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Bioethics: Selling Organs

Is it ethical to let organs be sold on the open market?

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Should people be allowed to sell their organs? Currently, exchanging organs for money or other "valuable considerations" is illegal, but some members of the medical and business communities would like to change that. One of those is the American Medical Association's influential Council on Ethical and Judicial Affairs. Convinced that the balance of moral and ethical concerns favors the ability to sell organs, they would like the laws to change, and the AMA's governing house of delegates is scheduled to vote in June on whether to support a pilot program. The American Society of Transplant Surgeons has already endorsed giving money for cadaveric organs to the families of the deceased.

There are two primary arguments normally offered in favor of allowing the sale of organs. First is the fact that a person's organs belong to them and that a person should be able to do with them as they wish. Second, the shortage of organs available for transplantation is so great that more radical solutions for getting additional organs are needed - and if paying for them will result in more organs, then this is justified.

A number of arguments against selling organs get bandied about, but there are two which lie behind most of the others and which address both of the above arguments. The first involves the concern with how selling organs leads to the commodification of human bodies, and the second is the concern with the exploitation of the poor for the benefit of the rich. These are difficult arguments to explain and are not convincing to everyone, but they cut to the heart of what we want our society ultimately to be like.

As to the issue of commodification, it is not clear that just because the only possible "owner" of an organ is the person in whose body it exists that, therefore, this same person should also be able to sell it to the highest bidder. You own your body as a whole as well, but does that mean you can sell yourself into slavery? Of course not - human beings cannot be made into commodities like that. There are even restrictions on how a person can sell their labor, such as laws concerning minimum wages.

A commodity is something that "can be turned to commercial or other advantage." A person certainly uses their body for themselves and their own benefit, but they cannot turn that body over to others for their own permanent use and benefit. Restrictions on the ability to transfer ownership and control are not only common, but in fact inherent in how society defines ownership in the first place.

In modern society, the "ownership" a person exercises over their body is treated as a unique sort in that it is not an ownership which can be legally transferred to any other party. Merely observing that you "own" something does not also confer the absolute right to transfer ownership and control to anyone else and in any manner you wish.

An important social reason why the ability to transfer "ownership" of one's own body is so restricted is because of the ways in which it is readily exploitable against the poor by the rich. Traditionally, rich people have not sold themselves into slavery, the poor have. Rich people are not protected by minimum wage laws, the poor are. And rich people are not protected by laws against selling organs, the poor are. Moreover, in each case, it is the rich who would most benefit by moving laws into the opposite direction, not the poor.

There are two possible forms which selling organs could take: selling organs of the living and selling organs of the dead. Because it is difficult to live without your internal organs, the former would be limited just to selling kidneys because people can generally live with only one of two kidneys if necessary.

Nevertheless, having a kidney removed is a difficult, painful and dangerous process. It hurts quite a lot, and the pain continues for a while after the surgery. Like any surgery, the process itself is dangerous, and it is possible that the person undergoing the process will not wake up. If they do, there remains the problem of post-operative infection - which can kill - and the muscles of their abdomen may never regain their former strength and elasticity.

Finally, there is no guarantee that the person really will be able to live with just one kidney - disease or injury later on could be fatal for a kidney donor. This is even more likely with the poor because of their health, behavior, where they live, etc. Do we really want to start flying poor people from Africa or Asia to Europe and North America so that they can sell a kidney to the wealthy?

Given the above circumstances, why would anyone sell a kidney? The rich don't do it, and neither does the middle class - only the poor are likely to do it, and it is without question an act of desperation. When such desperation is the motive for selling a kidney, to what degree can we argue that the decision is genuinely voluntary? In a just society, no person should have to sell off pieces of their body in order to survive. This, then, is why these issues cut to the heart of what we want our society to be like: will it be just enough that selling organs is something people can, but never feel they need, to do?

Selling organs from the deceased raises entirely different problems, because a dead person isn't desperate, and selling the organs of your deceased relative isn't nearly such an act of desperation on your part. Nevertheless, that doesn't mean that the situation would be entirely acceptable. Organ transplantation is already an expensive process - so expensive that many poor people are unable to have it done and simply end up dying.

Paying people for the organs of deceased relatives may make more organs available, but it would also increase the cost of the process - shutting out more poor people and increasing the cost for those who do have enough insurance to pay. Neither of those results is desirable, but the former one undermines the point of selling organs, which is to save more lives by making more organs available.

Another issue involves the pressures placed upon people before the donor dies. There are already serious ethical concerns when it comes to doctors recommending that a person on life support be taken off the machines and their organs donated. These questions will increase if money changes hands. Will families be tempted to have their relatives denied medical care in order to sell the organs? Will hospitals be tempted to withhold treatments for the sake of money?

However, a general policy against selling organs does not necessarily mean that such sales should not be allowed in very narrow circumstances or in the context of special exceptions. For example, it might be legitimate for two families to "trade," perhaps a kidney for a bone marrow transplant. This sort of trade is also prohibited as a type of sale, but it is not an unreasonable exception.

Narrow allowances for selling would have to ensure that the poor have other, genuine options in order to prevent exploitation. There would have to be safeguards to prevent things like bidding wars and "organ markets" which would cause problems with the general costs of transplantation. Finally, there would have to be sound measures to ensure that no one is pressured or tempted to allow others to die for the sake of cash. All of this would be difficult, but without it, the ethical problems with unregulated and unmanaged trafficing in human organs would be enormous and unacceptable.

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