Why sale of human organs should be legal

But kidney transplants are the most common, the only organ available from living donors. The—and this is a case that dramatizes the nexus between freedom of contract and personal liberty. Well in many parts of the world, such a sum is life-changing.

Both sides to this bargain receive benefits powerful to them. So why should this contract be illegal? When legislators who find such bargains repugnant pass laws imposing their views, they are quite literally causing sick people to die. How can this be morally acceptable? Our new venue is substantially bigger and will meet the demand for the kind of elevated public discourse we at IQ Squared try to provide.

It raises issues of ethics and economics, and morality, and mortality. Ira, the evening is yours. Thank you, Bob, thank you very much, Bob Rosenkranz. You can vote now. Now we have for the motion, professor of law at the end of the table, at George Mason University, Lloyd Cohen. Thank you. Today there are 75, people waiting for kidneys. I would still be one of them, but thank goodness, a wonderful friend of mine gave me her right kidney two years ago.

But thousands of others are not going to be as lucky as I was. Despite decades and decades of public education about the virtues of organ donation, the waiting list just gets longer, and the time to transplantation just gets longer. They rent billboards begging people to give them—to save them. They join on-line matching services to find a donor, in fact I did that. Some of them go abroad, and maybe if they go abroad to a place like China, they have to live with the sickening knowledge that the organ they got came from an executed prisoner.

They are just trying to save their lives. Now bless all the altruistic souls who have donated organs. Many people need more of an incentive to give. The government should sponsor a regulated system for living donors.

Compensation could be something as simple as a contribution to a retirement fund, a tax credit, tuition voucher for the children, possibly health care, all kinds of creative things we could do to benefit people who are willing to give a kidney. And as I said, since the government will be paying, not the patient, everyone can benefit. Now what about the donors. Would the promise of a reward exploit donors whose poverty makes the offer seem impossible to refuse? But a distinction needs to be made.

But, this is something we can guard against. Which is immediate cash. So you can build in several months of a waiting period, you can offer the kind of in-kind compensation I mentioned before. I mean, I can go on and on about details of how a system could be constructed. Now, what I want to do, is have you hear some of the misguided objections that our opponents are going to wage.

You may well hear that any effort to legalize rewards for donors, will end up creating a system that will look exactly like the corrupt organ bazaars that permeate the Third World, in this donors are almost considered no more than cattle, and their organs go to the highest bidder.

That is exactly wrong. We are talking about a transparent, regulated system of exchange, under the rule of law, in which donor protections are paramount. The donor is free to decide if participating is in his best interest, and then if it is, something miraculous happens.

He saves someone with his kidney. Well, we do have to do something drastic, because, of the 75, people on the list, it is true, not every one of them is eligible to get a kidney tomorrow.

But why did that happen? Tragically these were people who were healthy when they were first listed. So if anything, the glut, the one-third of folks who are ineligible to get a kidney today, is a sign for urgency, not complacency. But no one can ever explain to me how a fair, safe, and respectable implementation of incentives is an affront to anyone.

But what is a disgraceful assault on human dignity, is to sit by and let people die when we have the means to save them. Well, I reject this. Beautiful acts are performed every day by people who are moved by a combination of humanitarian and financial motives.

Are firemen who rush into a burning building any less heroic in our eyes because they were paid to save us? In the end, our critics have a chilling message for patients. But I also know the deadly consequences of following the same failed policy.

Thank you, Sally. Up next speaking against the resolution, is James Childress. Defenders of markets for organs often charge that the opponents of a market appeal to the emotions of repugnance, and disgust, the yuck factor. They often imply that the only grounds any reasonable person could have for rejecting a market would be such emotions. Well tonight, we, the opponents of an organ market, will not appeal primarily to emotions.

Indeed, I suspect that the proponents of a market will do so. Instead we will offer solid ethical, social, and cultural reasons not to legalize a market in organs. We ask you to consider very carefully, the reasons, the arguments for and against organ markets. Defenders of organ markets also tend to represent an extreme form of what I would call market fundamentalism. Market fundamentalism neglects the full range of relevant social values, especially justice and fairness which I will emphasize, and the probable negative effects of a market in organs, which my colleagues will stress.

Markets are truly wonderful mechanisms. But they may not be the best mechanism, for organ transfers. Defenders of organ markets appeal to two great social-ethical values, very important ones. Liberty, people should be free to sell their body parts if they want to. Utility, a market in organs would produce the greatest good for the greatest number. Libertarians affirming liberty, utilitarians affirming utility, take these values and join together in an unstable alliance, in support of a market in organs.

But both neglect another equally important value, justice, or fairness. As a result they ignore or downplay the injustice or unfairness of exploiting poor and disadvantaged people, as sources of transplantable organs. They tend to be poor and disadvantaged, or desperate. Of course we could devise a system of compensation for organs that would avoid some injustice and some unfairness, by separating procurement from distribution.

We can eliminate that, by having a single purchaser of organs, who would then distribute the organs according to a fair scheme, for example, to patients most in need. And we should not introduce an organ market into a society with major and increasing inequalities in wealth and advantage. If we did so, we would not, should not expect a positive outcome.

Why not. Well consider two possibilities. One possible target of an organ market or compensation system, would aim to increase—would be to increase the number of organs from dead people. Another would be to increase the organs from living vendors. Some of the same objections apply to both, for example financial compensation may crowd out donation, especially altruistic donation. But there are differences.

Take first a cadaveric organ market. Imagine a futures market in organs where individuals contract to provide their organs after their deaths, and in return receive a payment now, or designate the payment to be provided after their deaths to their families, or to a charity.

They worry about being declared dead prematurely, or even having their deaths hastened, if they have signed a donor card. Or consider the family sale. Individuals would have similar reasons to block families from making decisions because of conflicts of interest. We do not need to try such a futile market. There are other options for obtaining cadaveric organs. Our current system works fairly well, and can be improved.

And there are several potential improvements that we can make, some are already underway. We can increase education and the use of donor cards and donor registries. Some institutions now obtain consent to donation, from 70 to 75 percent of families of patients declared dead by neurological standards, who are potential candidates for organ donation.

And we can consider other sources including those declared dead by cardiopulmonary standards. A living organ market would probably work better than compensation with cadaveric organs, but there are other problems that my colleagues will emphasize. In conclusion…a market is not an idea whose time has come.

A market in organs is a bad idea. It is unnecessary, probably ineffective, possibly counterproductive, and would breach our sense of justice by exploiting poor, disadvantaged, and desperate members of our society. Hence we should not legalize a market in human organs. Thank you, James Childress. As a surgeon, I view the body with reverence.

The rights and dignity of every patient are paramount. My expertise is to—is sustaining lives by transplanting organs. Our opponents tonight would have me tell patients to stay the course. Wait with dignity for the organ that may never come. This message is poorly received, as it should be.

Our opponents may tell you, that the waiting list is too long, because it includes the wrong people. Desperate patients unwilling to die waiting have fueled a black market, whose magnitude is inadequately quantified, though certainly disturbing in scope.

What is known, is that organs are purchased, third-party brokers siphon funds away from donors, and safety is uncertain for both the recipient or the donor. Efforts to shut this market have been as unsuccessful as Prohibition was in inducing an end to the use of alcohol. I agree with our opponents that the black market must be closed. I disagree with asking patients to accept death gracefully, instead of resorting to the black market.

My position is that development of a legal, regulated mechanism for donor compensation is the only means of effectively eliminating the demand for this covert activity, closing down the black market, and improving safety for donors and recipients.

Today, we educate the kidney patient and family, hoping that a volunteer donor will step forward to surrender a kidney. Most transplant surgeons agree, there would be no justification for ever removing a kidney from a living donor, potentially causing harm to this healthy person, if there were sufficient organs from deceased donors. It may surprise you, that we still cannot tell this volunteer donor about all of the risks that kidney donation entails. Sure, the early risks, such as death, are known, but the long-term consequences are not, particularly for some of the more marginal donors being used in some cases.

Transplanters share nearly universal agreement, that these genuine heroes need lifelong health insurance and intermittent medical supervision. Delmonico has written that all living donors should be provided with life and disability insurance. Yet we are not deterred from removing the kidney. The opportunity to save a life persuades us and the donor to proceed. We are talking about saving lives.

The recipient gains the organ, life itself. The surgeons, transplant center, and for kidney transplants, even the American taxpayer, you and I, have direct financial benefit when a patient comes off dialysis. A reasonable system must include protection from nefarious third parties, and be guaranteed by centralized, independent oversight, that ensures equal accessibility to those in need, regardless of their economic means.

Lastly and most crucially, a transparent, informed consent process must be the mandatory condition of participation. Our opponents may suggest that payment would be so coerced, as to prevent the donor from giving informed consent. This is paternalistic.

This is an insult to the poor, in suggesting they are incapable of balanced thought and self-determination. Reasonable people rationalize risk daily, by personal prerogative, at times subjecting themselves to unhealthy conditions, and making unsafe choices such as working deep in the coalmine.

Any informed decision balances risk against the prospect of benefit. Though real, the risks of organ donation are likely substantially lower than those assumed by coal miners seeking their livelihoods.

Despite the dangers inherent in both cases, the miner but not the donor is legally compensated for these risks. The key difference is dependence on the participation of medical providers, White House are dedicated to doing no harm, to facilitate payment for the gift of life. This is precisely what does not happen on the black market, where transplants and donations are conducted covertly.

There is no dignity in dying without a transplant. Today, the choice is not whether compensation will exchange hands, but whether or not transplant operations and the sale of organs will be regulated and safe. What we do here, has a profound influence on the rest of the world. Legalize the market for human organs, what would that be. And is that indeed attainable. Now I wanna say something that comes across my mind… [. There should be no mistaking that, and I wish to expand every opportunity there can be, in providing for the people on this list.

And that entails care for live donors, that does not exist. So let me take you back to…what would this be. Well, those that have written about this say it would have to be a fixed price.

The kidneys would have to be distributed along with deceased donor kidneys, by the UNOS system. The kidneys would only be available by this, quote-unquote, market system. The vendors and the buyers would have to be restricted to the country of residence. It would only be that the vendor could be within the United States, and so too the recipient. Now just for a moment, I want to ask of a reality check about all of those issues, and whether or not you all could conclude that that in this global environment, of medical tourism, would indeed be attainable.

Do you think that such a market could be with a fixed price and a prohibition of brokers and a prohibition of Internet arrangements and only distributed through this system. And that the vendors and buyers would have to be restricted to the United States.

Fixed price for a kidney. Fixed cash payment. Markets deal in best prices, in cheapest prices. Shopping is Manila, shopping is Pakistan, shopping is India.

Shopping is South America. There are plenty of cheap prices. The prohibition of brokers in this regulated market. The insurance companies become brokers, when they send patients from Israel to Manila. About 20 patients a month go from Israel to Manila, because of cheap prices. But there is this piece that I want to just very carefully ask--we better evaluate this wait list. The contention that all on the list would have lived had they gotten a kidney, may not be a reality either.

And that is this question about what role do the insurance companies have in this, this is a good point that Dr.

Delmonico made. So if everybody acts very reasonably then, this will work—do you know anybody who acts very reasonably all the time about things like this? But I will say that, you know, the concept of how this system would be created requires, um, involvement of multiple parties, in a similar manner to the way UNOS is set up.

That there are not just providers, there are not just patients and family members, there are clergy, there are social workers,.

It has to be a uniform policy, and the way the law would need to be written, and we do need a law written, this is obviously currently an illegal activity, so we definitely need legislative change, would be to require that these activities go through the single processor. Do you think this is a strong enough issue that it should be brought up in this Presidential election year.

Do you think this should influence the way we choose our candidates about where they stand perhaps, on this issue. For if there is no substantial system of free donation in place, then free donation cannot be undermined by permitting sale.

But if an almost adequate system of free donation does exist as, in many countries, it does with blood then there is a serious possibility of its being undermined. Thus, the argument which says that what is wrong with sale is that free donation would be undermined might well work for blood, even if it does not for kidneys. The same might be true of the arguments in favour of an altruistic blood system proposed by Titmuss and others.

Perhaps the voluntary blood donation system and indeed a voluntary posthumous organ donation system can be used as a method of encouraging a valuable culture of altruism, but this is much less likely to work in the case of living organ donation Archard ; Campbell ; Titmuss This difference between kidneys and blood reveals a general structural difficulty for altruism arguments against sale.

For altruism arguments insofar as they work at all work better for those things which are already freely donated on a large scale, than for those things which are hardly freely donated at all.

Hence, they will tend to be most successful where, in a sense, they are needed least—because if there is already widespread free donation, then commercialization will be unnecessary. This is not a decisive objection, since there are things which are in short supply in spite of widespread free donation blood and sperm might be examples of this.

However, even if altruism can survive this first challenge, there is a second reason to question its importance for the debate about the permissibility of organ sale. This distinction is relevant for the following reason. If say altruistic kidney donation were morally obligatory, then to demand money for one's organ and, arguably, to accede to such a demand would be wrong. But if, on the other hand, altruistic donation were supererogatory, then to demand money for one's organ would not be wrong.

Rather, it would be merely non-supererogatory: perhaps not good , but not wrong. So, with this distinction in place, one might at least in some cases accept that altruistic donations are good whilst also saying that there is nothing wrong with non-altruistic donation—the point being that non-altruistic donation, while not as good as altruistic donation, is nonetheless morally permissible.

This has implications for the sort of altruism argument which can be made against organ sale. If it could be shown that altruistic donation is obligatory then the argument would be stronger, or at least more straightforward, because it would follow that selling was wrong it is wrong to demand money for what one ought to be giving freely anyway.

But if all that could be shown was that altruistic donation is good, then it would not follow from this, or at least it would not follow directly, that selling is wrong. This may be one area then where the differences between different possible organ sale systems are relevant. For it is not wildly implausible to posit the existence of a duty to donate one's organs for posthumous transplantation. Indeed, this view is not confined to utilitarian bioethicists, with even the Church of England stating in that posthumous organ donation is a Christian duty BBC News Online Thus there may well be a valid altruism argument against a system in which people sell rights to their body after death: the argument being that they should donate them anyway without expecting payment.

This style of argument looks less promising, though, when looking at non-directed living kidney donation to strangers. Here, I suspect most of us want to say that becoming such a donor is heroic and supererogatory, not a moral obligation, and so the altruism argument does not engage. Another interesting example is blood from living donors. In many countries, there is a widespread view that people ought to do this freely and if this view is correct this could underpin an altruism argument against paying for blood: the claim being that people ought not to be paid for that which they have an obligation freely to give.

Monetary incentives, it is sometimes argued, make valid consent difficult, impossible, or problematic Radcliffe Richards , Some of the main arguments offered for this view are that—.

For the fact that payments encourage people to do things that they otherwise would not does not, in and of itself, invalidate consent. If it did, consent problems would be endemic and occur every time someone was encouraged by payment to go to work for wages or to surrender property for a price. So although some people would only provide organs because of the money, this fact alone would not invalidate consent. Or at least it is plausible to suppose that we ought not to encourage donors to subject themselves to more than a certain level of danger.

But the fundamental problem with this would be not payment or consent, but rather the fact that they are exposed to too much danger. So, provided that we have an adequate way of controlling and regulating risk to organ sellers this particular worry about payment ought not to arise.

First, as mentioned earlier, the amount of danger remains the same regardless of whether or not payment takes place. Imagine someone who objects to paying astronauts on the grounds that it encourages them to do something excessively dangerous. Much the same goes for paying organ donors. If the worry is danger, we should object to dangerous donation of all kinds, not just the paid variety.

Second, it is not clear that monetary incentives make people act against their better interests or judgement. Indeed, this is a rather surprising view to take since people trade off monetary gains and losses against other factors on a daily basis; commerce and work require us to do this all the time. Rippon , , for example, tells us that:. So we would harm people in poverty by introducing a legal market that would subject them to such pressures. Suppose that a high minimum price for organs was set.

This would prevent one sort of exploitation However, this would do nothing to address the problem that some might sell their organs out of economic desperation, rather than out of a choice made free from external pressure.

The underlying argument here is that certain sorts of payment, or payment in certain circumstances, exert undue influence on a person's decision Nuffield Council on Bioethics Accusations of undue inducement almost always occur in one of two different contexts. Is valid consent possible in these cases? In both scenarios it may be terrifically hard to decline.

However this does not mean that valid consent to the offer is impossible. Radcliffe Richards , makes the point as follows:. It does not normally occur to us that people coerced by circumstances into doing things they would not otherwise do should have their consent regarded as invalid.

If you have cancer, with the choice between risking its unchecked progression and putting up with pretty nasty treatments, nobody would think of arguing that the narrow range of options made your consent to treatment invalid. So even if we grant that the recipients of enormous offers and desperate offerees will find it hard to refuse, this does not mean that they cannot validly consent.

This must be so. The difference between coercion by poverty and Radcliffe Richards' cancer example is supposed to be that whereas the cancer is a morally neutral natural occurrence, the poverty at least in some cases is the result of immoral acts and policies; it is unjust poverty. Within the context of a regulated system particularly that advocated by Erin and Harris, which would be limited to one economic area there is no reason to believe that most organ sellers would be desperately poor.

Organ sale may admittedly be more attractive to those with the least money for why would someone rich need or want to sell an organ? But let us allow for the sake of argument that organ vendors would be very poor.

What would follow from this? Poverty or threatening poverty can clearly be a method of coercion. An obvious example of this is the behaviour of exploitative employers during times of high unemployment. They can threaten workers with unemployment—and, hence, poverty—if they do not comply with their demands Wilkinson The position of the prospective organ buyer though seems rather unlike that of the exploitative employer and, as Wilkinson and Moore , point out:.

For example, if we poison you and then offer to provide the only available antidote in exchange for your stamp collection, that is coercive. If you are poisoned in a way for which we are not responsible, and we make the same offer, that is not coercive … as long as those making an offer are not responsible for the circumstances of the potential subjects, their offer is not coercive.

So in order for prospective organ purchasers to be coercing through poverty, they must be responsible for the poverty. This need not mean that they caused the poverty, for people may be responsible for improving or preventing situations that they have not themselves caused.

An illuminating analogy is Nozick's Drowning Case Nozick , One view of this case is that P coerces Q into paying if and only if P has a freestanding duty to save Q without reward. Whether P does in fact have such a duty is not something we need to decide upon here and that will depend upon a wide range of facts about the situation. Organ vendors then are somewhat like the person in the boat. If they have an independent duty to alleviate the poverty i.

It would be like charging someone who would otherwise drown in a situation where there is a duty freely to rescue. It is not hard to see how, in principle, this style of coercion argument could work against organ sale. What is much harder is working out whether, in most of the cases envisaged, organ buyers have a duty to alleviate the poverty. The case most often discussed is where the organ purchaser is a rich Westerner and the vendor is someone desperately poor from the developing world.

This may be the case if the Westerner has a duty to alleviate the prospective organ seller's poverty. But, as well as difficult general questions about global distributive justice and the like, there is also the question of whether the individual in question is directly responsible for alleviating the other's poverty in these cases. For example, a Western organ purchaser could have already devoted a large part of her income and time to charitable projects aimed at the alleviation of poverty and may herself have relatively little money—just enough to buy a kidney.

Do we really want to say that such a person has a duty to give her money to the prospective organ vendor without receiving the kidney without which she may well die in return? A more promising option is to focus on groups rather than individuals.

One might argue, for example, that the rich nations have a duty to alleviate poverty in the poor nations. With this plausible assumption in place, it could then be argued that when the rich nations collectively offer the poor nations money but only in return for organs, this is not really an offer, but rather a threat a threat to wrongfully withhold resources if they do not hand over organs.

The rich nations it is argued should be giving the money anyway, not demanding organs in return for it. So what the rich nations are doing is threatening to withhold resources to which the poor nations have a moral right, unless the poor nations hand over organs: a seemingly clear case of coercion.

The problem is that the argument works equally well against all trade between the rich nations and the poor ones. For in simplistic terms if the rich nations have a duty to give resources to the poor nations, then any time that the rich nations insist on trading rather than donating, they will be practicing coercion—threatening to withhold money that they should be giving anyway, unless they are provided with goods of one sort or another.

And, as far as the coercion argument is concerned, there is no reason to single out the trade in organs for special treatment. This looks like a decisive objection to the coercion argument. One possible reply to this is to make a distinction between forms of global trade which benefit developing world economies and societies and those which do not. Like many of the other arguments discussed in this entry, much depends on the how the empirical evidence shapes up, but this response does seem to have some plausibility.

However, it could still be claimed that the international organ trade is no worse as far as the quality of consent is concerned than any other form of international trade which fails positively to contribute to long-term development. So perhaps the organ trade is in this respect on a par with logging, or mining, or some basic forms of agriculture.

Perhaps more importantly, though, we must remember that, in any case, most of these concerns about coercion and poverty can be dealt with by having a controlled system such as the Erin-Harris proposal.

Of course it is not the case that there is no unfair poverty within the Western countries that they have in mind. And so, even under the Erin-Harris system, some account would have to be taken of the coercion by poverty argument.

Perhaps, for example, we would want to say that, in order for the national organ purchasing agency not to be coercing-by-poverty it needs to be the case that there is a minimum wage law and a welfare state that are at least close to being fair, so that there is no poverty in society for which the state is morally responsible either actively or by omission. This is probably a lot to ask but then we must remember that any actual organ sale system, along with all other aspects of the economy, is unlikely to be perfect; and, provided that the organ sale system is not substantially more exploitative or harmful than most other widely accepted economic transactions then it would seem arbitrary and unfair to single it out for particular condemnation or prohibition.

She asks us to consider a case in which your daughter is kidnapped. The kidnappers ask for a ransom in return for your daughter's life. Clearly, your consent to this arrangement if forthcoming would be invalid because coerced.

Suppose the police appeared on the kidnapping scene and prevented you from signing the [ransom payment] document, perhaps with the outcome that your child was shot. They might have good public policy reasons for doing this … but it would be preposterous for them to claim that they were doing it because the consent you were trying to give would be invalid … [T]he whole point of declaring invalidity is to protect the alleged consenter, and here the police would actually be compounding the wrong done to you by constricting still further the range of options already constricted by the kidnapper Radcliffe Richards , According to Radcliffe Richards, this is analogous to the situation in which state action is used to prevent organ sale.

As with the kidnapping, there may be legitimate reasons for such state action for example, if the police suspect that the organ purchaser's surgeon is planning to take several organs and then kill the organ vendor. However, the invalidity of the seller's consent due to poverty would not in and of itself be a sufficient reason for state intervention in these circumstances.

Since the metaphorical coercer poverty is still present, and the individual is making the best choice among a still-constricted range of options, disallowing the choice is like preventing you from meeting the demands of the kidnapper while he still has your child Radcliffe Richards , So even if there is a quality of consent problem in these organ sale cases this is unlikely to justify prohibition. Perhaps the most commonly discussed objection to organ sale is the claim that it is exploitative Greasley ; Hughes ; Lawler , ; Wilkinson Saying what exploitation amounts to is itself a complex task, however, and I will not say much here about how it should be defined see the SEP entry on exploitation.

It is, however, worth noting that, on one view, defective or invalid consent is a necessary condition for the occurrence of exploitation. Thus according to this view a transaction can only be exploitative if the putative victim of exploitation is coerced, lacking capacity, ill-informed, or manipulated or more generally, if there is some consent-invalidating factor in play.

If this view of the relationship between consent and exploitation were correct, then the discussion of exploitation could be ended here; for consent issues were dealt with in the previous section and the exploitation worry about organ sale would only be worth taking seriously inasmuch as those consent arguments discussed above were sound.

However, not everyone thinks that defective consent is required for there to be exploitation and so there may be some mileage in looking independently at exploitation. Similar thoughts apply to the unjust distribution of benefits and burdens. With this in mind, Harris , usefully distinguishes between two kinds of exploitation-claim.

The first:. Exploitation concerns of this kind, or at least most of them, can be taken care of by utilizing some version of the Erin-Harris proposal discussed above since this is designed to ensure that organ sellers receive just rewards and adequate care, whilst also going a long way towards ensuring that the distribution of organs to transplant recipients is fair.

Friday, 12 November E-paper. News Places People Lifestyle. Cricket Football Horse Racing. Sale of human organs should be made legal Your Voice Student speak on the issue of legalising human organ trade. Representational image. The Telegraph Published No Double-edged sword. Sheerin Bashar, First year, Centurion University of Technology and Management, Odisha No price tag If blood can be collected through voluntary donation, why not organs?

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