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Confined Live(r)s

Self-Infliction and Arbitrary Survival in the German Transplant System

Julia Rehsmann

This article traces the trope of self-infliction for the moral economy of liver transplantation. Drawing on ethnographic fieldwork in Germany, I discuss the trope of self-infliction to explore intimate uncertainties that people with an alcoholic liver disease face when looking for medical care. I claim that the moralising trope of self-infliction plays a significant role in considerations about who is deserving of a liver transplant and a ‘second chance’. As access to transplantation becomes a life-and-death matter when livers fail, I see the trope of self-infliction as a tool for triaging lives for liver transplantation. Moreover, I claim that the trope of self-infliction, with its emphasis on self-responsibility, has a gendered dimension that puts women with an alcoholic liver disease under particular moral scrutiny. Furthermore, I demonstrate how this moralising trope shapes regulatory practices, like the ‘six-month abstinence rule’, which consequently confine livers and thus, eventually, confine lives.