Ever since the time when the first organ transplant was made the supply of organs for sick patients has been a major problem of healthcare throughout the world. There are numerous ethical concerns with using organs from already deceased people but the donation of organs by living people poses even more interesting and debatable concerns. The donation of an organ is considered a purely altruistic act of helping someone and is therefore not associated with any benefits for the donators, who need to do it “out of the pure goodness of their hearths”. More and more economists however are starting to look at organ donations as a viable and prospective market that could benefit society as a whole. As outrageous as that might sound there is actually a system based on that idea that seems to be working surprisingly well – since 1988 Iran has adopted a compensated government regulated organ transplant program.
The Iranian government kidney procurement program can indeed be characterized as a “market” in the sense that a person is free to sell one of his kidneys, for which he receives a fixed amount of money from the government and an additional amount either from the patient to whom he is donating the organ, or in the case when the patient is financially incapable of providing the money, from charitable organizations. The results of this “social experiment” speak for themselves, by 1999 Iran had virtually no transplant waiting list – everybody who needed a kidney got one. Why are then all the other countries in the world prohibiting people to sell their organs? Aren’t our own organs our most personal possessions, thus giving us full rights to do with them whatever we desire?
A lot of ethical and moral issues arise if organ donation is turned into a “business”. Wouldn’t it be just another way for the rich to take advantage of the poor? Similarly to how guinea-pigging has become a “profession” for the financially disadvantaged, circumstances might force people to unwillingly donate organs for the sake of money. The need for organs however keeps increasing and smaller and smaller fraction of the people on transplant waiting lists actually get one. Even though the means for saving thousands of lives exist altruistic motives of society are not enough to supply the necessary product. A parallel can be made to human experimentation – if no money was offered to participate in experiments medical research would be in serious trouble, ultimately leading to a worse outcome for society since far more people would die. Organ donation doesn’t seem to be very far from this example – the introduction to regulated compensated organ transplant program might serve society a greater good that the voluntary principle that governs it now. The provided example really makes one think – can the idea of people selling their organs actually lead to a better outcome for a society.
Sources:
http://cjasn.asnjournals.org/cgi/content/abstract/1/6/1136
http://freakonomics.blogs.nytimes.com/2008/04/29/human-organs-for-sale-legally-in-which-country/
5 comments:
Your point about the financially disadvantaged is probably one of the main reasons why organs are donated instead of sold in the US. However, another key point is actually political in nature (thus it may be a bit irrelvant for discussion in this class). But briefly, the government as originally established in America is not meant to be the solution to the people's problems, because the more it begins to fix things itself, the more the people rely on it, which means the more power it will have, which in turn could lead to too much centralized power. Obviously, this one policy in regard to organ donation will not be the straw that breaks the camel's back, but it is part of an ongoing process in which more and more people turn to the government to solve their own problems - inherent suspicion of centralized power is no longer as common now. Look at welfare, for example.
Thus, a potentially positive utilitarian end meets up with ideological opposition (which actually also has utilitarian aspects about it in the long term). Which is more of a travesty? Overreliance on government or an short term organ shortage?
I was perusing the freakonomics site you linked to when I found a link to another article that posed an interesting solution. The situation is as follows: the current American system decrees that people do not automatically donate their organs upon death and instead must "sign up" to do so. Other countries use the opposite where people's organs are automatically donated upon death, and they can sign up to "opt out" of this agreement.
The article on "presumed consent" as it calls it poses an interesting statistic where "countries with presumed consent have 25-30% higher donation rates than those with informed consent." The article cites human behavioral nature, by which we might be, for lack of a better word, too lazy to take the initiative to sign up for something like organ donation, though we might not have anything against it, or actually support it. By this simple policy change we could easily increase organ yield, and not just of kidneys. I'm not sure of the numbers, but plenty of people do die everyday, so the increase could be very significant.
Of course, such a policy change would (probably) not cause a firestorm of controversy like legalizing the sale of organs would. I cannot compare the efficacy of the two methods, though I'm sure both would have nontrivial impact. The question is whether exploiting this facet of human behavior is ethical. I do not think so. First of all, this policy would not be marred by the ethics of financial compensation (exploiting the disadvantaged, right or wrong, etc.). The fact also remains that if someone feels strongly they could opt out, so nobody is forced into donating their organs. I do not see this so much as "tricking" people into donating as making it easier to do something they already want to. The article cites that "surveys show that 90% of the UK population support organ donation, yet only 23% have registered their wish to donate." It seems many people would like to donate, but are blocked by the hassle of "opting in." On the same vein, if we were to switch to a presumed consent system, we must make "opting out" a very simple and easy process, lest inadvertently influence those who wish to keep their organs from opting out.
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The kidney procurement program in Iran that you mentioned would scare any flag-bearing American out of his freedom-loving, government-fearing wits. This method of resolving the kidney shortage carries with its success inherent dangers, as anything with the words 'organ' or 'selling' tend to. There is certainly the fear of burdening the already burdened: have we really resorted to marketing the natural-born possessions of our poor? Are we devaluing their lives when we ask them to pawn off their most valuable possession? We also tread the fine wire between our revered capitalist market system--where 'anything sells'--and the utilitarian principles we love to hate. In fact, we cannot even be sure which category 'organ selling' falls under? Are we falling in line with our Americana when we offer a fair price for a quality good? Or are we adopting Big Brotherism to sort out this medical crisis? More importantly, what does this sort of discussion lead us towards?
It is noteworthy that there is a time for morality and ethically charged discussion and the sort of philosophical pondering that secures our "rights" and protects our "freedoms." Fortunately for us (or perhaps unfortunately), this is not such a time.
We, as a society, have become the sort of idealism that can only stem from (if you will) idle-ism. Given the present creature comforts of our thinking, reading, and writing Americans, we have forgotten the basic values of humanity. We have climbed Maslow's hierarchy of needs from our physiological need to eat all the way up to our self-actualization of moral judgment. And if possible, we have even surpassed the tip and arrived at over-self-actualization where 'musing' is perhaps the most apt description for our occupation. Now is perhaps the best time to re-evaluate: on our climb up to the highest degrees of humanity, have we lost sense of what keeps us alive? The Iranian kidney procurement system is one institution we cannot abstain from: in fact, we are morally obliged to follow suit. There is nothing we should value above saving a life, and truly nothing—not our liberal values nor our traditional freedoms. We muse about the encroachment of government on our personal freedoms, protection of the poor’s self-respect in the face of pressures difficult for most to understand, and the maintenance of altruistic actions. And as we sit and muse and debate the morality of the proposal, lives are lost to time. Our fixation with maintaining high morals has led us to the basest humanity; we are committing murder through inaction. The kidney procurement system has been proven successful in a test country already, clearing the waiting list for kidney donations rapidly. In addition, the kidney is vital to some while others have it to spare. If altruism cannot lead us give life to a fellow man, there is no shame in providing the financial incentive. If it means saving a life, then even an instinctive wrong such as putting a price on an organ is the absolute right thing to do.
While I realize the critical need for greater availability of organs in this country, I cannot in good faith support Iran’s solution to the problem. My only objection to providing a financial incentive for donating an organ is its intrinsic tendency to facilitate the exploitation of the poor. I can see that this program would be considered relatively acceptable in Iran, a country plagued by social injustice, but not here, not in a nation that values so highly the “protection of the individual over the common good.” Bioethicist Arthur Caplan protested the use of terminally ill babies as test subjects for a gene therapy trial on the controversial (but certainly feasible) grounds that parents would be essentially “coerced” into enrolling their children in the study by their desperation to find a miracle cure. I would like to offer a similar argument here: individuals facing severe economic difficulties cannot be trusted to fully consider the risks of a major surgical procedure like an organ harvest if they are being offered a significant sum of money in exchange for their participation. Therefore, the validity of their consent to undergo the procedure must be questioned.
To be clear, I do not believe that the American government should sit idly by while thousands die waiting for a transplant. I fully support the “presumed consent” system that Jeff mentioned. Alternatively, I also think it would be a good idea to launch a large-scale ad campaign and education program to spread awareness of the importance of organ donation. I suspect that the reason why so many people have not signed up to be donors is that they underestimate the severity of the organ shortage. A final suggestion to alleviate the shortage would be to try using financial incentive in a completely different way. Rather than turning organ donation into a market, I wonder what would happen if we left the system the way it currently is, but offered a *small* ($50?) reward for signing up to be an organ donor. I know more people than I can count who would jump at the chance to get a bit of “free money,” especially in this economy. It just might be worth a shot.
This post reminded me of the Will Smith movie, Seven Pounds which I saw while I was at home during winter break. In the movie Will Smith plays a man who commits suicide in order to donate his vital organs to various individuals. Both Will Smith’s character in the movie and the United States operates under a similar system of organ donation. Individuals have a right to donate their organs to either specific patients or allocated by a nationwide system. While in the movie Will Smith decides which candidates are worthy for his gift, the United States government determines recipients’ eligibility and priority based on their medical condition. And therefore not everyone who need organs get them because there aren’t enough people who donate their organs.
When I was discussing this blog post with a friend he told me about an article he read recently which was about the same issue. The President’s Council on Bioethics and the American Medical Association came up with a potential policy, which they felt was a balance between donating and the system of free market. This policy would provide the donors non-cash financial compensation such as tax deductions and Medicare benefits. This policy I feel might be a good solution to the problem.
Currently there is a dearth of donors because people don’t have any incentive to donate apart from the satisfaction of doing a good deed. Even though, some people might argue that the non-cash benefits are also a way to tempt people to donate their organs and treat their body as a commodity, I feel that we also need to be practical about the situation. Other charitable contributors also receive similar non-cash benefits that this new policy proposes and this puts the organ donors at the same level as these contributors. This policy is a perfect merger of practicality and ethics and offers a good balance between philanthropy and free market.
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