(INTER)CONNECTING TO LEAD: BIOPOLITICAL STRATEGIES IN ORGAN AND TISSUE DONATION ADVERTISING CAMPAINGS

(INTER)CONECTAR PARA DIRIGIR: ESTRATEGIAS BIOPOLÍTICAS EN CAMPAÑAS PUBLICITARIAS PARA LA DONACIÓN DE ÓRGANOS Y TEJIDOS

ABSTRACT

Objective

to analyze the organ and tissue donation advertising campaigns as biopolitical strategies.

Method

a qualitative research study inspired on the Post-Structuralist strand of Cultural Studies. Data collection took place between July and September 2020 and the research corpus consisted in the visual and textual components of 421 organ and tissue donation advertising pieces from institutional websites of the Ministry of Health, State Health Secretariats, State Transplantation Centers and the Brazilian Association of Organ Transplantation. The data were managed using the Ethnograph v6 program, submitted to analysis as proposed by Janice Morse and discussed following Michel Foucault's theoretical notions of Biopower and Biopolitics.

Results

two categories are presented. In the first, the representation of cultural and age diversity in the campaigns was discussed as a way to include all people in the donation and transplantation process; in the second, the use of heroism, altruism and empathy to mobilize the donor's “I” was addressed.

Conclusion

the inclusion of cultural and age diversity and the use of characteristics such as empathy, altruism and heroism in advertising campaigns are biopolitical strategies used by the Brazilian State to drive the population towards organ donation.

DESCRIPTORS
Securing of tissues and organs; Brain death; Family; Communication media; Culture

RESUMEN

Objetivo

analizar las campañas publicitarias sobre la donación de órganos y tejidos como estrategias biopolíticas.

Método

investigación cualitativa inspirada en la vertiente Post-Estructuralista de los Estudios Culturales. La recolección de datos tuvo lugar entre julio y septiembre de 2020 y el corpus de la investigación estuvo conformado por los componentes visuales y textuales de 421 materiales publicitarios sobre donación de órganos y tejidos de sitios web institucionales pertenecientes al Ministerio de Salud, a las Secretarías Estatales de Salud, a los Centros Estatales de Trasplante y a la Asociación Brasileña de Trasplante de Órganos. Los datos se manejaron en el programa Ethnograph v6, se los sometió a análisis según lo propuesto por Janice Morse, y se los debatió sobre la base de las nociones teóricas de Biopoder y Biopolítica de Michel Foucault.

Resultados

se presentan dos categorías. En la primera se analizó la representación de la diversidad cultural y etaria presente en las campañas como una forma de incluir a todas las personas en el proceso de donación y trasplante; en la segunda se abordó la utilización del heroísmo, el altruismo y la empatía para movilizar el “Yo” de los donantes.

Conclusión

incluir la diversidad cultural y etaria y recurrir a características como la empatía, el altruismo y el heroísmo en las campañas publicitarias son estrategias biopolíticas que emplea el Estado brasileño para inducir a la población a donar órganos.

DESCRIPTORES
Obtención de tejidos y órganos; Muerte cerebral; Familia; Medios de comunicación; Cultura

RESUMO

Objetivo:

analisar as campanhas publicitárias sobre doação de órgãos e tecidos como estratégias biopolíticas.

Método:

pesquisa qualitativa, inspirada na vertente Pós-Estruturalista dos Estudos Culturais. A coleta de dados ocorreu entre julho e setembro de 2020 e o corpus da pesquisa se constituiu dos componentes visuais e textuais de 421 peças publicitárias de doação de órgãos e tecidos de sites institucionais do Ministério da Saúde, das Secretarias Estaduais de Saúde, das Centrais Estaduais de Transplante e da Associação Brasileira de Transplante de Órgãos. Os dados foram gerenciados no programa Ethnograph v6, submetidos à análise proposta por Janice Morse e discutidos com as noções teóricas de biopoder e biopolítica, de Michel Foucault.

Resultados:

duas categorias são apresentadas. Na primeira, discutiu-se a representação da diversidade cultural e etária nas campanhas como forma de incluir todas as pessoas no processo de doação e transplante; na segunda, abordou-se a utilização do heroísmo, altruísmo e empatia para mobilização do “eu” do sujeito doador.

Conclusão:

a inclusão da diversidade cultural e etária e o recurso às características como empatia, altruísmo e heroísmo, nas campanhas publicitárias, são estratégias biopolíticas utilizadas pelo Estado brasileiro para conduzir a população para a doação de órgãos.

DESCRITORES:
Obtenção de tecidos e órgãos; Morte encefálica; Família; Meios de comunicação; Cultura

INTRODUCTION

Transplantation is a treatment that aims at improving quality of life in patients with organs in functional failure terminal stage or degenerated tissues. Brazil presents disparity between the number of effective donors and the individuals awaiting transplants. Data from the Brazilian transplantation registry indicate that in 2019 there were 3,768 effective donors for 37,946 individuals on the waiting list.1 This difference is responsible for the high mortality rate of the people waiting to be transplanted, in addition to the increase in public health expenditure on treatments for those with chronic diseases.1^-2

A number of studies show that the reduction in the effective donation index is related to refusals by the families, which are responsible for consenting to the procedure. Such denials are mainly justified by lack of knowledge about the deceased family member's will.1^,3 However, to reverse such situation, governmental and non-governmental institutions operating in the donation and transplantation system have developed strategies with the purpose of disseminating information on the topic, mainly to sensitize and raise awareness by publicizing advertising campaigns in the media,4^-5 as they have high informative capacity and induce certain behaviors.4^-6

It is important to emphasize that, in this study, we consider advertising campaigns as sets of advertising pieces that aim at communicating, informing and announcing a given idea to society.7 They are comprised by advertising pieces (banners, posters and folders, among others) that have the same visual elements, themes and concepts8. The attempt to lead the individuals’ behaviors through the media by means of advertising campaigns can be considered a biopolitical strategy.

Biopolitics, a theoretical notion developed by Michel Foucault, refers to the way in which the State regulates the reality of a given society, as well as the problems emerging from it. It aims at the promotion of life, at warding off death and at productivity of people, in the least costly manner in economic, political and social terms. It promotes control of the bodies, which are modulated by safety mechanisms, which interfere in prescriptions and modulate behaviors aiming at governing the life of a population.9

In the Brazilian scenario, the National Organ Donation Policy (Política Nacional de Doação de Órgãos, PNDOT) approaches an example of Biopolitics. It is put into practice by the State and by Knowledge Societies, such as the Brazilian Association of Organ Transplantation (Associação Brasileira de Transplante de Órgãos, ABTO) or the Federal Council of Medicine. Such institutions contribute to the constitution of a field of knowledge and practices about bodies, as they house experts who produce formulations and models on the theme, becoming references and authorized to utter what is considered true and accepted. They legitimize what is produced in the theoretical field, which captures, convinces and subjectivizes health professionals and the population for effective organ and tissue donation. The proposals and interventions enunciated by these institutions aim at enhancing vitality of the organs of those who are in a state of brain death, seeking to maintain continuity of other people's lives, especially young individuals affected by some type of chronic disease, but with the potential to continue living.10

Despite the important role of the advertising campaigns in organ and tissue donation for transplants, the studies that address the theme are still incipient.4^-5 In such studies, we found that advertising campaigns in health tend to incite behaviors since 1920, the beginning of their implementation in Brazil. Some of them replaced the educational bias by the appealing one, privileging emotional reactions to the detriment of the explanation about the need for organ donation. In addition to that, the production of standardized campaigns may not contemplate the multiculturalism existing in the country, which has a continental extension, in addition to diverse linguistic expressions, customs, moral values and beliefs.

Thus, the relevance of analyzing how advertising campaigns operate as a biopolitical strategy is justified, as well as how they are constructed and which discourses they evoke, seeking to convince people for organ donation and continuity of life. The movement around the campaigns can be understood as a game conducted by the State - represented by the Ministry of Health and the State Secretariats - as well as by entities linked to specific fields of knowledge about donation, notably the ABTO. In it we verify resorting to numbers in the elaboration of slogans as a way to appeal to the population: “One saves eight”, an expression used for many years in campaigns; or even “250+ people are currently awaiting a heart transplant in Brazil” or “1,000+ people are currently awaiting a liver transplant in Brazil”, phrases that circulated with images of the respective organs represented in balloons, appearing to move or fading, in the campaigns alluding to “Green September” promoted by the ABTO in 2021.

Use of these numbers is a resource to draw the attention to, warn about and show the importance of each person's participation in an attempt to maintain something close to “homeostasis” of the social and collective body, in order to keep the population alive. In addition to it, other elements related to desires, values, what each person or group considers important, seem to be used in advertising campaigns to convince individuals, but mainly to convince families to say yes to donation. It is these other elements that circulate and that challenge the subjects in everyday life, particularly in the month of September of each year, that we seek to explore. Given the above, we formulated the following research question: How do the organ and tissue donation advertising campaigns constitute biopolitical strategies in Brazil? Thus, the objective of the study is to analyze the organ and tissue donation advertising campaigns as biopolitical strategies.

METHOD

This is a qualitative research study that approaches the Post-Structuralist strand of Cultural Studies. Cultural Studies emerged in the 1960s in the United Kingdom and involve analyses of social practices, identities and arrangements, based on the individuals' interaction with different products of the Culture.11 From this perspective and through documentary analysis, ethnographies and interviews, among other possibilities, it seeks to problematize how the ways of thinking, acting, positioning and relating in a given society in specific historical periods are modified based on the diverse knowledge that circulates in images, pictures, advertising campaigns, soap operas, magazines, films and social media, the so-called cultural artifacts. Such artifacts act in a pedagogical way, constituting subjects, which understand and accept what they have as truths, transforming behaviors in the face of the most varied aspects of life.11^-12

For analysis in this study, organ and tissue donation advertising campaigns run by the Ministry of Health, the State Health Secretariats, the State Transplantation Centers and the Brazilian Association of Organ Transplantation represented the cultural artifact chosen. Regarding the Secretariats, we considered the materials from all the States and from Distrito Federal.

The campaigns were retrieved between July and September 2020, on the websites, on the social networks of the Institutions and through the Google search engine, given that the websites make posts available for a limited period of time. The following were delimited as selection criteria: downloadable campaigns, formatted in folders, banners, posters or posts on social networks and publicized between 2007 and 2020. This time restriction is justified by the date when Law No. 11,548 of 2007 came into force, which instituted the National Organ Donation Day. The use of social media allowed finding a higher number of materials in this environment. This fact can be associated with the use of these web pages as the institutions' main communication means, given that they allow greater reach of subjects. Another strategy to search for campaigns was to send an email message to the State Secretariats of Mato Grosso and Amapá, as well as to the State Transplantation Center from Distrito Federal, in order to obtain those available on the Internet. Forwarding to these Secretariats was due to the researcher not finding any campaigns, or finding a lower number when compared to other states. However, the Secretariats failed to answer her e-mail messages.

With regard to data organization, all images of the campaigns collected were grouped in folders of a service for storing and sharing files (in the cloud), entitled with the name of the institution, after performing the respective downloads. Due to the diversity of campaigns, it was decided to create a system to name them with the institution's initials, followed by the year of publication and a letter of the alphabet, respecting the selection order of the images. Two charts with the diverse information collected were also prepared and filled in. The first consisted in the date of the search, the person responsible for collection (the first author), search locus, date/year of the campaign, type and identification record of the campaign. The second included the institution, year, campaign, and the visual and textual components.13

The images were transcribed to extract the visual component, respecting the following stages: 1) identification of the elements present in the image, as well as their arrangement; 2) detailed description of these elements, enabling transformation of verbal data to a written document; and 3) extraction of the textual component, which implied a verbatim copy of the messages and logos present in the campaigns.13 The files derived from the transcripts were managed and coded in the Ethnograph v.6 program.

The data were analyzed according to Janice Morse's proposal, in which analysis takes place through the performance of four cognitive processes: comprehension, synthesis, theorization and recontextualization.14 Understanding consists in acquiring knowledge about the study object. In this research, it began with the recording of diverse information from the literature review on the existing studies (carried out during elaboration of the research project), of the advertising campaigns from the transcripts of visual and textual components, and of the organization and coding based on the theoretical notions used. The synthesis concerns the moment in which the codes are introduced and undergo changes and linkage with other parts of the text, attributing meaning to the units of analysis through the application of semantics.14

Coding consisted in identifying key words and/or topics in the transcribed text, which represent the textual and visual components of the advertising campaigns. Thus, we built 51 codes, which were grouped into five categories, joining the common information transcribed, considering the research object and the analysis tools, and then a synthesis of the findings was prepared. The codes built by the lead author were reviewed and compared by the paper supervisors; subsequently, a code book was created. We emphasize that the results pertinent to two of the categories elaborated will be presented in this article.

Theorization is associated with data analysis through interpretation, argumentation and criticism. In turn, recontextualization consists in applying or relating the knowledge produced to the practice.14 To this end, we appropriate the theoretical notions of Biopolitics and Biopower proposed by Michel Foucault. Biopolitics is a set of strategies and interventions that aim at controlling collective biological processes in order to enhance the State's government capacity. It is a policy on the actions that can make a population live15. For biopolitical strategies to be operationalized, there is exercise of biopower, which is an unfolding of the notion of power. In this theoretical perspective, power “is a mode of action of some on others”;16:242 it is characterized by the relationship between individuals or between groups, which results in the production of meanings, always productive and positive.16

As for the ethical aspects, we emphasize that, as it deals with the analysis of materials in the public domain or produced by public interest bodies, the research does not require approval by any Research Ethics Committee.

RESULTS

A total of 426 advertising pieces from 200 campaigns were selected. Of these, five campaigns were duplicates, resulting in 421 advertising pieces from 195 campaigns. Regarding the State Health Secretariats and the State Transplantation Centers, the states that stood out in the publication of organ and tissue donation advertising campaigns were the following: Bahia (20 campaigns and 42 pieces), Goiás (19 campaigns and 36 pieces), Pernambuco (13 campaigns and 34 pieces), Ceará (13 campaigns and 25 pieces) and São Paulo (eight campaigns and 11 pieces).

The states that presented the lowest numbers of organ and tissue donation campaigns were as follows: Mato Grosso (one campaign and two pieces), Mato Grosso do Sul (two campaigns and two pieces), Pará (one campaign and five pieces), Paraíba (one campaign and two pieces) and Roraima (two campaigns and two pieces). Amapá did not present any campaign or piece.

Below we present the Diversifying to donate: The population in advertising campaigns and Heroism, altruism and empathy: Mobilization of the donor's “I” categories. From them, it is possible to identify which population segments are mobilized, as well as to describe which elements inherent to the “I” of each subject are activated by the State to convince and effectively implement organ and tissue donation.

Diversifying to donate: the population in advertising campaigns

In the period analyzed, we found that different strategies were used in the organ and tissue donation advertising campaigns to convince the subjects, in order to lead them to decide and consent to the donation. We identified elements present in the campaigns that, both in their presentation and in the text content, such as colors and shapes in the images, represent the diversity and multiculturalism of the Brazilian population. These elements were as follows: presence of subjects considering sex/gender - men and women; age - children, youth, adults and seniors; skin color - white and black, with the latter occupying the place of both donors and recipients.

These elements can be noticed in Figure 1 and, in addition to that, the green loop that interconnects a group of subjects is used as a strategy. It seems to be uniting them around a given purpose; or even forming a collection and wrapping network. In the figure, distribution of the subjects takes the form of a pyramid, which is built from an order based on biological characteristics, such as women against men, black against white, and aged against young individuals. It is an arrangement that approaches the organization of the waiting lists.

Figure 1-
Maranhão State Health Secretariat's campaign.17

The cultural diversity present in the Brazilian states was also contemplated in the campaigns, as well as certain cultural elements that make a reference to a given group. The black-skinned population, for example, was present more frequently in the campaigns of institutions from the North and Northeast regions, such as the State Transplantation Centers from Bahia and Rondônia. In the upper area, the image of the mouth, chin and torso of a black-skinned woman, wearing a blue shirt with white hearts and smiling. On the woman's left breast there are two white hands in the shape of a heart(CETBA2017B).

In the central area, the image of a black-skinned woman with long black hair and wearing a blouse with drawings of flowers in pink, yellow and green, hugging and looking at a black-skinned girl(CETRO2017A). Such finding can also be identified in Figure 2.

Figure 2-
Maranhão State Health Secretariat's campaign.18

Another biopolitical strategy was resorting to children mainly in the place of organ and tissue recipients. Children appear less frequently than adults in the campaigns. In addition to that, the children's representations were related to illness most of the times. These children were in settings such as hospital rooms and presented features related to sadness and disease. On the left side, the image of a black-skinned child lying on a white pillow, holding a brown teddy bear on the right side and with a red and white hospitalization bracelet on the right arm (MS2010A). In the central area, the image of a black-skinned girl, with her curly black hair tied back, wearing a blue hospital bracelet and a pink tank top and with the arms crossed over her chest(SESES2011B). Along with the children's images, we perceive the association of elements that are part of their universe, such as toys, animals, drawings and the family, as exemplified in Figure 3.

Figure 3-
Ministry of Health's organ and tissue donation campaign.19

In contrast, the adult population was represented both in the roles of donors and of recipients, and aged people appear less frequently in the advertising pieces. We identified subjects in the waiting list in them, as well as individuals who undergo the transplants, and even the family member that authorized the donations. The use of proper names, the type of disease and the time they are in the waiting list were also identified in the advertising pieces as a strategy to approach possible donors. Guilherme Pradines is in the waiting line for kidney transplant. Josilene Ribeiro underwent kidney transplant 15 years ago. José Milson underwent liver transplant 4 years ago. Green September (SESAL2017A). In the central are, over the photos, the image of a white-skinned aged woman with short brown hair, with her arms crossed over her belly and wearing a green blouse with a green bow attached to the left side of her chest(MS2019D).

This time in the waiting list, represented in years, for an organ and/or tissue seems to be one of the elements used as a way to appeal for the representation of the time of illness and suffering, which can arouse a feeling of compassion in the population.

Heroism, altruism and empathy: mobilization of the donor's “I”

In this category we present the biopolitical strategies that correspond to the mobilization of the donor's “I”, highlighting some of the characteristics activated by the State to convince the population: heroism, empathy and altruism. These feelings are mainly evoked in the campaigns run by the State Health Secretariats, the State Transplantation Centers and the Brazilian Association of Organ Transplantation. Figure 4 shows a firefighter promoting a rescue in a fire situation, avoiding death and bringing people to life. These individuals carried on the shoulders of a hero refer to those who are waiting for a transplant and who can only be “saved” by the gesture of the organ donor's family.

Figure 4-
The ABTO's organ and tissue donation campaign.20

Altruism was identified in the advertising pieces through the use of words that impact on the other's “I”, such as “do good”, “gesture”, “someone's smile”, as well as in the possibility of positively transforming a person's life. Donate your organs. A hope for better days for someone else can begin with your gesture(SESCS2017A). Life is an enormous conquest. Help people win. Donate your organs (SESCE2015A). Be someone else's reason to smile (SESAL2017C). The decision to change someone else's life forever is entirely yours(CETTO2015A).

Empathy was another characteristic that was mobilized. It is associated with interpersonal relationships and, in the campaigns, there was reference mainly to the family members, in order to make the target audience think about their affective bonds. Consequently, references to the mother-child dyad are present in some advertising pieces, for example. “Only a miracle can save your daughter's life. And if it was up to you, wouldn't organ donation still be your problem?” (SESPE2016A). Your mother can't do hemodialysis anymore. Our only hope is to find a donor.” And if it was up to you, wouldn't organ donation still be your problem? (CET2015D). Empathy. The ability to grasp what other people feel and their needs. Organ donation is a symbol of empathy in the donor's family for a stranger(SESDF2020C).

Heroism was also recurrent. Be a hero. Save lives. Donate your organs(ABTO2019A). You can save many lives (SESMG2017C). Most of the times it is represented by the image of heroes, whether from American movies or cartoons, such as Superman, Captain America and Spiderman, among others. In the center, the image of a human heart wrapped in Spiderman's clothes(CETCE2013A). The background consists of a rough blue sea with high waves and a white-skinned man in a lifeguard suit coming out of the water with seven people on his shoulders (a boy, a girl and five men)(ABTO2014F).

In some situations, the representation took place through people and words, for example, “save” and “saving”, in an attempt to get out of the playful and imaginary world, and bring the population closer to the reality of the organ and tissue donation process. Donate your organs. Save lives! João Marcos authorized donating her mother’s organs(SESAL2018C). Shirlayni said yes and his son's organs saved another life(SESES2017A). The true power lies in you. Donate your organs(CETCE2013B).

DISCUSSION

Regarding the relationship between the numbers of advertising campaigns and of donations and transplants performed, we verified that, in 2019, in the states with the highest number of campaigns (Bahia, Goiás, Pernambuco, Ceará and São Paulo), there was a higher number of donations per million inhabitants and transplants performed, with organs from deceased donors.¹ On the other hand, in the same period, the states with fewer campaigns (Amapá, Pará, Paraíba, Mato Grosso, Mato Grosso do Sul and Roraima) presented a lower number of effective donations and performed fewer transplants.1 Such being the case, this finding can be related to the absence or lower frequency of publication of campaigns focused on the theme. It is important to consider that Roraima and Amapá recently implemented organ donation programs in 2015 and 2018, respectively.

However, this interpretation needs to be weighted, as better performance in the donation and transplantation process may not be exclusively associated with publication of campaigns. We highlight the state of Santa Catarina as an example, considered one of the leaders in the national donation ranking. In our study, it presented a lower number of campaigns when compared to Goiás and Bahia. However, a study indicates that health professionals with extensive knowledge on the theme, efficient support from transplantation centers and active participation of intra-hospital commissions for the donation of organs and tissues for transplantation in hospital institutions contribute to better results in Santa Catarina.21

Regarding the effectiveness rates, a German study,22 in which focus groups were carried out with people who say no to organ donation, sought to analyze which aspects can interfere with the denials. Corroborating other studies from that country, the authors identified that four factors are predominant in reluctance and rejection regarding organ donation, namely: 1) lack of knowledge about the procedures involving organ donation and transplantation; 2) mistrust in the way in which donation and transplantation are regulated in the health system; 3) the desire to “not” kill the person considered as a probable donor, an aspect related to disbelief in the criteria for brain death and its acceptance as a current synonym of death; 4) the fact that bodily integrity is considered a principle of human dignity, which would be affected when medications and surgical interventions are performed in some people to maintain the life and integrity of others' bodies. In the same study, the authors point out that, based on these four factors, it is possible to think of individual and collective mechanisms involved in the process of (not) being convinced in relation to organ donation. They indicate that it is important to recognize the “yes” to donation, but also the “no”, with the need to include all perspectives in the public policies and media campaigns. Considering the plurality of opinions and concerns about body and dignity, as well as the conceptions of what life and death are, it is possible to plan more inclusive and welcoming actions, which can be more sensitizing, encouraging the desire to donate.22

Regarding the biopolitical strategies, the image of the loop appears frequently in the campaigns in our analyses. The loop represents an alliance, a bond, the union of two elements or engagement around an idea that becomes common to all, regardless of the differences. It has been used to symbolize the struggle around a cause involving both public and private institutions. In the campaigns, it is evidenced as the fight against breast cancer, in the prevention of suicide or in the fight against the Acquired Immunodeficiency Syndrome.6^,23

We can consider that its use in the campaigns analyzed aims at bringing the largest possible number of people together around a common objective: carrying out organ and tissue donation and transplantation. Such a strategy refers to a government of “a body with countless heads”,21:292 the way in which the State acts in the context of Biopolitics. In other words, it is a way of mobilizing and leading a population, in its most plural sense.24 Thus, it seeks to include and reach groups that are precisely distinguished by their phenotypic characteristics, but that, ultimately, have a body - as a biological structure - in common, which makes the donation process viable.

The extensive representation of population diversity in the organ and tissue donation campaigns can be justified through democratic governability. This set of management techniques aims at developing actions that build subjects as citizens, enabling them to feel included in the government process and making them central in power relations. Therefore, from the moment these subjects are individualized, they become the target of public policies and, consequently, of control systems.25

We believe that when campaigns bring up images that are able to represent people of all ages and skin colors, they demonstrate that those subjects are part of the Brazilian donation and transplantation process. In addition to that, such inclusion also allows holding them responsible for the numbers of donations made and of the waiting list, for example. This responsibility is in line with Law 8,080 of 1990, which affirms the State's duty in relation to the right to health, not canceling the duty of individuals and families.26

Resorting to children, boys and girls, mainly in situations of suffering, in the advertising pieces of the organ and tissue donation campaigns seems to be an emotionally appealing strategy. That is related to the incompatibility of these representations with the children's images that are seen in everyday life, full of smiles, games and vitality. Thus, the target audience is faced with the different and is invited to think about the benefits that transplants provide to those who are waiting for an organ and, with this, they can become in favor of donation.

Some campaigns also resort to emotional appeal, markedly through the use of children's images or drawings. When referring to children, as an impact strategy, it is considered that these materials seek to resume each person's relationship with the care directed to children. However, this stimulus is only possible because there are discourses, disseminated in modern society, in relation to the need for investment in childhood, such as Education.27 Such discourses treat children as entities on which to invest, aiming at transforming and improving the society in which we live. Thus, it is possible to make approximations between the health and education discourses with regard to economic, social and care investments, with a view to enhancing children's life, with the ultimate purpose of changing a given context.

In Brazil, federal public policies aim at providing better conditions for children's health, such as the National Policy for Comprehensive Children's Health Care.28 When thinking from a Foucauldian perspective,25 it can be understood that State investments seek to improve physical, psychological and social means, favoring modulation of the bodies and, consequently, making children's development useful. In other words, the children's bodies are those that will receive all the investment in education and health to become productive, as the instruction of future healthy adults is projected on them, with the potential for consumption, for work, for the maintenance of life, and for organization of a society.25 Organ donation, for example, can also be considered as part of this strategy to promote children's health, especially in those with diseases for which transplantation is the main treatment.1

In 2009, given the growing number of children in need of transplants, Ordinance 2,600 of 2009 was enacted, determining that individuals under 18 years of age have priority to become recipients of organs from donors belonging to the same age group.29 This prioritization can also be related to the government's attempt to invest in the childhood and youth of those who will later be part of the workforce that will assist in development of the State.

Regarding the aged population, a limited reference to these individuals was observed in the campaigns. Withdrawal of older adults from the donation and transplantation process can be related to some age criteria present in the medical environment, which consider a patient's age as inversely proportional to the chance of a favorable prognosis and, consequently, of potential for recovery, generating less investment on them.30 This type of criterion is linked to contemporary thinking and to the effects of Biopower, which prioritize investments in young, potentially healthy or recoverable bodies, which will have consumption and production perspectives, to the detriment of aged bodies, considered frail and unable to contribute to development of the State.31

Another strategy used in the advertising campaigns was mobilization of characteristics in order to convince people to donate organs or families to accept organ donation. Resorting to altruism, empathy and heroism stood out in the materials analyzed. The term altruism can be considered as the opposite of egoism. It is associated with the positivist education that is able to spontaneously develop sympathetic instincts, making a person's happiness and well-being capable of providing a feeling of satisfaction in another individual.32 In addition to that, this term is also considered as modernized charity, as there is social value in the organs made available for donation, that is, they are not mere parts of the body made available for donation.10

Empathy is an individual's human predisposition to another person. It is linked to the actions of mimicking or projecting, which allows approaching another person's emotional state. Heroism is also related to dedication to others in a situation of extreme danger and to courage.32 The use of images of heroes is associated with the way in which society conceives them: strong men, warriors, vital and responsible for saving the world. Therefore, we identified that, when addressing issues related to altruism, empathy and heroism, the institutions responsible for the production of organ and tissue donation campaigns appropriate subjectivity elements to sensitize the target audience. In other words, they work with elements of the “I”.33

From a Post-Structuralist perspective, the “I” does not imply psychologization of a person; it is not about a conscience but about the relationships of human beings with themselves in a given historical and cultural period. It deals with what makes up the “personality” from the norms, knowledge and techniques that modulate the individuals' behaviors.33 Thus, when leading or governing populations in modern Western societies, it is necessary to explore the elements that involve desires, will powers, individual choices, and what makes people feel important in a given context or society, on a daily basis.34

Thus, in the organ and tissue donation campaigns it is possible to see that, whether through the Ministry of Health or the Secretariats, the Brazilian State resorts to something that could be called management of emotions, morality, desires or, simply, of the “I”.34 In this way, another strategy emerges to modulate people's choices and behaviors, which implies and considers that individual choices resonate with the collective, both in matters related to consumption and in those inherent to care, hygiene and beauty, among others.

By resorting to individuality, emotions and feelings, people are led to a self-commitment relationship, as well as to commitment to others. Thus, the campaigns seek to emphasize altruism, heroism and empathy as a way to distinguish the donors' social status. Visibility is given to the benefits of transplantation for those in the waiting lists, allowing the image of someone who contributes to continuity and maintenance of what is most “sacred” in religious, cultural and moral terms, that is, life, to stand out and promote a sense of engagement with a social cause.34

From the sociological perspective, this type of strategy has been called “moral economy of donation”. From this point of view, it is understood that human organs and tissues not only hold individual, social and economic value, but also affective. Affection concerns a person’s ability to be touched by dimensions of experience and impressions of a body. It is related to intensity and depends on interaction. Affect differs from emotion, which can be conceived as the cultural way in which affection is externalized and given visibility, the way in which each person felt affected by something.35

For this reason, mobilizing altruism, solidarity and the conception of life as a “gift” makes people participate in a game of affections. Affections in relation to the family, in relation to conceptions about oneself - through representations of one's own body - and affections in relation to society, when a person is called upon to think and exercise empathy. From this mobilization of emotions and affections, it is possible to produce new forms of “biointimacy”, that is, new affective and social relationships mediated by the technologies of life that interfere in the way each subject means their body and, consequently, positions themselves in the world.35 In the theme addressed in the current research, this stance makes them feel that they belong to a group of virtuous people, whose common identity factor is the act of donating, turning each of those that say yes to donation into a biological citizen34 of a large community supported by organ and tissue donation.

As contributions, the analysis of the biopolitical strategies made it possible to understand how the State and Institutions seek to sensitize and convince individuals to donate organs and tissues. We emphasize that this study encourages health professionals, especially nurses and physicians, to reflect on how campaigns circulate and are used to approach the population, considering the duties and roles they develop in society. In addition to that, knowing the strategies presented can favor the production of more effective campaigns. We highlight the following as limitations: the reduced number of campaigns published between 2007 and 2011, available on the Internet and accessible; as well as not receiving answers to the e-mail messages sent to the State Secretariats. In addition to that, lack of periodicity of the publications by the institutions can also be considered as a limitation.

CONCLUSION

This study allowed analyzing the organ and tissue donation advertising campaigns in Brazil, showing how they are constituted as biopolitical strategies aimed at convincing the population and subjectivizing it in favor of donation. In our analyses, we identified that the Brazilian State and governmental and non-governmental institutions establish a field of diverse knowledge and practices on continuity of life through organ and tissue donation; knowledge and practices that are grounded on the Science, numbers, altruism, empathy and heroism discourses.

When looking at the advertising campaigns from another perspective, we notice that death seems to be a rebirth possibility, especially for children and young adults. This population segment receives more attention in the campaigns, probably due to the idea that it can take advantage of an organ producing effects and impacting on social organization. They are young people and adults who work, produce and consume. In other words, they ensure life maintenance and the economic stability of a State. Consequently, they “deserve” that their lives are spared.

We believe that the idea of rebirth through death can denote our denial and fear in relation to finitude. For this reason, mobilizing the “I” proves to be important, as it sensitizes and makes each person think about their own existence, relationships with the family and the possibility of feeling immortal, even if it is through an organ that will continue to perform its functions in another body; and as if it were possible to continue living through other stories. When activating such aspects, the State and the institutions reach each person's intimately and in their “I”. Consequently, despite the impression that all men and women seem to be included in the organ donation campaigns, it is worth reflecting on how this inclusion takes place. In our view, it seems that inclusion of the entire population takes place with the aim that people become donors. However, when dealing with possible recipients, there is selectivity regarding the population segments considered as those that deserve the investment so that they can continue to exist.

Consequently, we believe that this study serves as a trigger for discussions involving organ and tissue donation in Brazil. Based on the analyses here in presented, it is possible to (re)think the way in which different population segments are positioned and activated in the campaigns. It is possible to understand how the State and the institutions use or can use individual and collective strategies to mobilize each and every person towards this contemporary practice - organs and tissue donation - which allows us to ward off death and save lives, even if it is the lives of some individuals.

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NOTES

• ORIGIN OF THE ARTICLE

  Extracted from the Course Conclusion Paper - Organ and tissue donation advertising campaigns in Brazil: Biopolitical strategies, presented at the Nursing Course of Universidade Federal de Pelotas, in 2020.

• APPROVAL OF ETHICS COMMITTEE IN RESEARCH

  For dealing with the analysis of materials in the public domain or produced by public interest bodies, the research waives approval by any Research Ethics Committee, according to Resolution 510 of 2016 of the National Health Council.

• CONSENT OF USE OF IMAGE

  Not applicable.

Edited by

EDITORS

Associated Editors: Laura Cavalcanti de Farias Brehmer, Monica Motta Lino. Editor-in-chief: Roberta Costa.

Publication Dates

• Publication in this collection
  29 Aug 2022
• Date of issue
  2022

History

• Received
  16 Feb 2022
• Accepted
  05 May 2022