Should people be allowed to sell organs? Two Outlines

YES: J. Radcliffe Richards

NO: The Institute of Medicine

“The Case for Allowing Kidney Sales” J. Radcliffe-Richards

The burden of proof in this debate falls to defenders of prohibition (in other words, it should be allowed unless those who want to prohibit it can come up with compelling reasons).

Therefore, to support sales of kidneys, one need only strike down the arguments for prohibition. There are nine distinct arguments.

First argument against: Those who would sell a kidney (a “vendor”) only does it because they endure poverty so great that they have no other choice.

Response: If poverty is the problems, giving them even fewer choices is unfair to them; they certainly aren’t made better off by having fewer choices.

Second argument against: The ignorance of those tempted to sell shows that they are not competent to sell, so they cannot be allowed to do it.

Response: This does not support prohibition. It supports sorting good reasons from bad. This could be solved easily by introducing oversight by competent guardians of their interests.

Third argument against: There is too much risk involved for the vendors. For their own good, we must prohibit this.

Response: Given that we don’t ban many behaviors that are more risky than this, this is hypocritical. What it really amounts to is the denial that these people understand what it’s worth to them (we are imposing, from a perspective of comfort and wealth, our assumptions about what it is worth to us). The rich don’t accept the going wage for a great many activities, which is why the poor do them. As long as we REGULATE the behavior to minimize the risks, there is no reason to prohibit sales. In fact, it is easier to reduce this risk through oversight when the activity is legal and regulated.

Fourth argument against: Sales are unjust, because the vendors are motivated by their unfair treatment (e.g., huge gaps of income).

Response: Then MOST of what we do in modern medicine is equally wrong. There’s no special reason to prohibit THIS activity.

Fifth argument against: Only ALTRUISM can justify this sacrifice.  Donations are acceptable, but not sales (which motivates through greed).

Response: We wrongly assume that the money won’t be used to improve the lives of others. Many poor vendors will use the money to make life better for their families (including providing health care to sick family members).

Sixth argument against: Commercialization would undermine our trust in the transplant process.

Response: This argument makes all medicine immoral except “socialized” medicine. It cannot be a serious reason for American doctors to oppose the sale of kidneys.

Seventh argument against: The most vulnerable (e.g., children) will be coerced into selling kidneys.

Response: Why isn’t this also an argument against DONATIONS of kidneys?

Eight argument against: The slippery slope: this will just open to door to all sorts of organ sales, e.g., hearts.

Response: No one would object to donating kidneys on the grounds that it might lead to donating hearts. Furthermore, there is nothing to stop us from using the laws to limit sales to non-vital organs.

Ninth argument against: It would offend prevailing cultural standards.

Response: Not really. It offends doctors more than most people. Furthermore, we cannot extend it to many of the people who WANT to be vendors, who have non-western cultural values.


 

The Institute of Medicine offers additional arguments against:

Sale is only attractive if we assume that a free market will operate to determine prices, setting them high enough to attract sellers.

Problem: With MOST organs, the organ to be bought and sold is not one that functions in a free market (even after we solve the problem of informing potential vendors of the risks, etc.)

While kidneys can be taken from a living donor, vital organs cannot be. What will encourage either living individuals or the families of recently deceased donors to sell?

  • Many customs and religious beliefs interfere with this decision.
  • Many families will refuse even large sums of money because their will suspicions about their treatment of the recently deceased.
  • To encourage the living to agree to donate at death, must recruit large numbers of donors, very few of whom will die in the right circumstances to provide organs. It will be a “futures market.” Therefore the amount that can be paid to donors will be very low, and not attractive to most vendors. To assign a larger payment IF the donor provides usable organs requires assigning the payment to those who inherit it, which will motivate an unkown number of vendors.

The DEMAND SIDE of the market is not one in which those in acute need are themselves responsible to pay. (Most people pay through insurance of some kind.) The current system does not tie service to ability to pay. So the most important mechanism for determining free market price is not available. There is no reason to expect efficiency here, and no reason to think that the market in organs will be adopted as long as we have this approach.

The COMPLEXITY of the relationships involved in moving organs to donors (required by the speed at which donors and recipients must be matched) works against efficient pricing.

So it is not clear that a price would be offered that would attract vendors.