Las Conferencias Mundiales sobre la Mujer

The National Transplant Agency (NTA) was set up in 2004 triggered by the issue of Directive 2004/23/EC and was made responsible for accrediting organ, tissue and cell banks in Romania.

However, in practice, many legislators and medical professionals saw it not only as an administrative body, but also as a legal counsellor and source of regulations. This perception cast the NTA as an expert in the field. Nevertheless, the NTA had to constantly legitimate this position (Jasanoff, 2012): some participants challenged not only its capacity to deliver unbiased and accurate knowledge that could act as the basis for normative actions, but also its accountability towards the public and other relevant actors. A closer look at the way in which the NTA operated led many of these actors to contest the NTA’s authority on several

grounds: the conflation of cells and organ provision, an unclear

delineation of attributes coupled with insufficient resources, and a lack of accountability towards other stakeholders. Below I will take these in turn in this and the following section.

While the Tissues and Cells Directive, as its name suggests, deemed ‘organs’ as a separate category to be regulated through other legal instruments, Romanian legislators grouped cells, tissues and

organs together. Because of the time that had passed since Law 95 was drafted and the complicated processes involved in the creation and adoption of any law, it is hard to identify those who contributed to its conceptual elaboration. At the time, Romania did not have experience with regulating reproductive cells but it had encountered problems with organ procurement, and Severin was, according to his declaration, involved in drafting a law on organ transplant. Readers can also remember his attempts to explain Romania’s issue with ova

commercialisation by drawing on his experience with organ procurement.

And yet, during my fieldwork, Severin emerged as one of the main consultants on the issue of AR. Due to his association with the NTA, where he has held various managing positions across time, Severin has been invited to parliamentary debates concerning AR legislation.

Severin’s political, scientific and administrative roles have often

overlapped, since in Parliament he has been summoned as a counsellor, but as a member of the NTA he has also authored secondary regulation later issued by the Health Ministry. As a public figure bridging the world of organ and ova provision, and as a representative of the NTA, Severin illustrates how organ and ova provision were institutionally cast as equivalent phenomena, delineated by similar material and discursive agencies. This approach was contested by several medical

professionals, who argued that eluding ova provision specificity has negatively affected their work. Liviu Zeca, clinician, explained during a phone interview:

There are three types of transplants: of organ, tissue or cells.

These are three fundamental notions. Unfortunately, the cell, which is where we come in, is put together with the organ and that makes it much more restrictive (...) they judge according to the donation law, and donation in Romania should not include financial gains. And thus they automatically include assisted reproduction in this category. (Liviu Zeca, clinician, interview)

According to Zeca and other medical professionals, the

knowledge embodied in regulations, the protocols that were created,

even the institutions assigned to accredit fertility clinics meet organ provision standards, but are not appropriate for ova. Part of the

Romanian infertility establishment performs an ontological delineation between ova and organs. Consequently, in their view, ova provision should trigger the enactment of different technical and ethical

choreographies (Thompson, 2013). Nevertheless, the ova provision practices, the regulations, and the institutional arrangements that constitute the Romanian state apparatus for managing and supervising ova provision do not recognise this ontological differentiation argued for by infertility specialists. The state apparatus defined and imposed the legally acceptable terms of the procedure, enacting an enduring official ova provision regime. The regime performed a validation of certain medical and social practices, obscuring others by classifying them as either ‘illegal’ or unethical, as I will discuss below.

The first step in the enactment of the state apparatus and its regime was the ban on ova commodification in 2006, which was followed by more detailed instructions through Order 1763/2007 issued by the Health Ministry. According to it, infertility patients (single women or couples) who need ova provision have to find a willing ova provider who agrees to give them eggs for their IVF treatment. The two parties then have to go to a notary who issues a declaration confirming that no material incentives have been used as part of the agreement. The patients and the provider also have to pass through a Donation

Committee comprised of infertility specialists, psychologists and other clinicians who approve or dismantle the agreement. Finally, if the

patients and provider are admitted for the procedure, the provider has to undergo hormonal treatment and a surgical intervention for the extraction of eggs. This is what the regime legitimates in practice, or what

Romanian authorities consider legal, unequivocal ova provision.

In light of the regime, infertility specialists have contested the professionalism of legislators whom they see as unfit to tackle the specificities of ova provision, despite previous experience with organ provision issues. As Zeca highlighted above, one of the main discontents is the official regime’s strict interpretation of money, deeming financial gains illegitimate (and hence illegal), and relying entirely on the altruism

of ova providers in a manner reminiscent of Titmuss (1970). Severin, a supporter of the regime, argued:

Any compensation of this kind opens the gate to abuse, and it will be done in the name of compensation. I don’t know, I’m not in favour, to me...I understand that the fact that some of the state institutions can’t handle some legal provisions should not lead to interdictions, I agree, but at the same time my opinion is that it’s not that we are not specialists, this is an invitation to abuse, to give compensations. (Mircea Severin, legislator, interview)

What Severin refers to when he mentions ‘abuse’ is the possibility of ova commercialisation, or ‘trafficking’, by medical professionals, ova providers, and IVF patients. As I have discussed in the previous chapter, the concept of ‘trafficking’ is very narrowly defined in Law 95/2006 and it fails to address the multiple practices circumscribed by ova

commercialisation, and the different degrees of harm it can inflict. Such a narrow understanding of money means that all parties involved in such an exchange are liable for prosecution, and that once again ova

commercialisation is approached solely in criminal terms. This suggests a limited understanding held by legislators regarding the embodied work undergone by ova providers, as well as the social underpinnings of ova provision. The official regime reiterates the broadly held conviction that women are or at least should be ‘altruistic’ (Almeling, 2007). This, coupled with the systematic ignorance of the reproductive labour providers perform (Birch and Tyfield, 2012; Cooper and Waldby, 2014;

Pande, 2014), obscure the understanding of ‘altruism’ as a material-discursive performance for which the state is also responsible (Healy, 2006). Just as altruism is not a mere character trait, but is a performance that needs to be aided by institutional arrangements (Healy, 2006), money is not inherently a corruptive element of social relationship since its use is determined in accordance with the larger socio-cultural context of the exchange (Skeggs, 2004; Zelizer, 1997).

Nevertheless, Severin’s stance needs to be put into perspective:

he has held high institutional positions with considerable responsibility,

and given the subsequent cases of ova commercialisation, his

reluctance to support a re-evaluation of the ova provision regime has been about ensuring the legality of medical procedures, as much as it had been about avoiding blame. To those contesting his backing of the regime, he responded not only by affirming the professionalism of the approach (“it’s not that we are not specialists”), but also by performing responsibility in a context fraught with limitations: although Severin’s measures are unpopular, in his view he is doing his best to protect

people from unwanted harm. Moreover, Severin suggested that the extra precautions he took are meant to compensate for others’ irresponsibility and possible incompetence (“the fact that some of the state institutions can’t handle some legal provisions should not lead to interdictions”). The risks Severin envisioned and tried to minimise were both about avoiding the negative consequences of ova commercialisation at a societal level, and about appearing accountable to those who also had a say in matters of governance. He addressed the first by employing a strategy of

containment (Jasanoff, 2013), consisting in efforts to limit the possibility of ‘trafficking’, and managed the second through performances meant to convey professionalism and dedication to people’s welfare. Thus, the difficulties of governance were presented as emanating not only from the complexity of ova provision as a scientific, medical, and social practice, but also from the shortcomings of the state apparatus itself. According to Severin’s framing, then, the official regime instantiated a series of ‘truths’

concerning ova provision, one of which being the inevitability of commercialised provision going awry for various reasons. The police regime analysed in the previous chapter offered considerable evidence in this regard.

5.4 The National Transplant Agency: Negotiating roles