On January 6th 2016, Nancy Scheper Hughes from the University of California, a organs watch director, an advisor to the UN, the EU and WHO wrote on the Washington Post about organ donation. She expressed concern that even if you get an individual willing to sell his or her Kidney to you, always be cognizant of the fact that you are entering into an area of ethical, moral, social and political gray zone (Roth and Sönmez, 2005). She explains that getting a person to purchase a kidney from seems beneficial to the purchaser since it means that the one purchasing doesn’t have to queue on the list of kidney recipients and also the dialysis costs and complications associated with waiting but it put the seller and the buyer at risk (The Washington, Post 2016).
Nancy reiterates that according to the studies she has conducted, the kidney sellers are worse of economically a year later than even when they had no sold the Kidney. The deterioration economically is due to the fact that many of the seller are laborers who do menial jobs to fend for themselves and these jobs require a significant amount of physical strength. Since they have been operated on and their kidneys removed, it means they have to be excluded from their work rendering them economically helpless. In fact, in Pakistan, those who sell their kidney call the day of operation “the day of my death”. And true to their declaration, to most of them, it is the day they economically, psychologically and socially decline (The Washington, Post 2016).
The illegal organ market is run by brokers whose by their cunning nature exploit both those who sell and the buyers. There is a lot of concerns surrounding the sale of organs, and government, non-governmental organizations hospitals etc. have been found to commit atrocities in the name of organ trade.
Nancy advices that there are complexities and difficulties in developing a more rigorous and reliable regulation mechanism for organ selling and therefore if u must by a kidney for example purchase it from someone you know or probably from someone you love because she advices it will be the right thing to do for a buyer to monitor a seller over a long period of time especially if the health of the seller fails. Since you can’t put a price on life ((The Washington, Post 2016).)
Above is just but one analysis by a professional that shows us that a lot needs to be done in the organs trade market. With all the negativity surrounding the organ trade a question we need to ask ourselves is the moral legitimacy of the organs market.
But before we answer that, we need to answer the following sub questions.
1. What is moral in the organ trade
2. What is legitimate in the organ trade
3. What is ethical in the organ trade?
This paper is going to look at this issues that surround the organ market and we are going to examine the morality, the legitimacy and the ethicalness of the organ market.
Theoretical framework
The look at the numbers
Before we look at the theoretical framework let us look at the numbers. The number of patients on the waiting list to receive a kidney is colossal. Each passing year a number of them are removed from the listing with the devastating news that they are now too sick to withstand the transplanting procedure. In the year 2001, over 10,000 were removed from the waiting list 9936 of whom were either waiting for a kidney or a Liver. From 1995 to 2011, the removals from the organ waiting list stood at 29535 while those that were removed since they had died, was 88,517. There is an approximate of 40 people who die daily in the US while waiting to receive an organ. Out of these 30, around 19 were waiting to receive a Kidney and almost 8 waiting for a Liver. These numbers clearly show that there in an obvious imbalance between the demand and the supply of the required organs. It should not be forgotten that as the population continues to grow the numbers are going to increase. We actually ask ourselves that had these people received this organs in time maybe their lives would have been saved. (Organ Procurement and Transplantation Network, 2012)
The feeling that they would have survived is supported by the fact that now, organ transplanting achieves a 96% survival rate from those donors who have already died and a 99% rate for living donors and this are figures for a Liver transplant. For the kidney the numbers are 87% and 91% respectively. This implies that if many of the people on the waiting list are able to receive an organ in time, their chances of survival is really high (Organ Procurement and Transplantation Network, 2012)
In the United States, the demand for organs from the list of those waiting for a transplant stood at 113,770 of whom 91714 were waiting for a Kidney in the year 2011. Sadly there were only 14140 donors and from record, 28353 transplants were done, where 16812 were for kidney transplants. Imagine these are numbers from the US only. We can bet that the numbers from other countries are not so encouraging. This clear deficit in the supply of the required organ has the consequence of making those patience in need to wait for years and unfortunately their health conditions continue to deteriorate to the extent that even when the organ if finally available they are too sick to receive the organ high (Organ Procurement and Transplantation Network, 2012)
Were it not for the imbalances that exist in the organ market, this people actually had a fighting chance. Yet the organ donation system is not able to deliver the needs of those who want this surgery.
Supporters of a legal and legitimate organ market argue that the problems above can only be solved by
Adopting a market system for organs from those who are still alive. The proponents argues that the market will provide incentives which will motivate more people to give their organs and this will significantly increase the supply of the Kidneys. However those who oppose an organ market argue that adopting a market system for human organs will have very serious ethical problems. They say that human life is so precious so as to be left to the forces of demand and supply (Bryce et. Al., 2005).
For us to understand Market for organs, we first have to understand how a market for a normal good or service works. There we will look at the following terms that define a market. In a market we have demand, supply elasticity and international trade just to mention but a few.
Market for organs
Kirzner (2002), defines a market as a place where goods and services are purchased or sold. It a place where buyers and sellers come to exchange their goods of services and the medium of exchange is money. In the same accord, as Becker and Elias (2014) illustrates a market for organs will mean a system where those who demand for the organs and those who have them can come to exchange the same. As for the other goods in the normal market are regulated, the organs market can also range from a slightly regulated market to one which is heavily regulated. Borrowing from economics we can have a seriously regulated monopsony market where distribution is rationally done (Mohr and Fourie 2004).
Demand for Organs
According to Elberse and Eliashberg (2003), Demand for a good or service, implies the rate at which a product can be bought by the consumers. Demand for a good or service will be determined by two factors i.e. taste and ability to purchase. Taste implies the need for the good in question and ability to buy implies the consumer being able to buy the good at a specific price but he has to have sufficient income to do so (Chiotis, 2015). This can also apply to the organ market. Those who are sick and in need of a kidney definitely have the taste of the desire for the kidney. But the same will not be said to the ability to buy part of demand. There will be those who really need the kidney but their economic status will not allow them to purchase the same (Friedman, 2006).
Supply for organs
Elberse and Eliashberg (2014), further define Supply of a good or service as the amount of good or service that is available to consumers. It can be the amount of goods of service available to consumers at a certain price or for a range of prices. The number of kidneys therefore available to those who need them will comprise the supply for this kidneys. It is worth noting that where the demand and supply interact provides the equilibrium price. The type of regulations and controls that will be implemented in the organs market will determine what kind of good the organs will be since we have different types of goods in the market. For a normal good, as demand increases the supply will be less, which will lead to an increase in prices. I presume the organs won’t be a normal good since to address the moral and ethical issues surrounding the organs market, a lot of regulation and price control is needed and this will not make organs just depend on the forces of demand and supply (Calandrillo, 2004).
Elasticity in the organs market
Elasticity in general terms implies how one variable changes with respect to change in another in economics, elasticity refers to the degree to which consumer demand or producer supply will change with respect to price change or income change. Obviously the demand and supply of the kidney in the organs market will have to be affected by the changes in price of the kidneys or by the changes in the income of those who need the kidney (Kirzner, 2002).
International Trade.
International trade is the exchange of products and services between countries. Normally countries will produce and sell goods which they have comparative or absolute advantage in producing while importing those goods which they don’t have absolute or comparative advantage in producing. International trade will also have to be taken into consideration in the organs market. Pertinent questions need to be asked for instance when a citizen of one country decides to sell a kidney to another person in another country how does the “exporting” and “importing” country agree on this kind of trade? What restrictions will there be on the organs market when the trade is across borders, among other pertinent questions. International trade will also mean people with different moral values trading on organs (Elberse and Eliashberg, 2003).
Organ trade and inequality
Ross (2002), postulates that like any other market, there will have to be inequality in the organ market. In this case we will look at inequality from two fronts. First, when a good or service is left under the mercy of the forces of demand and supply, inequalities will have to arise. This is for the reason that the organs market won’t be a perfect market where buyers and sellers are many and have the same information about the price and there are no barriers of entry and exit from the market. Definitely information flow about prices will not be smooth and exit and entry in the market may have barriers. This will definitely lead to inequality since the issue of the ability to purchase sets in. those who are economically able will definitely control the market since they can afford to purchase leaving those in need but do not have the financial power with no option but to rely on the benevolence of others. Inequality can also be brought by prohibition when governments do not allow the organ trade, they will be violating the principle of Justice. When the transaction between a willing seller and buyer is not allowed to happen, it means that the patient will depend solely on how socially he or she is connected. Meaning that they will now totally depend on family, friends and well-wishers for donations. On the other hand, it denies the poor who are willing to sell their kidney for economic gain an opportunity to do so. Prohibition has the implication of causing scarcity and scarcity condemns to death some people who were not supposed to die (Ross, 2002).
Morality in the organ market.
As argued by Hacker (2010), those who object the creation of an organ market do so mostly on moral grounds. It is understood that morality can only be analyzed within a certain ethical framework. For the purposes of this papers we are going to look at a few ethical theories namely, utilitarianism, Kantian ethics, virtue ethics, and principlism in order for us to ascertain to what extent the a market for organs/blood morally legitimate (Hurst house, 1995).
Utilitarianism
Most of the time those who support the organ market subscribe to the utilitarian framework. In this framework, they argue that the moral status of an organ donation system will depend on maximization of utility (Satz, (2008). Therefore they say an organ market is what is likely to bring maximum utility to those who are involved. Conversely, those who oppose the organ market consider consequences that can be brought by the market against values like equality. This theory of utilitarianism is going to prove that those who oppose are not making a strong point and hence provide a justification for an organ market (Ross, 2002).
Under utilitarianism we have classic utilitarianism where an action is said to be morally right if and only if the consequences of the action are a maximum good or a maximum bad. By a maximum good we mean that the action brings only joy and pleasure and by bad we mean the action brings only pain and suffering. Needless to say this kind of thinks is not without problems since perception of pain and pleasure is really different from person to person (Thomas, 1992).
We also have Preference utilitarianism which tries to avoid the above problems by claiming that an action can be said to be morally right if and only if the maximum number of people are satisfied by a maximum number of preferences. Therefore it means that whatever an individual says is his or her preference is the good (Thomas, 1992).
Having looked at utilitarianism, then we ask ourselves whether the organ market entails immoral acts. The answer is most probably that in an organ market that is regulate, an individual’s behavior will not always be an immoral act. In fact in many case and individual selling a kidney is the most morally right thing to do (Thomas, 1992).
Therefore to know what is morally right act or system Utilitarianism compares the consequences by looking at the utility the action or system brings. Hence unless two actions or systems lead to same happiness or satisfaction, only one of them is morally right. In utilitarianism once the evaluation is made, the system or the action that brings maximum good is chosen to be the one that is morally right (Thomas, 1992).
Principlism
Bioethics most of the time depends on the moral ethics theory principlsm. Beauchamp and James (1979) argue that four principles act as the fundamental guidelines in making rules and these include these are principles of respect for autonomy, nonmaleficence, beneficence, and justice. In bio ethics, this principles are used to give guidelines in determining what is morally right.
The most significant thing about Principlism is simplicity instead of employing complicated theories, it just employs the four principles making it easier in application (Beauchamp and James 1979).
For instance the four principles will ensure that a medical practitioner tells a patient to make a rational decision which is voluntary and informed in this case, the respect for autonomy principle is used. The principles of nonmaleficence and beneficence will guide the surgeon in making sure that the medical procedure is giving the patient more benefit than harm and finally the principle of justice will ensure that the kind of treatment the patient is receiving is what other patients will receive under the same circumstances (Beauchamp and James 1979).
From the brief discussion of the two theories of ethics, it is evident that many of those who oppose the organs market do so on mare ground of moral taboos which are inefficient. Creating markets will influence morals since the organs market will be created and regulated on a certain framework.
Objections to an organ market
Becker and Elias (2007), point out that there are many objections to accepting the creation of a legitimate organ market. The two most significant concepts that support objection to an organ market is the crowding out effect and the social preference concept. Both of this concept are against the proposal that an organ market will enhance utility. The fear of crowding out effect is that the existing number of organs available may not be greater in a market system that is incentivized. While the social preference argument fears that the negative utility that comes from the dissatisfaction of the public in endorsing certain values will be more than the utility that the organ market will offer.
Crowding out effect
Under this argument, creating an incentivized organ market will not increase the number of suppliers for organs instead, it may reduce them. This is based on the fact that those who donate organs in a non-incentivized system only do so because they derive happiness by saving lives willingly without any economic benefit therefore incentivizing the organ market will lead to loss of existing organ suppliers. In this case the heroic connotation of organ donation is lost and thus it becomes a selfish act of economic gain. The fear is those who become suppliers in the incentivized system may not be more than those lost due to the economic incentives leading to crowding out effect.
Social Preferences
Those against organ markets argue that people have social norms that they really value and organ donation may be conflicting with this values hence reducing the overall utility. The claim by this objection is that societal satisfaction is derived from subscribing to certain values like solidarity which may be eroded by the advent of the organ market since organ donation will be viewed to be a mare business transaction.
Analysis.
We have had very deep discussions on the issue of market for organs and blood. For the purposes of the discussion of this paper, two reasons really make the market for organs and blood morally legitimate (Dworkin and Gerald 1994). First it is the statistics. From the analysis of the numbers of those affected by imbalances in the organ market, we observed that a great number of people really whose lives would have been saved are affected by the imbalances in the organs market. Many lives that otherwise would have been saved are lost since we oppose the organs market only on moral grounds (). In my opinion, saving most of those lives is more justifiable than losing them due to our moral rigidity. The principle motivation of creating an organs market should be saving of lives. When we appreciate the greater good of saving lives, then we will have the impetus of looking at the moral issues and others surrounding the market. Statistics also show that the level of success in the medical procedures are really high, and actually both the donor/seller and the buyer/recipient return to their normal life after a short while hence dispelling the fear of harm health wise (Björkman, 2006).
Secondly what makes market for organs and blood morally legitimate has been clearly brought about by the two theories of ethics discussed (Mohr and Fourie, 2004). Basically the theories give those that are involved in the market an opportunity to give guidance and make a decision on what is morally justifiable and what is not. For instance under utilitarianism two ideas are really articulate concerning morality. It tells us that what gives an individual maximum utility can be considered to be what is morally right and hence prohibiting the existence of an organ market will cause the two parties involved not to receive maximum utility. The buyer will be denied better health and better life, while the seller will be denied better economic status and by extension better life and better emotional satisfaction of saving a life. Still utilitarianism helps us to evaluate actions around the organs market. Those actions when evaluated brings maximum good will be said to be morally legitimate. We are also persuaded by principlsm to use the four principles in ensuring that acceptable morals are applied in the organs market (Björkman, 2006).
The two most significant concepts that support objection to an organ market is the crowding out effect and the social preference concept. Both of this concept are against the proposal that an organ market will enhance utility. The fear of crowding out effect is that the existing number of organs available may not be greater in a market system that is incentivized. While the social preference argument fears that the negative utility that comes from the dissatisfaction of the public in endorsing certain values will be more than the utility that the organ market will offer.
Conclusion and questions for further research.
From the research above it’s not really conclusive to what extent organ donation is morally legitimate. But the issue of societal values and their effect on determination of what is viewed has moral really have a significant effect in answering our question. Therefore before we conclude on whether organ donation are morally legitimate, a conclusive study should be conducted so as to ascertain the effect of societal values in determining morality.
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