Blood and Citizenship in a Fragmented Nation: Logics of Gift,Debt and Inheritance in South Korea

Abstract

Drawing on archival materials and interviews with donors, blood bank staff and experts, this article explores how the logics of gift, debt and inheritance shape the moral and affective economies of citizenship in South Korea. From leading haematologists’ reflections on the introduction of blood banking in the mid-20th century to national crisis narratives surrounding COVID-19 blood shortages, the article traces how the figure of the nation continually transforms as it both animates and is animated by South Korean blood banking. Taking a closer look at the case of North Korean settler blood donors, the article examines how their ambiguous belonging generates a fertile terrain for renegotiating relations of gift, debt and inheritance. Blood sharing conjures different collectives and (un)common fates for actors whose belonging to the South Korean nation is contested and renewed, instantiating ‘mutations’ in nationhood and citizenship.

Communities of Blood and the Obligation to Give

Spread across the globe to counteract massive bloodshed caused by modern warfare over the early to mid-20th century, blood banking has co-evolved with national security concerns and patriotic sentiments (Starr, 1998: 53–146). In the post-WWII order, voluntary blood donation came to be regarded as a motor of social solidarity undergirding social policy and the welfare state, as formulated in Richard Titmuss’ (1970) seminal work, The Gift Relationship, which paved the way to the formation of ‘a contemporary globalized blood donation ecumene’ (Copeman, 2009: 9). While Titmuss’ work highlighted social bonding and membership through blood donation, public anxieties concerning the HIV/AIDS epidemic and related blood scandals over the 1980s and 1990s (Chauveau, 2016: 71–88; Cullinane, 2005, 2007; Feldman and Bayer, 1999; Starr, 1998: 261–336) have prompted scholars to scrutinize forms of exclusion and boundary-making in donor screening and deferrals. The concept of biological citizenship has proved particularly useful in this body of literature to delineate the processes of exclusion and political mobilization around the ‘right to give’, especially among gay activists and racially marginalized groups across the world (Avera, 2023; Seeman, 1999; Strong, 2009; Valentine, 2005). Foregrounding the politics of othering, further research has conceptualized blood donation as a ‘citizenship regime’ that validates and institutionalizes the ‘model’ citizen while structurally disadvantaging ethnic minorities (Wittock et al., 2021: 538). What these studies have highlighted is how blood donation serves as a crucial site wherein citizenship is practised and embodied beyond the languages of rights and duties, but as a matter of belonging and relationality.

Thomas Strong’s notion of ‘vital publics’ is noteworthy here, as it draws attention to the relational dimension of the collective conjured through blood donation. Defined as ‘forms of embodied association elicited through the generalised exchange of body’ (Strong, 2009: 173), Strong’s ‘vital publics’ captures the relationality formed among potential donors and recipients, ‘characterized by an intimate strangerhood’ (Strong, 2009: 173). While tracing how gay activists endeavoured to evoke more inclusive vital publics, Strong ultimately seems to follow Titmuss’ understanding of the social as a homogeneous unit, when he argues that vital publics ‘represent and elicit a form of cultural intimacy that exceeds the reach of affective or symbolic identification’ (Strong, 2009: 173). What requires further consideration, I argue, is a historical view of the making and unmaking of vital publics, through which legacies of blood-based identifications seep across time, even as their meanings and forms change. It is precisely these seepages that render blood donation such a powerful site where invocations of national or racial essence, blood ties and pure blood transform into volatile political projects, giving rise to new belongings and becomings (Biehl and Locke, 2017; Grosz, 1999).

Building on the rich insights of previous studies, I would like to consider how vital publics intersect with heterogeneous embodied collectives enacted through transfers of blood: in South Korea’s case, the nation appears as a prominent figure due to blood’s material and symbolic role in defining citizenship, yet there are other forms of collectives invoked through blood, from immediate kin relations to ethnicised communities. At the same time, I pay attention to instances in which vital publics fail to be conjured. The key question I ask then, is not who are included or excluded from the vital publics of blood, but what are the logics that (dis)connect different bodies and varying vital collectives. To put it differently, I draw attention to how blood economy activates ‘moral’ and ‘affective economies’ of citizenship, whereby relationships among individuals and collectives are contested and transformed around the common good tapped through blood donation (Ahmed, 2004; Fassin, 2005).

What becomes apparent through this exercise, as will be shown later in this article, is the intertwining logics of gift, debt and inheritance tackled by various actors involved in South Korean blood banking. As in many other places, the gift of blood has historically been tied to wartime ethics in South Korea, viscerally manifesting the obligations shared by members for the sake of being part of a community. The gift of blood, in this sense, has epitomized what Roberto Esposito called the munus (gift, obligation) in the original Latin sense of the term communitas: ‘to belong entirely to the originary communitas means to give up one’s most precious substance, namely one’s individual identity, in a process of gradual opening from self to the other’ (Esposito and Hanafi, 2013: 84). Meanwhile, as citizenship has been bestowed through the principle of jus sanguinis in South Korea, blood became a medium through which the unilateral direction of munus (from individuals to collectives) acquired cyclicality: it is blood one has inherited from the national community that is called upon to be (partially) returned in times of crisis. In other words, the obligation to give has been situated within the longue-durée primordial relationship between citizens and the nation state. This is the sacrificial logic that has been propagated in blood donation through much of the military dictatorship over the 1970s and 1980s and one that occasionally resurges in contemporary narratives of blood crises as discussed later in the article.

However, this national vital public is instantiated only precariously and transiently, if ever successful. Contrary to evidences of ‘bionationalism’ in support of tissue donation for biotechnological research in South Korea (Gottweis and Kim, 2010), blood donation has only been reluctantly embraced by most citizens, despite their relatively high participation. ¹ In this article, I attempt to provide an answer to this conundrum drawing on Jane Guyer’s nuanced discussion of the temporalities of gift and debt (Guyer, 2012; also see Guyer’s introduction to Mauss, 2016). In her compelling review, Guyer notes that ‘gift appears to belong in the temporal arc of the human life’, that is long, indeterminate, open to contingencies and surprises, whereas debt is both ‘bound to the calendar’ and ‘to the time of eternity’ (2012: 491). While attending to these differences, Guyer emphasizes the overlapping of the two in social practices across human history:

The play of time in the human life span, the calendar and eternal, fixed validity lies squarely at the centre of the terrain where gift and debt meet, a terrain that is traversed ambiguously by ‘obligation’ and its reciprocal ‘responsibility’, along with ‘promise’ and ‘credit’, captured by one or another temporal configuration in different times and places. (Guyer, 2012: 492)

The modern legal, ethical and financial sanctions around gift and debt, then, involve the work of ‘temporal precision’ to hold actors accountable to a reinforceable timeline of actions and verifiable intentions (Guyer, 2012: 492). Guyer, here, cautions us not to confuse the modern temporal precisions of gift and debt with the ongoing mutual binding of things, persons and sentiments that Marcel Mauss’ originary essay on the gift so powerfully captured and advocated for (Guyer, 2012: 500). In other words, mutuality in gift relations arises not only from reciprocity itself but also from the indeterminate temporality invoked by the parties involved.

Guyer’s insights are valuable in delineating how various actors involved in South Korean blood banks productively engage with the obligations and right to give and repay, evoking long-term commitment at times, or inherited debt to be extinguished at others. By adding the dimension of inheritance, as the cross-generational gift, to Guyer’s discussion, I aim to lay bare the forging of collective fates – legacies and futures – through the gift and debt relations around blood. What is notable in the accounts and narratives I present in this article is that the gift of blood is often understood in terms of a prior debt – from transfused blood to aid and welfare services, incurred not only necessarily by the individual donors themselves but also by the collectives to which donors have been ascribed. Blood donation, then, indispensably involves a ‘misrecognition’ (Bourdieu, 1977: 112) of a collective to which the gift is directed, the debt is owed, and one’s belonging is reaffirmed or contested. Blending the logics of gift, debt and inheritance, blood donation enacts variegated communities of blood and their constituent members.

The data for this article come from an ongoing comparative study of the politics of blood donation in South Korea and Japan, combining ethnographic, archival and social media research. Ethnographic fieldwork in South Korea was conducted primarily between September and November 2021 and July and August 2022 and included interviews with blood donors (n = 30, including eight minoritised donors), blood bank nurses (n = 16) and experts (n = 5), as well as observations of 15 blood donation centres and two blood processing facilities. Blood bank nurses and most donors were recruited and interviewed on-site during prearranged visits coordinated with the Korean Red Cross and the Hanmaeum Blood Centre, while experts were recruited through purposive and snowball sampling, as were donors from ethnically minoritized communities. All interviews were conducted in Korean and subsequently translated by the author.

This article draws on archival materials, including published accounts, policy documents and promotional materials by the Korean Red Cross, as well as interview data in which claims to nationhood were especially pronounced and explicitly contested. From leading haematologists’ reflections on the introduction of blood banking in the mid-20th century to national crisis narratives surrounding COVID-19 blood shortages, I trace how the figure of the nation continually transforms as it both animates and is animated by South Korean blood banking. Taking a closer look at the case of North Korean settler blood donors, I examine how their ambiguous belonging generates a fertile terrain for renegotiating relations of gift, debt and inheritance. The sharing of blood, I argue, conjures different kinds of collectives and (un)common fates for different actors whose belonging to the South Korean nation state is contested and renewed, instantiating ‘mutations’ in nationhood and citizenship (Kowal et al., 2013; Ong, 2006).

Pure-Blood Nationalism and Citizenship in South Korea

Scholars of Korean ethnic nationalism trace its modern formation back to Japan’s colonial rule over the first half of the 20th century (Pai, 2000: 23–56; Schmid, 2002; Shin, 2006). It is well documented that the Japanese imperial expansion propagated a racial epistemology drawing on Social Darwinism, which simultaneously constructed the ‘Asian race’ against the white while placing Japan at the top of the hierarchy within Asia to be followed by others according to their closeness to Japan to justify their ‘civilizing mission’ (Tikhonov, 2010: 17–18). Furthermore, the modern science of race mobilized a pure-blood ideology which combined newly imported eugenics thinking with older beliefs about bloodlines and ritual purity, creating a hierarchy between ‘pure-blooded’ Japanese and various internal and external others (Robertson, 2002). Japan’s colonization of Korea, in turn, solidified Social Darwinist understanding among Korean intellectuals and activists who drew upon inverse arguments about Koreans’ pure blood as a powerful rationale for independence (Park, 2010: 106; Shin, 2006: 41–57). Even in the anti-colonial thinking during and after the Japanese occupation, the very ordering of nations and races into levels of civilization tended to be left unquestioned. The sudden shift from Japan’s colonial rule to the American trusteeship (1945–1948) and the Cold War order, then, rather contributed to a neat translation of the Social Darwinist understanding of national survival in the hierarchical world into programmes of modernisation in South Korea (Tikhonov, 2010: 219–221). In short, pure-blood ideology has undergirded understandings of national identity, modern developmental trajectories and global hierarchy in much of postcolonial South Korean history (Diederich, 2021; Hyun, 2019; Jeon, 2022; Shin, 2006: 96–109).

Meanwhile, the relationship between blood and nationhood has been further coalesced by the principle of jus sanguinis of South Korean citizenship. The inheritance of ‘Korean blood’ has been the ground that offers Korean diaspora and North Koreans access to exceptional tracks towards citizenship, in contrast to other foreign migrant groups whose entitlements have been limited to temporary visas and extremely selective routes for permanent settlement and naturalization (Seol and Seo, 2014). Despite the growing recognition of demographic diversity and the implementation of multicultural policies, the idea of Korea as a monoethnic (pure-blooded) nation continues to shape the daily practices and negotiations of belonging in South Korean society today (Kim, 2015; Seol and Seo, 2014). The scenes captured in this article reflect the diverse attempts made by differently positioned actors in redefining and remaking nationhood and citizenship through blood. In what follows, we first consider how blood donation comes to be established as an exercise in modern citizenship and an expression of national spirit (minjok jeongshin) ² under the military dictatorship, as blood banking was institutionalized over the 1970s and 1980s. The following section discusses how such a national vital public proved to be particularly vulnerable, and only superficially sustainable, amid the blood crisis during the COVID-19 pandemic. The final section considers how the Korean nation is further renewed through blood donation by North Korean settlers in South Korea. Ultimately, the article highlights the shapeshifting figure of the South Korean nation and its constituents in the imbricated logics of gift, debt and inheritance connecting diverse individuals and embodied collectives.

The Postcolonial Debt of Blood and Modern Donor Citizens

Blood banking, which was introduced as the cutting-edge biomedical infrastructure of the United States in mid-20th century, easily lends itself to South Korea’s claims to a successful but incomplete modernisation narrative. The role of blood as a metaphor and biological substance of nationhood is paramount here, as the infrastructure of blood banking is seen to reflect not only South Korea’s level of development but also the national character of Koreans and their collective will for survival and prosperity. In particular, the logic of gift-giving in blood donation has offered a productive ground wherein the relationships between individuals and the state were redefined in terms of collective duty, self-sacrifice and mutual aid for developmentalist progress.

The Korean haematologists ³ who wrote the History of South Korea’s Blood Donation Movement (Hanguk Heonhyeol Undongsa, hereafter History) open the book with the mention of how the introduction of this miraculous American technology was delayed in Korea by Japan’s colonial rule that favoured German medicine (Kim et al., 2011 [1990]: 37). Nearly 600 pages long, and one of the few publicly available histories of blood donation in South Korea, the book chronicles these pioneering haematologists’ efforts to introduce American medical advances and accelerate the nation’s progress along a developmental trajectory. First witnessing the life-saving power of transfusion demonstrated by the American medics during the Korean War (1950–1953), ⁴ many Korean haematologists went to the United States for further medical training (Hyun, 2019: 249). Despite their dedicated endeavour to import cutting-edge transfusion technology, a large hurdle lay in securing sufficient raw material for this crucial infrastructure. ⁵ To their dismay, many medics found themselves having to rely on American blood supply to treat Korean soldiers during the Vietnam War. ⁶ Over the course of the conflict, sentiments of remorse and moral resolve helped spur South Korea’s blood donation movement, later formalized through the Korea Blood Donation Association (Hanguk Heonhyeol Hyeophoe, KBDA, est. 1969), a development underscored by the authors of History:

Korea’s armed forces had already received blood from the American Forces during the Korean War in the 1950s, and to repeat the same thing in the Vietnam War after fifteen years, it is natural that we received the criticism from the US ‘Don’t Koreans have blood?’ This became a source of han (deep regret and sadness) for those of us medics dispatched to Vietnam. (Kim et al., 2011 [1990]: 125)

Many economic anthropologists have pointed out how the international aid activates moral economies of debt that reinforce the hierarchy between the Global North and the South (Elyachar, 2005; Ferguson, 1990; Smith, 2008). In the case of the American military aid, the fact that part of the gift took the form of a vital bodily fluid added another layer of ‘postcolonial indebtedness’ (Watson, 2016), placing ‘blood independence’ at the heart of Korean haematologists’ decolonizing enterprise (Diederich, 2021: 132–137; Hyun, 2019: 250–251). The urgency of the Vietnam War prompted the KBDA’s Director of the Secretariat and Christian activist, Park Jin-tak, and its board member and haematologist at Yonsei University, Lee Sam-yeol, to make a personal visit to the Minister of Defense to resolve the issue of blood supply for the conscripted Korean army ⁷ in February 1971. Soon after, the Military Blood Management Regulation (Ministry of National Defense Ordinance No. 218) was promulgated, encouraging all conscripted servicemen to donate blood at least once during their term of duty. By the next year, 100% of blood used in military hospitals was collected within the army through voluntary blood donation (Kim et al., 2011 [1990]: 128–133). These efforts were boosted by the strong support from the military dictator, Park Chung Hee (in office, 1961–1979), who personally donated the nation’s first bloodmobile to the Korean Red Cross, and the first lady Yuk Young-soo, who donated blood at a Red Cross blood donation centre in Seoul to set an example for civilians (Korean Red Cross Society, 2018: 113). Blood donation campaigns, then, mapped onto broader efforts of cultivating ‘fellowship among compatriots’ (dongpoae) to guard the nation against internal and external threats. Take, for instance, the following notice card celebrating the issuance of a blood donation promotion stamp on 1 October 1979:

Blood donation has a great meaning, not only in protecting patients through the use of pure and clean blood in treatments, but also in guarding the purity of donors’ own blood. It is equally of grave significance as the movement for the purification of national spirit (gukmin jeongshin sunhwa undong), manifesting mutual aid by sharing precious blood. (Ministry of Communications, 1979)

Cast as spiritual and bodily purification for the nation, blood donation was presented as a prophylaxis against the moral and microbial impurities associated with blood trade. Beneath this injunction towards purification lay a deeper concern: the preservation of the ‘pure blood’ of Koreans, feared to be ‘mixed with foreign blood by transfusion’, as a news editorial warned as early as 1963 (Pi-reul guharyeoneun pi, 1963). Within this framework, blood donation emerged as a civic duty intertwined with the modernisation of the fatherland (joguk geundaehwa) under Park’s dictatorship. Blood donors were positioned as model ‘modern citizens’, offering their bodies to safeguard and sustain national vitality. In this way, blood donation was institutionalized as a profoundly embodied performance of citizenship in the militarized South Korean state (Moon, 2005).

By the 1980s, more than 90% of blood was collected through non-remunerated voluntary blood donation, and commercial blood procurement was eventually phased out following the 1999 amendment of the Blood Management Act (Act No. 5383) (Kim et al., 2011 [1990]: 460; Korean Red Cross Society, 2018: 598). Over the subsequent two decades, new measures such as gift cards and souvenirs have been introduced to incentivise donors. Yet, the demographic spread of donors reveals enduring legacies of institutional mobilization established under decades of military dictatorship. As recently as 2018, the Korean Red Cross’s statistics showed that 45.3% of donors were students (roughly equal portions from college and high school), 23.9% were company employees, and 15.2% were military personnel, many donating in the context of institutional incentives and collective blood drives (Korean Red Cross Blood Services, 2018: 22). Overall, 68.4% of donors were in their teens and twenties, a pattern that sets South Korea apart from countries like Japan, where the majority (79.06% in 2018) of donors were aged 30 or older (Japanese Red Cross Society, 2018: 9–10; Korean Red Cross Blood Services, 2018: 22). These demographics were highlighted in the Ministry of Health and Welfare’s 5-year development plan for blood services announced in April 2018, which aimed to raise the donation rate among the middle-aged and senior groups from 29% to 42%, benchmarking Japan and France (Korea Centers for Disease Control and Prevention, 2018). Although this target was met in 2020, partly due to the unexpected effects of the COVID-19 pandemic on school and military blood drives, the imperative to foster a voluntary blood donation culture to catch up with the advanced nations (seonjinguk) continues in the Basic Plan for Blood Management (2021–2025) announced in December 2020 (Ministry of Health and Welfare, 2020).

For policymakers, blood donation may sit comfortably within the nation’s unencumbered modernizing mission. For many South Korean citizens today, however, it remains a site where the developmentalist doctrines of collective duty and self-sacrifice are keenly felt. As late as 2019, the legacy of militarized citizenship was evident in a Korean Red Cross promotional video featuring military donors, which positioned blood donation within a patriotic narrative: ‘Shall those of us guarding the nation become heroes by saving lives as blood donors?’(Daehan Jeokshipjasa Gongsik Chaneol, 2019). ⁸ While such militarist rhetoric holds limited resonance in today’s democratic South Korea, it nonetheless exposes the moral conundrum faced by blood banks in recruiting donors: if not for the nation, then who are the publics being served by blood donation, and what moral obligations do potential blood donors bear towards them? This moral tension surrounding voluntary blood donation was amplified during my fieldwork over 2021 and 2022, when the COVID-19 pandemic brought a steep decline in collective donations.

The Limit of Nationhood during a Crisis

Never more than during national crises, often accompanied by blood crises, are blood’s material-semiotic entanglements with nationhood in South Korea most forcefully manifested. To put it differently, the imaginary of a one-blooded nation becomes prone to the process of what Marilyn Strathern called ‘literalization’, or ‘a mode of laying out the coordinates or conventional points of reference of what is otherwise taken for granted’ (Strathern, 1992: 5, see also Carsten, 2007: 407 and Copeman, 2009: 4). For instance, during the epidemic of MERS (Middle East Respiratory Syndrome–related Coronavirus) in 2015, the leader of the ruling conservative party, Kim Moosung, had provoked controversy when he boasted that Koreans could beat any epidemic as ‘a nation (minjok) who eat chilly paste (gochujang) and kimchi’, in his bungled attempt to encourage blood donation amid a critical shortage (Son, 2015). When the blood crisis resurged during the COVID-19 pandemic, politicians avoided repeating Kim’s mistake in appealing to the nation’s superior biological condition. Nevertheless, many from the left to the right of the spectrum continued to evoke the collective duty of national subjects (gukmin) to address the blood shortage. ⁹ With the whole country declaring a war against the virus (Seo, 2020b), the level of blood reserves was added to the list of metrics that citizens became collectively accountable for, along with the numbers of COVID-confirmed cases and deaths.

Amid mass cancellations of collective blood drives at schools and in the military, a host of reservists were mobilized to make up for the loss, mainly employees of the public sector and big corporations. Meanwhile, blood donation centres increased the material incentives for blood donors, with the enticingly advertised ‘1 + 1 events’, doubling the usual perks like gift cards to be used in cafes, movie theatres and convenience stores, among others. The gift cards, ranging between ₩5,000 and ₩15,000 in monetary value as of 2025 (roughly between £3 and £8 at the current exchange rate), have played a controversial yet important role in motivating young donors in the last two decades. ¹⁰ Although critics caution that such measures are short-term and risk undermining the voluntary ethos of donation, blood centres nonetheless expanded their use during the COVID-19 pandemic in a desperate effort to attract donors.

Yet, most blood bank nurses I interviewed in 2021 expressed ambivalence about the efficacy of material incentives. Several noted that public appeals by the government, rather than material rewards, were far more effective, as evidenced by the high donor turnout immediately after the national disaster text alerts. These real-time alerts used a Cell Broadcast system to automatically send out text messages activating an alarm to all connected smartphones within a defined area. While the national warning system was adopted nearly a decade earlier for disaster and crisis management, its use exponentially grew during the COVID-19 crisis, constituting an immediate and visceral conduit of the South Korean state’s care and surveillance of its citizens. As anthropologist Bo Kyeong Seo (2020a) incisively captures:

When everyone’s phones are beeping at the same time in offices, subway trains, and buses, regardless of the content, the message is loud and clear: It is a time of crisis, so we are all warned together. While this novel virus can sometimes present no symptoms, emergency alerts have become a physical mode of knowing, relating, and attending to this state of emergency in South Korea . . . . This new pandemic is rapidly changing public understandings and feelings of individuality, privacy, responsibility, transmissibility, and the common fate. (emphasis original)

As citizens were alerted daily of the details of the COVID-19 confirmed cases within their districts along with tailored social distancing recommendations, they also received nationwide warnings, including the state of the national blood reserve. Over the course of the pandemic, there were three nationwide alerts on blood shortage sent out, respectively, on 15 May 2020, 18 December 2020 and 26 November 2021. The reminders for blood donation operated within the IT-mediated apparatuses of bodily discipline and care for individual and collective survival against the rampant ravages of the SARS-CoV-2 virus in South Korea. While the COVID-19 countermeasures highlighted the immunitary paradigm (Esposito, 2008: 45, 2011) of individuals to be shielded from the communitas for self-preservation, the encouragement of blood donation invoked the continuing munus that the communitas needed during this time of crisis.

Each time, the blood alerts triggered a rush of blood donors, resolving the shortage within a matter of a day or two (Choi, 2023; Park et al., 2022). However, it would be a mistake to construe the emergency responses as evidence of the nationalistic fervour of South Korean citizens. In fact, the 30 blood donors that I interviewed over the course of the pandemic rarely mentioned the nation or the state. One middle-aged regular blood donor I met in the conservative city of Daegu, which saw the nation’s first mass COVID-19 outbreak, stood out in his cynicism against any nationalistic view of blood donation: ‘There is nobody who will be happy to hear that I come here, because the image of the Red Cross is so bad . . . . It’s all a robbery . . . . You know, they send you those giro slips for Red Cross membership fee every year-end. They take money from people (gukmin), ¹¹ but they also take money from the hospital for blood’. ¹² Despite his deep distrust of the system, he has been a lifelong blood donor, having had a family member and a friend receive transfusions. His only conviction was that ‘blood will go to someone who needs it’. So if there was any communitas enacted through blood donation, it was not a harmonious one. For sceptics like him, blood donation evoked vulnerable circles of families and friends who had no means of supporting each other than through exposing themselves to the predatory demands of the Korean Red Cross, and by extension of the state that sponsors it. Far from responding with patriotic zeal, these donors were bitterly reminded of the limitless munus one had to give for the sake of belonging to the communitas of South Korea. South Koreans’ response to the national blood emergency alerts, then, may be comparable to the sacrificial volunteerism shown in other contexts wherein citizens are mobilized to make up for the retreating or threatened state (Muehlebach, 2012; Ning and Palmer, 2020; Weiss, 2014). Instead of inducing feelings of ‘intimate strangerhood’ (Strong, 2009), emergency blood donation intensified ambivalences around giving for a communitas, amid uncertainties about receiving any security or protection in return.

During the COVID-19 pandemic, the fragmentation of South Korean vital publics was felt most acutely among patients who had to bear the cost of the blood crisis. Despite the temporary successes of the emergency alerts, the blood reserve remained low throughout the pandemic, and patients were often told by hospitals to seek ‘directed blood donation’ (jijeong heonhyeol) from families and friends. ¹³ Originally adopted as an exceptional measure to support patients with rare blood types, the directed blood system came to be over-utilized by hospitals during the pandemic. The total number of blood units collected through the system reached 142,355 units (5.5% of total units) in 2021, more than three times its 2019 level (Oh et al., 2024: 81). Shifting the primary responsibility for blood supply from the blood services and medical institutions to patients and their families, the directed donation system has been criticized for exacerbating the vulnerability of the latter. In the National Assembly debate on directed donation organized by the Korea Leukemia Patients Organization (KLPO) on 17 August 2022, one patient with acute leukaemia recalled his experience as follows: ‘It was not even a full day since I was diagnosed, but I had to call all my acquaintances to ask them if they could help me because I got leukaemia. It was really difficult to call each of them and ask if they would be eligible and be available to come on the scheduled date, I really cried a lot’. ¹⁴ Defying any possibility of anonymity, directed blood donation obliged patients to solicit donors for their life-saving needs, specifying the precise form and timing of the ‘gift’: for example, +A platelets to be given between 18 and 21 March 2021, directed to Kim Hyeonjoo at Hana Hospital. Blood, in this context, was closer to measurable and traceable credit than a gift open to ‘contingencies and indeterminacies’ (Guyer, 2012: 499). This sense of indebtedness was underscored by An Gi-jong, director of KLPO, during the National Assembly debate, when he cited a patient testimonial: families often felt obliged to offer gifts to donors as a gesture of gratitude, a practice that can impose significant financial strain on patients requiring repeated transfusions.

While nationalistic rhetoric and emergency alerts had limited success in sustaining the national blood reserve, the shortfall was taken up by a proprietary logic (Esposito, 2008: 63–69), whether through increased material incentives that rewarded donors or through directed donation that locked the donors and patients into a credit-debt relationship. In the entrenched biopolitics of the pandemic, immunitas prevailed over communitas: the demand of the common, or the shared obligation to the broader social collective, yielded to the imperative of protecting one’s own life, eclipsing a generalized sense of mutuality.

Straddling the National Divide through Blood

Where the COVID-19 pandemic saw blood donation promoted through appeals to nationhood, earlier campaigns mobilized blood donation itself to address a different national crisis: Korea’s enduring division. In one of the most recently publicized events, the Ministry of Unification sponsored a one-off collective blood donation campaign, ‘Country Love, Unification Love, Blood Donation Campaign’ on 25 June 2016, marking the 66th anniversary of the onset of the Korean War amid escalating tensions with the North (Korea Hana Foundation, 2016). The year 2016 started with North Korea’s fourth nuclear test and a long-range missile test which led to a spiralling series of events, including a temporary shutdown of the inter-Korean economic cooperative zone, Kaesong Industrial Region, the strengthening of international economic sanctions against the North, a joint US-South Korea military exercise and the deployment of the THAAD missile defence system in the South.

The ‘Country Love, Unification Love, Blood Donation Campaign’ was advertised as both commemorating the war dead who sacrificed their lives to defend the ‘free’ democratic regime of South Korea and as anticipating the future of ‘free’ unification, or unification led by the liberal democratic regime of South Korea. According to the hosting organization, the Korea Hana Foundation, the campaign was attended by more than 100 individuals from North Korean settler organizations and government-sponsored North Korea-related think tanks and political organizations. Beginning with a silent prayer for the war dead, the event concluded with a symbolic ceremony in which the representatives of the Korea Hana Foundation presented the ‘blood certificates’ to the Korean Red Cross. Ordinarily, these certificates are issued to blood donors as tokens of appreciation, which can be used to offset transfusion fees. ¹⁵ At this event, however, participating donors symbolically returned them to the Korean Red Cross, represented by a large placard reading: ‘North Korean Defectors (talbukmin) Country Love Blood Certificate Donation’. This ceremonial transfer signified a dedication to the Korean military service members who might require transfusions, according to the organizers (Korea Hana Foundation, 2016). Blood donated by North Korean settlers, then, became a particularly potent substance to safeguard the national fate in multiple senses: as the medium to save the lives of the South Korean military force, thereby offsetting the past (and future) blood-loss caused (and to be caused) by the North, and ultimately, as the medium predetermining the victory of the South Korean regime.

While this politicized spectacle aimed to prefigure the future of national unification led by the South Korean regime, for the two individuals I interviewed, ¹⁶ blood donation also revealed the precarity of their belonging to the newly embracing state. Sujin, ¹⁷ a North Korean settler in her 30s, told me that when her South Korean friend first suggested to donate blood together a couple of years after she settled, she thought it would be meaningful to give back to society.

You know when I got the social adaptation training from Hanawon [The Settlement Support Center for North Korean Refugees], they told us not to tell people that we received settlement allowances and so on because people might discriminate against us, asking whether we had laid a single brick or paid a single penny of tax to this country. Those words were actually useful for me.

Sujin, a doctoral student at a prestigious university in South Korea at the time of the interview, indeed faced numerous jealousy-laden comments and accusations negating her achievements as merely coming from the ‘privileges’ she received as a North Korean settler over the years. Blood donation, in Sujin’s narrative, figured as one way that Sujin could defy such accusations and claim her rightful place in South Korea.

Blood donation made me feel really good. Isn’t it a proof that my blood is clean? You can save lives in emergency, and we’re sharing this life-like precious blood as the same nation (minjok). They say that we’re historically not pure-bred and that we have Mongolians’ blood and so on, but still, even as languages changed, our blood didn’t change.

Explaining that she didn’t have a chance to donate blood again since then, Sujin added that she would like to do it with her South Korean husband sometime: ‘as my husband says, we are a unification family’. For Sujin, blood donation was a reminder of the primordial bond of blood, which not only proved her rightful belonging to the land but also put her ahead of her South Korean compatriots within the prefigured future of unification. At the same time, the national unification evoked by Sujin was less about pitching the South and North regimes against each other, as was the case in the politicized collective blood donation. In claiming a rightful belonging through blood, Sujin was challenging the moralizing discourses raised against her and fellow North Korean settlers as forever indebted to the South Korean state. Situating blood donation as returning the gift (blood) she had inherited from the communitas where she rightfully belongs, Sujin was debunking the paradox underpinning the moral economy of citizenship wherein the legally defined right of inheritance was continuously recalibrated into a debt relationship between North Korean settlers and the South Korean state. Returning the gift of life not only reaffirmed the primordial bond but also tilted back the scale in this balance sheet of debts that have been handed over to her and her fellow North Korean settlers.

If Sujin’s narrative of blood donation hinted at a renewed future for herself and the nation, for Heena, ¹⁸ another North Korean settler of the same generation, blood donation highlighted a sense of continuation. As an aspiring paediatrician, Heena was completing her residency at one of the major hospitals in a wealthy area in Seoul. When I asked about her experience of blood donation, she told me that the thought was always with her because of her rare blood type and profession: ‘I’m AB negative, so my blood is kind of precious in South Korea. It’s not like in Europe, where there are more Rh negatives among the whites’. A couple of years after she got settled in South Korea and passed the national licencing exam, she found an online community of Rh- negative blood types and became a member. It was when she saw a post of a leukaemia patient member seeking directed blood donation ¹⁹ that she decided to donate blood. She had severe anaemia at the time, so she took iron tablets for a month to raise her haemoglobin level and donated blood on the scheduled date to be sent to the patient’s hospital. While she never saw the patient in person, she was relieved to see the post by the patient later thanking everyone for helping them complete the treatment: ‘I was proud that I could be helpful somewhat . . . . For people like us, we have to help each other to make it [supply] sufficient. I think I would do it whenever there is any need’. By ‘us’, Heena meant those with Rh-negative blood here, but there was another group of ‘us’ that figured as prominently in her narrative:

Since I’m working in medicine, these things are taken for granted. Everyone in my profession, all my peers doing residency also think this way. There are many who donate blood when they see a blood donation bus. People around me have that kind of mindset.

Unlike the ‘us’ ascribed to by Rh-negative blood types, the ‘us’ of medical professionals was a belonging Heena had to strive for, and her entitlement to which was continuously questioned. Even though Heena graduated from an elite medical school in the North and passed the national licencing exam in the South, suspicions were often raised about her training. Patients would notice her accent, asking whether she was a Korean Chinese (Joseonjok) or a Chinese national, and even refuse to see her. ‘Anybody can make mistakes, but when people like us make mistakes, it gets the attention. So we need to double our effort to do well’. As much as her profession exposed the fault line between the North and the South, it was also the only way Heena could sustain symbolic connections with her family in the North, connections she was otherwise forbidden to have. These included her mother and grandmother, both of whom were experts in paediatric health, whose professional legacy she inherited. Suturing the rift between the North and the South was the work that Heena continued to engage in within her profession. Citing a very well-known case in the North wherein doctors donated skin to save a child with a third-degree burn, Heena noted, ‘Everywhere, there are people with a strong sense of social justice, trying to save lives. I think it’s the same’.

While appealing to different kinds of connections than Sujin, from the sharing of a rare blood type to professional and familial ties, Heena was also naturalizing her citizenship. For her, blood donation expressed the biological property she had in common with fellow Koreans (‘Rh negatives are rare among Koreans unlike Europeans’), as well as the sacrificial virtue ingrained in her profession to save lives. In emphasizing biological and moral identicalness, Heena effectively disengaged from the logic of debt that she and North Korean settlers were unduly subject to. Instead, in Heena’s account, the North and the South were the same, and just as she inherited blood and professional virtue from her kin in the North, it was only natural that she relayed such inherited matter and virtue to people in the South. The North and the South were already unified, or rather, had never been divided. Her sacrificial gift of blood was to this communitas of one Korea, as she transformed debt relations into ongoing mutual implications between herself and the many collectives she evoked: the Rh negatives, the medical profession and the North Korean settlers in South Korea.

Thus, we see different embodied collectives conjured through blood donation. For Sujin, there was a sense of returning to a one-blooded Korean nation, her belonging to which was justified as settling a debt relationship between North Korean settlers and the South Korean state. In the collective blood drive organized by the Korea Hana Foundation, meanwhile, the gift of blood by North Korean settlers was further promoted as repaying the debt of blood that the North Korean regime as a whole owed to the South Korean regime, and at the same time, as providing blood credit to the latter to ensure its survival against the former in present and future conflicts. For Heena, blood donation was a natural transfer of her inherited matter and virtue to the communitas of one Korea. If we can extrapolate an immunitary paradigm that characterizes South Korea’s geopolitical strategies against the North, the ambivalence of North Korean settlers as neither the self nor the other was productively utilized in the communitas-sustaining efforts of blood donation events. Against the suspecting South Korean gazes laid upon North Korean settlers as burdensome and potentially dangerous ‘others’, blood donation by Sujin and Heena served to negate any differences between themselves and other South Koreans. The politicized collective blood drive, in the meanwhile, invoked an entrenched communitas from which any affinities with the North have clearly been expunged. Yet, this self-protection was attempted through the immunitary principle, ‘introducing within it a fragment of the same pathogen from which it wants to protect itself’ (Esposito, 2008: 46), that is, by infusing the blood of ‘the other’ into the self.

Mutating Blood and Citizenship in a Fragmented Nation

The government should mobilize diverse promotional methods to instil the idea that blood is a national resource (gukka jawon) and something to be shared among the people (gukmin, lit. national subjects). (Won, 2007: 3)

The above quote appeared in the second issue of the National Blood Surveillance Monthly Report published by the Korea Centers for Disease Control and Prevention in 2007, a year after blood surveillance came under the organization’s purview. Attributing the fragility of Korean blood services to the lack of governmental oversight, the author argues for more proactive approaches to promote the idea of blood as a national resource. Since the publication of the piece, the Korean blood management system has certainly moved towards the direction of the author’s recommendations, being integrated into a permanent governmental agency (currently, the National Institute of Organ, Tissue and Blood Management) under the Ministry of Health and Welfare. The Ministry has been promoting ‘life-sharing (saengmyeong nanum) culture’ since 2018, encompassing all organ and tissue donations for transplants, with the annual Life-sharing Week in September, Life-sharing Certificates of gratitude issued by the Ministry, and Life-sharing Hope Mailbox allowing anonymous messaging among donors (their families) and recipients, among others. In a 2021 interview, the director of Korea National Institute for Bioethics Policy explained to me that bodily donation presumes a mindset in which everyone is organically connected, and that cultivating such a mindset is far more important than soliciting one additional unit of blood. ²⁰ The concept of life-sharing culture opens up new ground for biological citizenship in South Korea, where claims to health care can gain further credence in the name of collective well-being, as bodies are seen as interconnected through shared parts.

However, these changes are happening concurrently with an increasingly entrenched conceptualization of citizenship that also forms the context of blood donation: citizenship as an entitlement reserved for those who prove their deservingness. Here, the relationship among citizens and the state is predominantly defined by the logic of debt, as keeping credit-debt balance sheets of rights and duties. In South Korea, this has never been clearer than during the COVID-19 pandemic, when citizens were made responsible for their own and collective survival. While blood shortage alerts appealed to a collective duty to protect the national vital public under threat, for the majority blood donation was seen as a nuisance, worth undertaking only in exchange for immediate compensation, or as an undue sacrifice demanded by an ungiving state. Within this context, the overreliance on directed blood donation appeared particularly harmful to patients, who were rendered susceptible to the tyranny of the gift (Fox and Swazey, 1992: 40; Scheper-Hughes, 2007: 509).

Meanwhile, the stories of Sujin and Heena highlight how the logic of debt in such entrenched understandings of citizenship can be tackled through the gift of blood. Blood donation allowed them to reverse their assigned position in South Korean society, transforming from debtors to givers. For Sujin, this meant reaffirming the primordial bond of blood, while for Heena, it manifested her inherited professional virtue. By doing so, they not only naturalized their belonging to a unified Korean nation but also exposed the very inconsistency in the logic of citizenship in South Korea: the fact that the majority enjoys the inherited gift of citizenship through jus sanguinis and blood nationalism, while foreign-born and other marginalized citizens are unfairly pressured to settle the debt. As ‘inheritance’ becomes a key element in reactionary politics, in what may be termed ‘heredity redux’ (Fitzgerald et al., 2020), it is crucial to trace how the logic of inheritance itself is refracted through everyday performances of citizenship and belonging. What this article has shown is not necessarily a radical emergence of ‘citizens of humanity’ (Malkki, 1994) or ‘cosmopolitan bio-subpolitics’ (Beck, 2011) that transcend the regimes of the state, but a gradual transmutation of the collective through the transfer of vital matter, akin to grafting tissues. In the mundane act of blood donation, each donor remakes and renews the various collectives they claim to belong to, implicating themselves in mutating circuits of gift, debt and inheritance that sustain citizenship.