Why I didn't write a blog today.

“A Modern Proposal”

The medical world of today has a wealth of tools at its disposal for treating sick people: Vaccines prevent people from getting seriously ill; medications help fight bacteria, ward off infection, and bolster the capabilities of various functions of the body; there are now cameras and tools small enough to fit through incisions less than an inch large for operations that would otherwise be highly invasive; methods of analyzing a person’s body with high-powered magnets have made otherwise invisible causes of illness visible.

But for all of the advances medicine has made in treating people, there is still no way to save a vital organ once it has failed. At that point, it becomes necessary to find a replacement organ in order to prevent the patient from dying. This requires either a deceased person to have been an organ donor, or in the case of certain organs, a live person who is willing to give the organ. Unfortunately, these circumstances don’t occur frequently enough as to keep the ratio of sick people to healthy donors balanced (or, preferably, in favor of the healthy donors). With this in mind, the question arises as to whether or not there should be incentives put into place for people who would decide to give an organ to somebody in need. To answer that question, we should first look at the current allocation of healthy organs that could be easily given, then we will look at how the allocation of those organs would change if we created a legal market for them, and then we will analyze the moral and ethical implications of each of these decisions.

As of 2000, the number of people in Western Europe awaiting a kidney transplant was estimated at 40,000 people, and only a quarter of those people received a transplant (Cooper DKC). This condition relies on people who were otherwise healthy when they died, and on living people who are willing to part with one of their kidneys because of altruistic motivations. Since it has been medically proven that humans can live comfortably with only one kidney, the rationing of kidneys shows a surplus in a vast majority of the population, and a death-inducing shortage among some people.

There is, however, heavy debate on whether or not it would be possible for the organ-transferring process to involve what L. D. de Castro calls “monetary compensation” to the person from whom the organ originates. The overall consensus of those in favor of a system such as this is that the market would be overseen by a public entity, to whom the organs would be sold and then from whom the organs would be distributed (Erin, Charles A.; Harris, John). In the system, Erin and Harris say, “There would be no direct sales or purchases, no exploitation of low income countries and their populations (no buying in Turkey... to sell in [England]). The organs would be tested for HIV, etc., their provenance known, and there would be strict controls and penalties to prevent abuse.” Erin and Harris admit that there would need to be a high enough price point on organs to actually attract people to sell their organs, but maintain that the altruistic nature of donating an organ would not be diminished if people only sold organs in seeking compensation for the act. However, if this method did work to make more people willing to give one of their organs, it would indeed help to greatly diminish the number of people dying for lack of precious organs.
The questions that arise in this hypothetical situation pertaining to the safety and security of opening a market for organs are mostly answered with the notions of careful screening and assigning priority to people according to their need, as opposed to how much they are willing to pay for the organ (this safeguard is an automatic installment of having a public entity through which all transactions are made).

But the questions actually pertaining to the idea that this would become a market are left roughly unanswered, and would be where the moral battleground exists. How would the price point of an organ be decided? Would it be a case-by-case basis, where the quality of the organ is weighed against the demand for it at the time? Would organs being donated by people of rarer blood types be valued at a higher price? Or would an organ be sold for a uniform price, so long as it passed a set of requirements according to the type of organ it is? If people still refused to sell their organs, would the price point shift upward? If the price point continued to shift upward until it reached an exorbitant price, could the government have a solid legal case in being able to have those people who still refused to donate as legally insane, send them to an asylum, and then take the organ on the grounds that they aren’t of a sound mind to decide to donate it on their own?

At the same time, there are severe moral implications on the part of those who currently aren’t donating organs and who physically could without seeing severe side-effects in their daily routine. Proponents of a market for organs argue that the loss of life in the current system is clearly unacceptable, and that “[p]eople have a right to make a decision to sell a body part. If we should be allowed to sell our labour, why not sell the means to do that labour?” (Savulescu).

While there aren’t any easy answers to the questions pertaining to this idea, it is apparent that something needs to be done for those people who have failing organs. However, it is also difficult to reach a conclusion on how a market, and will likely leave the problem unresolved until a modern-day Jonathan Swift comes forth with a modest proposal.

Works Cited

de Castro, L. D. “Commodification and Exploitation: Arguments in Favour of Compensated Organ Donation.” Journal of Medical Ethics. 29 (2003): 142-146.

Cooper, DKC; Lanza, RP. Xeno - the Promise of Transplanting Animal Organs Into Humans. New York: Oxford University Press, 2000: 7-17.

Erin, Charles A. and John Harris. “An Ethical Market in Human Organs.” Journal of Medical Ethics. 29 (2003): 137-138.

Savulescu, J. “Is the Sale of Body Parts Wrong?” Journal of Medical Ethics. 29 (2003): 138-139.