least, as alike, there are differences of import
and impact between the categories of exclusion.
Narrowings of eligibility criteria for blood donation after 1983, most notably
the ineligibility of those who have lived in the UK because of the theoretical risk
of the transmission of vCJD through blood transfusion, have not generated the
same controversy as the exclusion of gay men. This is doubtless attributable in
large part to the impact of HIV and HCV transmission through blood supplies.
Public recognition of blood as an anonymous, disembodied resource now also
accommodates blood as an individualized substance. The politics of these eligi-
bility criteria, so visible in 1983, have been largely transformed to the apparently
neutral framework of health. However, while the response of gay men 20 years
ago to being excluded from donation should be understood partly in terms of
changing meanings attributed to blood, this is not the full story. Exclusion from
public practices is a political act for those forced to struggle for rights and public
recognition, regardless of the reasons for that exclusion.
Different responses to exclusion by different groups reveal the political
identity and repertoires of those groups, and the meanings given to that
exclusion. In 1983 a politicized community, made up of individuals with a strong
attachment to homosexuality as an identity, recognized exclusion as political and
responded through innovative use of available resources. In contrast, the
exclusion of ex-residents of the UK was not directed at an identity group belong-
ing to an active social movement, and was not recognized as a political gesture.
Gay men reacted to exclusion in ways that reveal the existence of homosexuality
as an identity category as well as the political mobilization of that category. In
contrast, the non-response of one-time UK residents reveals not just the politi-
cally neutral meanings given to blood by that group of people, but the weakness
of that category as a social identity. While it is not possible to pursue this issue
here, the variation in responses to the exclusion of a social category from blood
donation has the potential to throw light on the ways embodied identity is
formed and understood. In particular, the third category of healthy people
excluded from blood donation in Australia injecting drug users occupy a
social space somewhere between these other two. The forces producing drug
user as a social identity, the strength and extent of a movement based on that
identity, and the means for political claim-making by that movement, are less
120

visible than in the case of gay men and ex-UK residents. The non-response of the
latter group resembles, at rst glance, the absence of an organized protest around
the exclusion of IDUs. However, as we will see, there is a marked contrast
between the absence of political meaning attached to ex-UK residents and the
identication of drug users as a social category and individual identity.
Exclusion
The identication of blood donation with altruism is reinforced by responses to
the imagined impact if payments were offered to donors. Four indicated a neutral
response, and ve a positive, encouraging response. Mostly, however, hostility
was expressed to the prospect of payment. Overseas examples of payment
systems were nominated as a troubling precedent, echoing Titmusss analysis of
private blood banks in the United States. The impact on the resources of blood
banks, in terms of both nding the revenue required to pay donors and the neces-
sity of additional screening processes, was raised. A number of responses
connected payments to donors with a privatized blood banking system for
example, Isaac, a blood recipient:
Oh denitely it would change it altogether because then youd have to pay to have it. Like the
amount of money Id have to, you wouldnt be able to afford it you know. Like I wouldnt be
able to afford [blood products]. Like how much is a bag of blood going to cost you?
In some ways, the imagined devaluing of blood donation by its being accorded
a monetary value corresponds to the non-commercial value of other altruistic
practices, such as unpaid labour for charities. A strong sense was evinced by
several participants, with different experiences of donating, that donation should
remain outside the commercial sphere, that altruism should be preserved in the
practice of donating and the identity of the donor.
To be honest I think it would actually cheapen the donation. It would make it feel less worth-
while. Once you put a value on something like that then you probably couldnt afford my
blood anyway so I wouldnt be giving it. (Derek, donor)
The value of altruism to the person performing the altruistic act is suggested here,
as is the value of practices deliberately excluded from any assessment of commer-
cial value.
Yet negative assessments of the impact of blood donation were not only about
maintaining the altruism of donors, or what Titmuss called the value we accord
people by giving to strangers. When asked to identify what changes in donation
practice would be brought about by payment, a number of different kinds of
people, some ineligible to donate, some not, were identied as likely to become

121
donors if paid. Several responses indicated poverty due to unemployment or
unspecied reasons as a motivation for donation. However, the single largest
group identied as donors likely to be motivated was drug users.
People in poor health and people who have ever injected drugs are ineligible
to donate. But the identication of drug users as likely to donate were payment
offered reveals something more than recognition of the technical requirements
(the Red Crosss protective guidelines) precluding some people from donating.
Homosexually active men were not identied as likely to be responsive to
payment, and nor, with one exception, were those who have lived in the UK. It
is not always evident whether or not participants knew of the criteria for eligi-
bility as a blood donor, and whether their identication of drug users as undesir-
able was based on some drug users not meeting that criteria. Instead, the moral
value accorded to blood donors is reversed here in implicit and explicit associ-
ations with drug users and some impoverished people as of degraded ethical
standing.
Aldo (blood recipient): People who need the money, like drug people from Kings Cross [an
inner city suburb of Sydney with an active drug market and numerous
services for injecting drug users] they dont care, they just want the
money, theyve got all these drugs in their system, and they are the
kind of people we dont want. I mean I dont want blood from them.
Carl (blood recipient): Yeah it would. Youd get every drug addict in the western suburbs [of
Sydney], every drug addict around here that needs a couple of dollars.
You know, thats the way they are. Like and they will be trying to get
money. You know.
Maxine (donor): I dont think you would get people doing it for the right reasons, they
would be just doing it for the money, and the blood wouldnt be as
safe, that was just something I read. Like if you pay people for blood
you get like minority groups.
Interviewer: Like what groups?
Maxine: Poor people or drug users, or something like that.
Interviewer: And theres a high risk of disease?
Maxine: Not poor people, but maybe homeless people, like drug users.
The sharing of self practised by blood donors becomes, in the context of people
getting paid to donate, the presenting of an inappropriate, unwanted self. Those
who would donate if paid should not donate at least in part because they are
the kinds of people who are willing to give their blood for money.
Aside from responses specically about drug users, more general comments
about the character and quality of potential donors characterize some of the
122

responses although others explicitly disavow moral judgements about donors
or potential donors.
Trudy (donor): I think youd get juniors that come in that just want their $20 to go out and
spend. And I think you might get a lot more less desirables in the community.
Interviewer: What categories are you thinking there?
Trudy: People that need the money that dont care how they live or where they live
and dont take care of themselves. Like I wont turn around and say homeless
because I dont think the truly homeless will come in to get the money. Im
thinking the late night partiers, the people who dont care, the people that
really are just the Hey man, free money, I dont care, that sort of thing. Its
hard to explain but I dont believe, as I said, its a charity work but if, I think
youd just get those two sorts of people. You would get more people but I
think youd lose a lot more blood in the testing. Yeah.
Jill (IDU): Because I know that if people were getting paid to give blood youd get all
the dodgy people of society, you know myself included, you would. At least
where it is now you only got, you know like, do-gooders, like you know,
wanting to do it, but you know.
Interviewer: And why would that matter?
Jill: Because in my eyes do-gooders are cleaner. Do you know what I mean?
Theres less, they have a less risky life so theres less chance of, you know.
Again, the moral valuing of the donor as a compassionate and more generous
citizen than normal is reversed in assessments of the potential, paid donor. Such
potential donors are undesirable donors because they may indulge in riskier prac-
tices than current donors, or they may be in poor health. These render people
ineligible to donate but many people are ineligible to donate. What is signi-
cant here is that the imagined donor is willing to expose other people to harm, is
willing to practice a donation that is not just not altruistic, but dangerous.
Not all drug users are ineligible to donate, only drug users who have injected.
It is therefore not always clear if the identication of drug-users and others as
potential paid donors is an explicit assessment of these groups as willing to lie
although some responses do name paid donors dishonesty about their ineligi-
bility as likely. However, whether an explicit attribution of risk or dishonesty is
made or not, most participants indicated disagreement with the prospect of
donors being paid, and expected payment to encourage people to donate who
shouldnt. These responses reveal in line with the valuing of donation and the
donor an investment in blood as a personal and specic substance unlike other
donated resources. Unlike money, blood bears the mark not just of the donor,
but the motive of the donor. Privileging donors motivation imbues blood with
the properties of its source, and the process of its donation.

123
Hannah (IDU): Because its to help someone. Its to help to live again to see another
day. Not to see another $100 bill. I mean moneys plastic. I mean to a
lot of people money talks every language. I know that but not my
language. I talk from my heart, I speak from my heart. Not from my
pocket. My pockets dont talk for me. Its from my heart and my mind,
whats in my head.
Sally (donor): And all of them all doing it for the wrong reasons. Theres got to be
an alternative reward other than money and we just havent found it
yet.
Lisa (blood recipient): [I]t would be like the needle exchange, youd walk to the, youd see
them all hanging around outside with their cups of methadone and you
know, no, itd be awful. I can just see it now. What it would be like.
And I think Id rather die probably.
Interviewer: Do you really mean that or . . .
Lisa: Oh Id be very unhappy about accepting their blood. I wouldnt be
happy at all.
Judy (recipient): I would hope people would, if I needed blood, people would give it to
me because I needed it. They think the same as I do. Not because
theyd been paid to do it.
Gordon (donor): I like to think that the blood I am receiving has come from people who
gladly volunteer it and not from people whose nancial situation
necessitates it; on the other hand it might swing more people to do it.
Like you might be teetering on the edge, I might do it, or I might not,
but I like to think that all the people who give blood are happy to
volunteer it.
Interviewer: Why is that?
Gordon: It seems like the fundamental way it should be done, it should just be
people doing it without seeking a reward.
These responses also reafrm afrmations of donors as people with a higher
moral capacity than non-donors. The universality of blood connects easily and
intuitively with an assessment of those who voluntarily donate blood as belonging
to the same social group as those who dont donate but possessing a greater moral
capacity. However, as the responses to questions about paid donation indicate,
blood is not a universally donatable substance to public blood banks. Equating
blood donation with moral superiority is obviously benecial in terms of the
recruitment and valuing of donors, and matches well with both common-sense and
theorized ideas of donation as altruistic. However, it elides the specicity of criteria
for donation. It can also be assumed to have an impact on those who cannot
donate. As noted earlier, the response of gay men to exclusion in 1983 is one proof
of this impact. The responses of interview participants in this study is another.
124

Len (IDU): It was in the era when people were getting their licences marked with
donations and stuff like that with the organs, I did mine too. I thought that
was quite cool. And Ive felt really awful, now I cant give blood. I cant get
my little badge and say Ive done the right thing. Ive got no status symbol. I
feel as though Ive been cut off in a way. Like Im now not good enough.
Angela (IDU): Yep, Id donate blood except for the fact that I use, and you know, as a young
girl, I dont know, I think its just a good Samaritan thing, you know for a lot
of people, and for myself it would be just like something that I could do to
help others, but its something that I cant do so I dont even really go there.
Im actually a bit sad about that. You get that.
Mary (IDU): By the time I sort of got to that age where I started thinking about that, I had
hep C. So I couldnt. But I really, thats about the one thing that upset me the
most about having this disease, was not being able to give blood or give my
organs when I die. That was about the most emotional part [of diagnosis].
These three respondents have injected drugs, and drug users, as noted above,
were named more often than any other single category as likely donors were
payments made. Their accounts describe emotional reactions to the recognition
of ineligibility of donating, of exclusion from the community or identity of
donation. This exclusion of drug users operates on three levels. First, IDUs are
excluded at a technical level: their blood cannot be utilized by blood banks.
Second, they are excluded from identity categories of altruism and moral superi-
ority, of what can be called good citizenship. Third, and particularly, they are
excluded from these moral categories because their motives are suspect and their
ethical standards deranged: they would do harm rather than good if money was
involved, and so become the reverse of the altruistic blood donor, a bad citizen.
Other people are also excluded from the blood donation in the rst two senses,
but drug users are morally devalued twice: in their ineligibility to assume the
identity of the blood donor and in their imagined willingness to assume it
dishonestly. Drug users are thus not only remote from but threatening to the
existing, valued gure of the blood donor.
Conclusion
Recently, Lifelink, a network of health organizations responsible for coordinat-
ing all (deceased) organ donations that take place in New South Wales and the
Australian Capital Territory advertised the expansion of eligibility criteria for
organ donation to people with hepatitis C. It is now possible that a hepatitis C
infected but reasonably healthy liver can be transplanted into someone who
already has hepatitis C (Hepatitis C Council of New South Wales, 2003: 37). This
is obviously a positive move at a number of levels. First, it will add to the stock

125
of limited resources available. Second, the marginalization of those with hepati-
tis C will be addressed and countered by the identication of the hepatitis C
infected body as nonetheless useful and available for sharing in the same way that
other, healthy bodies are. It is now possible for some people with hepatitis C
to adopt an altruistic identity previously denied them.
At another level, if organs can be circulated among people with hepatitis C,
then our understanding of what constitutes public altruism can be rened.
Organs emerge from this invitation as individual donations with uses to particu-
lar groups. People with hepatitis C can publicly donate their organs, but to a
particular public, constituted by other people with hepatitis C. This too suggests
further uses for recognition of these particularities and communities, and for our
thinking around blood. As the study conducted here shows, blood is recognized
as both universal and individualized, and blood donation as both universally
available and vulnerable to appropriation by those who are not meant to do it.
These polarized understandings have the capacity to marginalize further indi-
viduals and identities already assailed as morally suspect, as not quite citizens.
Accounting for intimate and individual corporeality in models of citizenship
broadens and enriches our understandings of the way private and public inter-
sect. However, the imaginative construction of the altruistic, embodied citizen as
blood donor seems also to risk a corollary of the bad or non-citizen, the donor
who is not altruistic and who endangers the public sphere through inappropriate
occupation of it.
Jeffrey Weeks writes that sexual citizenship accommodates newly complex
questions about citizenship raised by HIV/AIDS, especially about the degree to
which the execrated and threatening person with a life-threatening syndrome
who nevertheless fails to engage in safer sex can be fully included in the social
(1998: 44). AIDS has inected sex with not only political but civil obligations,
imposing a need to balance individual needs and responsibility to others in a
community of identity. A homological shift is revealed in the case of blood
donation, an ostensibly civil practice constituted by intimate, embodied agents.
Mostly without a political identity, drug users are nevertheless subject to the
same questions of inclusion in the social, and their representation as damaging to
the socius is mostly unchallenged. Sexual citizenship has been discussed exten-
sively in the context of political mobilization, belonging, and moments of trans-
gression and citizenship; the research conducted for this project discloses the
tensions of belonging and identity in a context where these elements are absent
or incipient.
Alternatives to such tensions are possible: in the active recognition of blood
donation as available to some people at some times and not others, and of blood
126

as neither wholly public nor wholly private. The moral capacity of blood donors
should be recognized and valued, but so too should their membership of a
particular community. Donors are not morally superior in a kind of generic way
they are located in particular networks of blood collection and processing, and
the donating body is possessed of particular characteristics. Non-donors belong
to a different set of networks and the non-donating body may be possessed of
different characteristics. It is not necessary to evacuate recognition of the
altruism of blood donation to recognize these different categories of donors and
non-donors. Theories of the self, and our intuitive understandings of what blood
donation is, emphasize the embodied individuality that is inseparable from acts
of public participation. The motives of blood donors cannot be subsumed under
a single category of altruism, and public recognition and gratitude for donation
need not preclude examination of the intersection of the public and private forces
behind these motives. Equally, abstention from donation is not simple. Singling
out drug users as threats to the category of the altruistic donor collapses distinc-
tions between those who are not invited to donate and those who are invited but
do not. But even these distinctions do not take account of the particularities of
the public and private spaces occupied by different non-donors. The convenient
ction that members of the public can and should donate to a public blood bank
sits in tension with the recognition that the public is not singular, that donation
is not always possible, and that normative judgements about donation vary and
polarize according to the category to which donors are imagined to belong.
Persisting with this ction may reward those who donate, but at some cost to
those who are not invited to donate and to our understandings of the ways
private and public are imbricated in blood donation.
Notes
1. The study recruited 78 participants with different relationships to blood: ex- and current
injecting drug users; blood donors; blood transfusion recipients; those with haemophilia and
thalassemia; those with high occupational exposure to blood (ambulance ofcers); and those with
hepatitis C acquired through means other than injecting drug use. The study was funded by the
National Health and Medical Research Council to research the range of understandings of blood
among these groups of people, and to use this knowledge in the formulation of hepatitis C prevention
strategies and materials. The interview was semi-structured and took about one hour to complete. All
interviews were taped and transcribed. Participants were de-identied and aliases were ascribed.
Analysis of data was facilitated by the use of NVivo software. Codes were developed based on a
sample of early interviews and adapted as the interviews progressed. Coded data were then sorted and
retrieved according to the research question. This article focuses on the parts of the interview
concerned with blood donation. The article makes clear if participants were donors, people who have
received blood in a transfusion, or injecting drug users, although their status as current or former
IDUs is not specied. Participants are identied as donors, non-donors, or injecting drug users, for

127
while people in the last group are obviously either donors or non-donors their drug use, as we will
see, is identied as important.
2. Cf. Healy: We can think of blood donation as a special kind of volunteering that involves more
than just money or time . . . the physical and symbolic nature of the gift of blood is what makes it
attractive as the perfect example of altruistic giving (2000: 1641).
3. Kath Weston analyses media coverage of the 1997 blood drive for Betty Shabazz in New York
and argues that the altruistic community response to that blood drive was predicated on an ignoring
of the particularity of blood, made possible through the technologies of blood banking: It is this ware-
housing of blood in an intermediate stop between bodies that allows blood transfers to be resignied
to represent a timeless, depoliticised, universal solidarity (2001: 165).
References
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Cortiula, Mark (2001) Banking on Blood: A History of the Australian Red Cross New South Wales
Transfusion Service. Walcha: Ohio Productions.
Healy, Kieran (2000) Embedded Altruism: Blood Collection Regimes and the European Unions
Donor Population, American Journal of Sociology 105(6): 163357.
Hepatitis C Council of New South Wales (2003) The Most Precious Gift, The Hep C Review
40(March): 37.
Johnston, Hank, Enrique Lanaa and Joseph R. Guseld (1992) Identities, Grievances, and New
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kylie valentine is a Research Associate at the National Centre in HIV Social Research and at the Social
Policy Research Centre, both at the University of New South Wales. She is the author of Psycho-
analysis, Psychiatry and Modernist Literature, published by Palgrave.
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