Eight Ethical Objections to an Organ Market... And Why They're Wrong

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My
last article
gave a cursory overview of some of my thoughts on organ scarcity.
It didn't, however, address specifically how a solution to that
problem could work or why any of a plethora of proposed organ allocation
schemes would function most effectively. I believe there is one
way to best deal with the high demand for organs and relatively
short supply. And it stands up beautifully to the barrage of criticisms
thrown at it.

I
am convinced that the best way to approach organ allocation is simply
to allow a free market in human organs. I want to convince you,
too.

I
must tell you that proponents of an organ market have been making
their case for years; some of these basic arguments are not my own
but part of a discourse on the subject. If you are interested in
reading about practical considerations and ethics in organs markets,
I have listed some intriguing resources at the end of this article.

Now,
for the objections.

  1. Some organs
    — such as kidneys — can be removed and sold while the donor
    is still alive, but who would want to sell organs which kill
    the donor when removed?

This is
usually the first objection raised after anyone broaches the
subject of making organs into commodities. You cannot benefit
from the sale of your organs if you are not alive. This problem
is best addressed by allowing a futures market in organs. In
a futures market, individuals could sell the right to harvest
their organs after they die. Benefits would become part of the
individual's estate, and would be paid to their next of kin.
Alternatively, sellers could be paid a small amount of money
during their lifetime for the rights to harvest their organs;
the sum paid out would reflect the probability of the seller
dying in a manner suitable for organ harvesting.

The organ
seller would enter into a contract with a firm — it could be
a lifetime contract or an annual one. This
is an interesting essay which details how the author envisions
practical futures markets in organs.

Of course,
organs like kidneys and lobes of the liver can be removed without
killing the donor. These types of organs could still be sold
in a futures market. They would probably be more commonly sold
in the manner of most other goods. Sellers would have a choice
between making a large, immediate profit from the sale of non-vital
organs or selling vital organs on a futures market.

  1. An organ
    market would encourage organ thieves. It also encourages the
    killing of comatose and brain dead patients to harvest their
    organs and make a profit.

Everyone
has heard the urban legend about the guy who goes to a bar,
has a few too many drinks, and wakes up the next day in a bathtub
full of ice with one of his kidneys missing. It's just that
— an urban legend.

Practical
considerations prevent organ theft from becoming a real threat.
Any organ transaction requires that several immunological factors,
such as blood type, match between the donor and the recipient.
The possibility of finding a match for a specific recipient
in a random victim of organ theft is practically zero. It would
not be profitable for organ thieves to randomly attack victims;
nor would it be feasible for them to search and target a specific
match for the recipient.

Additionally,
organs must be harvested surgically and handled in a very specific
manner in order to be viable for transplant. Organ thieves would
have to hire a qualified surgeon to do the job. Many qualified
surgeons make so much money that they have no incentive to get
involved with shady organ thieves. The potential costs of being
caught would be immense enough to deter participation in organ
thievery even for those surgeons in training or in financial
trouble.

Another
factor that makes organ stealing implausible is physical distance
between the donor and the recipient. A live victim would have
to be sedated and transported to a location near the recipient
before he knew he was being robbed of an organ. If the victim
was murdered in another location, his organs probably would
not be viable once they reached the recipient anyway. However,
a significant market in the development of new technology instrumental
to the preservation and transport of organs exists. Companies
such as Organ
Recovery Systems
are making it possible to harvest and transport
organs from donors whose hearts have stopped beating. (Thanks
to Dr. Ron Klatz for
drawing my attention to this technology.)

Some
people also worry that doctors will encourage their families
to "pull the plug" if they end up on life support
and their organs are viable. For many people this is a very
real concern. But an organ market would increase the supply
of organs so much that it would lessen the impetus for doctors
to pressure families of brain dead or comatose patients. A patient
truly concerned about this should make it clear to his family
that he does not wish to be an organ donor, or that he does
not want to be an organ donor unless he is already completely
dead — i.e. his heart has stopped of its own accord. Anyone
who wishes to be an organ donor can stipulate to his family
which specific organs he wants to donate, and to whom he wants
them to go.

Remember
that organ donation is completely voluntary, as would be organ
sale.

Some
people complain that under the current system, doctors and transplant
surgeons pressure families to remove their loved ones from life
support in order to profit from harvesting their organs. If
the family were allowed to reap some of this profit, money from
organ sales could even help to offset the enormous hospital
costs associated with keeping a loved one on life support. I
refuse to believe that any family would decide to remove a loved
one from life support just to make money from the sale of his
organs.

  1. An organ
    market would supply poor quality organs — those who would be
    most likely to sell their organs have organs that are of the
    worst quality.

This
is not true, but even if it were: aren't organs of poor quality
preferable to no organs at all? Right now, the supply of organs
is so short that nobody has a choice about which organs they
receive. A market in organs would increase the supply so much
that recipients would probably be able to choose among several
matching organs.

Legitimate
organ brokerage firms would emerge. They, or insurance companies,
would do diagnostic testing to ensure donor-recipient match.
They would screen potential donors for diseases and probably establish
a rating system for the quality of donor organs. The organ's
price would take into account several factors: organ type, organ
quality, current supply and demand, surgical costs, transportation
costs, diagnostic testing costs, and a finder's fee. I'm sure
that broker firms would have an incentive to screen donors carefully
— imagine the lawsuits which would result if a recipient contracted
a disease from a donated organ. Over time, these firms would
build reputations for safety and quality. Consumers could choose
among them just as we choose among competing companies for any
other product.

  1. An organ
    market exploits the poor. They do not get paid enough for their
    organs. They will sell their organs for drugs.

Although
poor people would probably be the most likely to sell their
organs, an organ market would not be exploitative — in fact,
it would help poor people by increasing the amount of options
they have for money making.

Realistically,
the most common organ transaction would probably be that of
kidneys. According to UNOS,
there are more people currently waiting for kidneys than any
other type of organ. A kidney can be harvested without killing
the donor, and the donor can lead a relatively normal life with
just one kidney after the transaction.

I
won't claim that recovering from having a kidney removed is
easy or fun. I don't want to downplay the fact that the donor's
quality of life will probably suffer. However, allowing the
sale of organs affords people a choice that they don't have
under the current system.

We
make economic choices every day — if I buy a cup of tea at Starbucks,
I have shown that I prefer having a cup of tea to having a few
bucks in my pocket. If I sell my kidney for $20,000, I have
shown that I prefer $20,000 in my bank account to a kidney in
my gut.

People
choose whether or not to sell their organs. Choice represents
economic power. The option to sell organs is one opportunity
for poor people to lift themselves out of poverty. Nobody can
force a person to sell his organs. But if he makes an informed
decision to sell, more power to him.

If
a person sells an organ in exchange for drug money — well, that's
also his choice. My guess is that one of two things will happen
if drug addicts decide to start selling their organs: either
the addict will run out of non-vital organs to sell, or the
addict will not be able to market his or her organs because
they will be distressed from drug use and possibly infected
with diseases. Of course, the reason drugs are so dangerous
and expensive is precisely because of the "War on Drugs."
That, however, is another subject for another column.

  1. Selling
    organs is dangerous, even for those organs which can be removed
    without killing the donor.

Isn't
it more dangerous to have black market organ transactions?

Black
market organ removals must be done in secret. Often this means
they take place under poor or dangerous conditions. Sellers
of organs on the black market take enormous risks because they
essentially have no legal recourse if they don't get paid, or
if they suffer complications from the surgery. Sellers may not
be able to afford treatment for those complications, which could
result in death. A legitimate market in organs would allow donors
to choose a firm to broker their organ transactions, and to
enter a contract where the specifics of the transaction were
clearly delineated. Violating the contract would warrant legal
action. Competing organ brokerage firms would have an incentive
to gain a reputation for being the safest, the cleanest, and
the highest paying (for the donor) or the most economical (for
the recipient).

  1. An organ
    market is unfair. Only the wealthiest people could afford to
    buy organs.

Wealthy
people on the UNOS waiting list already do buy organs on the
black market. They also get preferential treatment if they are
"important" enough. The current "fair" system
is actually massively unfair.

If
the market were legitimized the price of organs would plummet.  Many
more people would be able to afford them, because the supply
would increase. Besides, having an organ market would in no
way prevent people from donating their organs for free – either
in death or while they are still alive.

Regardless
of a patient's financial status, a condition which requires
having an organ transplant is bound to incur huge costs. The
financial cost of staying in the hospital or getting treatment
(such as dialysis) while waiting for an organ may surpass the
price of buying an organ on a legitimate market. Consider, too,
the opportunity costs of losing wages, missing time with family
and friends, and enduring years of poor quality of living.

  1. Isn't
    it more ethical to use xenografting? What about other techniques?

No,
xenografting
is not more ethical. A market in organs facilitates voluntary
exchange between the donor and recipient; the donor consents
to sell his or her organs. Animals cannot give consent. And
as far as we can tell, they do not experience altruism. An animal
would not receive any benefit from having its organs involuntarily
removed. We can reasonably assume that no animal would consent
to having its organs removed, were it even able to give consent.
Therefore, xenografting is not ethical.

It
also poses additional problems.
First, having a xenotransplant probably would be less cost-effective
than buying an organ on a free organ market, at least with the
present technology. There are also concerns about viruses which
naturally occur in some species intermingling with human ones.
Some scientists believe that this could potentially create a
new pathogen which might be very dangerous. And perhaps the
most significant problem with xenotransplantation is the issue
of rejection by the recipient's body. Some companies
are working to develop technologies that address these issues.

As
far as other methods, a cost-efficient way of cloning single
organs or body parts or a way of synthesizing organs would be
an ideal solution to this problem, provided the parts were made
available on an unfettered market. I don't doubt that these
things may one day be possible with the continuing incentives
for innovation that capitalism provides. However they are not
available right now, so they can't be considered as a practical
solution to the organ shortage at this point in time. (An interesting
footnote: synthetic
blood
is already emerging as a possible solution to the
ever-prevalent blood shortage.)

  1. Some religions
    prohibit organ donation as body mutilation.

Organ
donation is voluntary. Organ sale would be voluntary, if it
were legal. You decide what do with your body. On the same token
we should all respect other people's wishes to do as they please
with their own bodies. Ultimately, a market in organs boils
down to one key concept: autonomy.

In
1999, someone
attempted to sell
a "fully functional human kidney"
on eBay. Some debated whether
or not the auction was a hoax. But bids apparently rose to $5.7
million before eBay decided to shut down the auction. Jeffrey Tucker
tells me that the Mises Institute had to put out this
notice. Why? A Mises
daily article
which extolled the virtues of a human organ market
prompted numerous emails and phone calls from people asking to buy
or sell organs.

These
situations merely demonstrate the high demand for organs.

It's
time to start thinking seriously about letting the market do what
it does best — allocate scarce resources efficiently — with human
organs.

Interesting
Resources

January
3, 2005

Stephanie
R. Murphy [send her
mail
] studies Biochemistry at the University of Massachusetts
at Amherst. She is a member of LifeSharers
Organ Donation Network
.

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