By Ishika Arora
Should you be paid to give away your kidney?
This uncomfortable question is now being brought up in medical ethics discussions as the organ waiting list grows. As I write this paper at 9:21 p.m. PST, there are currently 113,198 patients on the United Network for Organ Sharing wait list for organ transplants. With only 28,535 transplant surgeries performed in the United States last year, it is clear that actions need to be taken to increase the supply of available organs; but is a human meat market the answer to this problem?
Most developed nations have legalized altruistic organ donation but none of them have legalized an organ market. Currently, many patients on the wait list rely on a heavily corrupt black market system or transplant tourism, in which patients travel abroad to receive organs from foreign donors. Many, such as Nisha Bhakta from PROSPECT Journal of International Affairs, argue that legalizing the organ trade would not eliminate, but decrease the prevalence of the black market and greatly increase the number of transplants performed yearly — as she states in her February article. There are two main aspects that must be considered before legalizing the organ trade — the social problems associated with it and its economic effectiveness as a market.
When considering the legalization of the organ trade, it is important to examine the donor’s environmental situation. Although there are several health risks associated with organ donation, the market is very prominent in countries such as India and Brazil where there is extreme poverty, lack of clean water and little access to basic healthcare. In a study of India’s kidney market, 86 percent of donors had major health issues after their surgery. Theoretically, it may seem that these risks would be minimal due to an increase in medical technology, but an increase in health risks is inevitable in areas of poverty where people perform extensive manual labor and have little access to clean water and food. Also, a free market organ system would not allow these poor donors to ever be recipients, as organs would belong to the highest bidder. The destitute would not be able to afford a transplant but would disproportionately be the ones parting with their body parts.
In addition, poverty tends to create a decrease in agency. A lack of basic necessities allows poorer individuals to be exploited through organ trading. In India, this lack of agency causes women to become collateral damage in the organ market. The same study of kidney sales in India revealed that 79 percent of sellers regretted their decision to donate an organ and a shocking 71 percent of sellers were married women. Because poor women in India have little power, they can be easily forced by their husbands to sell their organs. In this case, the libertarian idea of “my body, my choice” is not applicable.
In order to address the issues of environment, poverty and personal agency, policymakers may suggest implementation of more extensive post-operational care as well as required courses that explain the risks behind donation. Realistically, however, these poorer countries have less infrastructure and governmental regulation, which will limit the success of these programs. In addition, given the extreme economic situations of the sellers, it is not clear whether a greater awareness of operational risks will discourage them from donating. While it is important to understand the myriad of health risks involved in transplant tourism, one can argue that there are risky jobs that are currently legal. Working as a miner or a military officer is considered to be socially and morally acceptable and allows citizens to be put at risk in exchange for money. However, according to Stanford philosophy professor Dr. Satz, a line must be drawn where “the potential harms are worse than from other sales that we currently permit.”
Defenders of an organ market also reference Iran’s monopsony in which the government is the only legal buyer of organs. In this model, all middlemen and medical professionals involved are not paid for the transplant. The patients rely heavily on government-subsidized treatment and on the kindness of the volunteers involved. This allows poor citizens to not only sell their organs but receive transplants when in need. It also increases the umbrella of government healthcare by providing free care to those who donate organs. In addition, they claim that sellers come from all socioeconomic classes and not disproportionately from the poor. Because of a lack of data, however, it is unclear whether Iran’s method has truly eliminated organ waitlists or if there are major loopholes. In an ideal environment, the Iran model would seem to be effective. However, it is important to consider the economic culture and healthcare system of a nation before implementing such a model. For example, could this system work in the U.S. where healthcare is not universal and economists are major supporters of a free market system? In India, would the lack of funding for governmental regulation organizations as well as for healthcare allow this model to be effective? The Iran model is worth consideration. Overall, it is possible that governmental regulation could, to a certain extent help remove some of the social issues involved in organ trading. Assuming an organ market was introduced, however, would it solve its initial goal of increasing a healthy supply of available organs for ill patients? An analysis of its effectiveness as a market will show that it will not be able to solve this issue and will create additional problems. The purpose of legalizing organ trading is to save the lives of thousands of patients on the transplant waiting lists. It is possible, however, that introducing this new market may not increase the number of organs for transplantation. This idea can be understood by creating a parallel between the blood market and organ trade. In Richard Titmuss’s study, The Gift Relationship, he reveals that altruistic donation is more efficient. Titmuss claims that introducing blood markets “represses the expression of altruism [and] erodes the sense of community.” Thus, those who would previously donate blood for purely altruistic purposes may decline to give a part of their body for monetary compensation. If this occurred in the organ market, it may not result in an increase of available organs. Altruistic donation is clearly a better model.
In addition, while it would seem that legalization of organ trading would create national and international quality standards, in reality it might create an “unclean” supply. Because many of the donors would be of lower economic status, their desperation in destitution could cause them to lie about the health of their organs. In addition, these sellers may have little access to healthcare, creating a situation in which they may truly endanger their lives by parting with an organ their body cannot afford. Not only will an organ market be unable to increase a healthy supply of organs, it will also create other issues. From a purely economic perspective, legalizing the organ trade may force more poor citizens into selling their organs. In anthropologist Lawrence Cohen’s study of the organ belt in rural India, he found that most of the money that sellers received was used to paying back loans they had previously taken to feed their families. An increased prevalence in the organ trade will cause organs to be considered an economic asset that everyone can part with. This will cause an increase in loan collaterals and people who do not want to sell their organs will have access to fewer loans. Essentially, poor people will have to “mortgage their organs” in order to find a reasonable loan.
As Bhakta already stated in her article, legalization will not eliminate the black market. However, the organ market will not be effective for several reasons. Not only will it not solve the issue of low organ reserves, it will also contaminate the current supply and exploit poorer citizens. The reason there are so many problems caused by organ trading is because it is not meant to be an international market. Instead, Israel’s “no give, no take” policy could be implemented in which those who opt out of donating their organs would be placed at the bottom of the transplant list should they ever need one. In addition, other actions should be taken to increase the number of yearly altruistic donations. A more aggressive social campaign could be the solution, but a human meat market is clearly not the answer.
Image Courtesy of Jonathan Cook