Currently, there are an estimated 1 million people worldwide with end-stage renal disease. Without a kidney transplant, these patients will die in a matter of months to years. By far, the largest source of transplanted kidneys is from relatives or loved ones – after all, one is able to live with only one kidney. In some instances, there are those who donate kidneys to complete strangers out of pure altruism. On the other end of the spectrum are the patients who sell their organs illegally or are forced to "donate" their organs. However, these combined only add up to 66,000 kidney transplants annually -- well below the 1 million desperately waiting for transplants.
Could establishing a legal global market for organ sales be an answer to this dilemma? The ethical issues of this immediately stand out – the poor would be pressured into donating their kidneys for financial compensation. In addition, instances where people are kidnapped and stripped of their organs could increase. However, if those extra kidneys would save the lives of those with kidney failure, would that justify such a market? Even if the idea sounds repugnant, it would benefit both the donor and the recipient.
When considering the ethical ramifications of such a market, one has to consider the fact that such a market already exists for kidneys – an illegal black market. In third world countries around the world, the poor already sell their organs for money and organized crime already strips victims of their organs for sale. With this organ market, even the poorest person in the Philippines or India has “a couple of gemstones – diamonds – on each hip”1. The price of kidneys ranges from $1,000 in Iraq to as high as $68,000 in Bosnia-Herzegovina2. This leads desperate kidney searchers to resort to what is called “transplant tourism” – where patients travel to another country (usually a 3rd world country) in search for cheaper, more freely available medical treatment.
Relative to the current market system, a legal global market for organs could attempt to more strictly monitor and oversee the transplant process, as opposed to black market transactions which are often unsanitary and lead to infection or death. In my opinion, this fact makes such a global market justifiable. In a sense, this argument is analogous to legalizing prostitution – one could argue that if the government cannot control it, the least they can do is oversee and regulate it.
1 Ethicists, philosophers discuss selling of human organs. http://www.news.harvard.edu/gazette/2008/02.14/01-organs.html
2Transplant Tourism. http://emeritus.blogspot.com/2006/11/transplant-tourism.html
4 comments:
The development of a global market for human organs is an unviable solution for two reasons:
First, as Mike mentioned, such a system would place undue pressure on the poor and disadvantaged to sell their organs for money. This would be similar to the practice of giving money to blood donors, except that there are no long term negative health effects of donating blood. Furthermore, although there is currently a blood shortage, no one is going to go out and kidnap someone to steal his or her blood.
Secondly, such a market would unfairly disadvantage poor people in need of organs, who may, in fact, be in even greater need for organ transplants as many of them have inadequate health or no health care throughout their lives. This situation is reminiscent of Kelley’s post, which addressed the problem of unfair access to genetic engineering for rich people. Thus, poor people would be both the main donors of organs, as well as the people who are least likely to be able to obtain them, because in such a market, prices tend to be high if there are some who can pay much more for something valuable than others.
Although it is unfortunate that anyone would ever be in a situation where they would need an organ transplant, I think the current system of waiting lists is probably the best way to handle it. However, organs culled from car-crash victims etc. should be given to those who have the best chance of surviving long term, as it seems pointless to give a perfectly good organ to someone who wouldn’t last very much longer in any case. Either way, the creation of a global market would only serve to give the rich more advantages while further disadvantaging the poor.
One of the main issues presented is the legalization of a global market for organs. While in theory this may be the ideal solution, I would argue that not only would this decision fail to ameliorate the current situation, it would worsen the effects of illegal organ harvesting.
As mentioned, legalization of a global market for organs would bring up the ethical dilemma of pressuring the financially challenged to sell their organs for money. However, there are other ethical dilemmas that are pertinent with respect to a legalized organ market. While these extra organs, such as kidneys may lengthen the lives of the recipients, the procedure also significantly increases the risks for the donors who are left with only one kidney. I believe that in the same way healthy subjects should not be coerced into participating in experimental phase I trials for economic reasons, organ donors should also not be coerced into donating their organs due to financial pressures.
Additionally, I believe that instead of decreasing the amount of illegal organ harvesting, the legalization of a global market for organs would actually increase the amount of activity of the black market. How so? Well, currently the black market exists, however patients are wary of breaking the law, and very few people resort to using the black market in fear of illness, contamination, etc; which in turn results in a relatively small market for illegally obtained organs (especially because illegally harvested organs often have a very short viability). However, with the legalization of a global market, the social perception of organ harvesting be changed from a perspective of fear to approval. This approval increases the amount of patients willing to turn to the organ market, which in turn provides a greater demand. This increase in demand would be fulfilled in part by people will to sell their organs legally for financial compensation (the ethical consequences of which I have discussed previously), but would also be filled by the black market. Although there is no evidence to support my theory, I believe that in the same was the “dirty” money is laundered, “dirty” organs obtained from the black market would then have a source through which to launder the illegally obtained organs.
While hypothetically the legalization of an organ market presents a very appealing solution to the current dilemma of supply and demand with respect to organ transplants, I believe in practice such a decision would not only bring up numerous ethical dilemmas, but also be very difficult to maintain in reality. Instead, I believe researchers should focus their efforts on developing methods to increase the length of organ viability outside of a patient’s body. While this would require more time to develop, it presents a much more practical and ethical solution to this pressing issue.
I do not see as much harm from creating a global market for kidneys as Mike, Rachel, or Cecillia. I really don't understand how putting a price tag on one's kidney "forces" a poor person to sell their kidney. There are plenty of things that we have in our daily lives that we can live without. There are plenty of things in poor person's lives that they can live without. Yet this does not lead us to sell every possession that serves no purpose. Just because one can obtain money from selling a useless item does not mean that person will do such a thing and it surely doesn't force them to sell it.
Maybe the argument is that a global market would force the extremely impoverished to sell one of their kidneys. However, I just don't see what is wrong with this. A dying patient receives a usable kidney, and the extremely impoverished person receives a handsome sum to improve their life. It is a trade with both parties becoming better off. In such a situation, don't you think the impoverished person should at least be able to decide whether or not the risks are worth the benefit? Furthermore, don't you think such a donation of a kidney would increase the value of the impoverished person's life? The contribution to the saving of another human's life is worth even more than the money they would receive. Not only does the impoverished person benefit from the added cash, but the dying patient's family, friends, and loved ones benefit from the fact that the person with kidney failure is going to live.
Rachel - I had not considered the fact that the poor, who would be donating their kidneys, are also the group who would have least access to them. So you would argue that the current system (waiting list), in which all people are given equal priority, is preferable to a system in which there are more overall organs, but the rich have more access to them?
Cecillia - I would disagree that a global market for organs would increase the black market activity. While it is true that illegal organ harvesting might increase, all of the voluntary organ sales currently occurring on the black market would transfer to the global market (which would be safer and cleaner). While I don't have any statistics, I would guess that the number of voluntary sales moved to the global market would outweigh the additional organ from harvesting.
Yuri - Overall I agree with your points. As I mentioned in my original post, both the donor and recipient would benefit from the selling of a kidney. However, the selling of a kidney is not the same thing as selling any other nonessential item. In selling a kidney, the seller suffers potentially long term consequences and risks in exchange for the few thousand dollars they get -- if you're willing to accept Wikipedia as a source, the article on Organ Transplant says "Thilakavathy Agatheesh, 30, who sold a kidney in May 2005 for 40,000 rupees said, "I used to earn some money selling fish but now the post-surgery stomach cramps prevent me from going to work." Most kidney sellers say that selling their kidney was a mistake."
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