Introduction
There are many people in the world suffering from diseases which could be cured by transplants ranging from a liver transplant, kidney, blood, and other organs (Hippen, B. (2007). However, these patients end up dying due to the shortage of such organs. Even those who get a transplant reported to have waited for long before the operation especially in the less developed countries, during which their health deteriorates. Some researchers have argued that there are verified methods of increasing supply to meet the demand which would be to permit live donors who want to sell their organs to a competitive market which is filled with high demand but low supply. However, there is a staunch opposition, barring people from selling their organs freely. Those people who objected stated that allowing free trade of human organs would undermine altruism, coerce the poor who need money, encourage people to make some large decisions without adequate information, and increase inequality. They also argued that it would degrade those people who engage in the trade and reduce the options available to the third party. There have been many discussions on the human organ markets whereby in 2002 during an annual meeting, the American Medical Association voted in favor of further studies to determine whether financial incentives could lead to an increase in the supply of human organs. International Forum for Transplant Ethic in 1998 suggested that rather than banning the trade of organs, the market should be regulated. To meet the ethical and regulation conditions surrounding the sale of organs, the market should be built to safeguard against exploitation of both parties. From these statistics, it is clear that loss of life due to the shortage of organ donors is a major crisis which comes with many scandals and opposition from different groups of interest. There is however a lot of hypocrisy about the ethics of buying and selling human organs which have led to my research question for this paper which is; to what extent a market for human organs/blood morally legitimate?
Paper Focus
This paper focuses on the sale of kidneys, livers, and blood but sales of other organs will be considered explicitly in places. In section 1, I present a theoretical background based on a competitive market for organ donors. In chapter 3, I raise and refute the main philosophical objections to a demand for human organs. In large parts, I have used Satz 2010 for the objections. In section 4, I conclude the discussion and provide questions for further research.
Theoretical Background
According to statistics from 2002 to 2003 in the United Kingdom alone, around 668 people had donated organs ranging from kidneys and livers while more than 2000 people were beneficiaries of these organs. From the statistics, still, around 6000 people were still awaiting transplants. In the world as a whole, the number of patients on dialysis was more than 700,000 (Becker, G. (2017). In India alone, there are an estimated 700,000 people each year who are diagnosed with kidney failure. In the US, close to three million cases have been reported of people suffering from heart failure with deaths related to heart failure estimated at 250,000 each year. In Western Europe, more than 40000 patients were awaiting kidney transplants based on 2015 reports with only 10,000 kidneys available (Becker, G. (2017). These statistics are only based on people who make to the waitlist of the recipients; therefore it remains unclear on the actual number of patients since people on dialysis have not yet qualified for the waitlist.
The Case for Market for organs
This argument is mainly based on the summary case presented in the book, cash for kidneys, by (Becker and Elias (2000). Recently, saving lives has become n recent times, has become practical by transplant whether liver or kidney transplants. Many organs come from recently deceased people; but in some cases, some liver-sections and kidneys can be donated by live donors mostly being family members. In many instances, people waiting for transplants have been reported to wait for long periods during which the quality of their lives reduce and their health deteriorates. The gap between supply and demand for human organs is a consequence of the fact that it is forbidden for donors to sell their organs except in Iran. The demand for human organs varies inversely with cost. This has been seen where recipients directly bear the full cost of the transplant since the higher the cost of operation, the fewer people can afford it (Crepelle, A. (2016).
Currently, the supply of these organs depends upon altruism or pressure from family members. There are different cases whereby some people arrange that when they die, their organs be given out for a donation while some people offer themselves as living donors. However, people who are altruistic to want to donate their organs to people who they are not related to might be prevented for the suspicion that money is most likely to be exchanged. If those in need of organs were allowed to buy them, the monetary incentive would call forth a greater supply in two ways.
The first one is that more people would be expected to donate their organs after their death since the money would be received by their heirs. However, this would not necessarily mean that there will be a substantial increase in supply since many dead donors do not have healthy and well-functioning organs free of infection. On top of that, relatives of the deceased donor might refuse the removal of the organs causing a further delay which might make the organs unusable (Erin, C. (2003).
The second argument is that people would be attracted to sell their kidneys or part of their liver while alive. The market for potential supply from live donors is large relative to the demand for the organs. Further, the organs from live donors are normally of better quality than cadaveric organs and live donation facilitates matching which would largely benefit the recipients. Provided there is proper surgery and aftercare, the risks to the donors are minimized, and since a person can survive with one kidney, people would be compelled to donate for money.
In less developed countries, however, donors face many risks due to the low level of hygiene and nutrition and also due to lack of proper surgery and after care. For example, surveys indicated that almost fifty percent of Indian donors and two-third of the Iranian donors suffer bad health after a transplant and most of the donors have been reported to regret their decision. Some of the contributing factors include donors being given misleading information and the fact that these countries are known to have many black markets for organs. The situation could be improved by ensuring that donors get all the information about the risks involved (Hippen, B. (2007).
It is thus clear that a competitive free market for human organs would bring demand and supply closer to the equilibrium especially by increasing the supply substantially from live donors. This would eventually mean that people in need of organs would get them at ease, the waiting period would be reduced, and the number of deaths due to lack of organs would marginally reduce. Quality matches would also be improved, high survival rates of the donors, substantially improved life of the survivor and the donors would also benefit financially. Further, in contrast, prohibiting the sale of human organs not only prevents the realization of these benefits, but it also promotes the sale of these organs in the black market which only favors the wealthy individuals who can afford. This shows that with a good competitive free market, the sale of organs would benefit many recipients making it legitimately acceptable economic wise.
International trade
The most used method of trading organs across borders is called transplant tourism which involves a recipient traveling to abroad for an organ transplant. Transplant tourism does involve not only the purchase and sale of organs but also other elements relating to the commercialization of organ transplantation. International trade is organized and facilitated by health providers who arrange the travel and recruit sellers. There are also facilitators in the recipient's countries whereby in China, 118 patients who underwent a transplant reported that their transplants were facilitated by doctors (Hippen, B. (2007).
There were also allegations that the embassy's from less developed countries, for example, Pakistan and Philistine, facilitated over-seas commercial kidney transplants. The trade for organs across borders, however, may lead to inequitable allocation of deceased donor organs and has also led to ethical concerns.
Inequality
According to Satz, (2010, 197-99) introduction of human organs market would increase inequality by including body parts in the scope of things to which there is a ready market with good prices. For example, a kidney market would mean that the kidney goes to the highest bidder where the bidder would most likely be from a well-off family with the donor most likely being from a poor background. From her book, Satz asks the question "shouldn't kidneys be allocated to people based on their needs, the waiting duration, medical suitability, and not by the ability to purchase the organ?" It is true to say that the sellers of these organs are on the average likely to be from poor backgrounds than the recipients.
Inequality also arises when the allocation of the organs goes through a bureaucracy which decides how many organs are required and who would be the beneficiaries, instead of such matter being decided by the donor and the recipient. Further, the cost of the bureaucracy will have to be recovered either from the recipient of the taxpayers in general and given that most of the bureaucracies are monopolistic agencies; they will have small incentives to keep minimal expenses. If the objectives of this arrangement are to help the poor, it would be better served by giving the poor more money (Parker, P., & Parker, P. (2006).
Another inequality is on the unexplained reasons why organs should be allocated based on the need, the waiting period, and medical suitability while other health services are not. Some researchers argue that all factors should be put into consideration since they are all matters of death and life. Therefore, for consistency, all goods and services necessary for life should be allocated by need. As methods of reducing inequality, the prohibition of a market for human organs would be ineffective. It makes the poor worse off, as well as the wealthy individuals, and brings about a wasteful bureaucracy.
Analysis
There are many reasons as to why markets in donating human organs are morally legitimate, but there are also those people who are opposed to the donation of organs.
Organ donation saves lives
With the currently increased deaths caused by organ failure, some people have come forward to support the efficient market of human organs. The two economists Gary Becker and Elias argued that it is better to pay donors than to rely on voluntary donors stating that in the US alone, 95,000 patients were in 2012 put on the recipient waitlist. The two economists wrote that paying donors a sum of $15,000 a kidney would bring more supply of kidneys. The number of dialyzes would also decline significantly and deaths due to long waiting periods would essentially decline. Becker was aware of the opposition he would receive after publishing the book, but he argued that it was unnecessary to have such huge numbers of deaths while people would save lives by donating (Roth, A., Sönmez, T., & Ünver, M. (2005).
Further, the idea of money for body parts was fallacious according to Becker and Alias since it was almost the same idea in surrogate mothers. They saw no harm in people wanting to give out their kidneys, adding that the risks involved such as sellers suffering from depression could also be reduced.
Megan Clay and Walter Block (2010) stated the shortage of donor had created more problems saying that doctors and medical professionals in their work must choose who to live and who to die. Most of the times during transplants, they base their decision on age, sex and health status. For example, a 60-year-old male with a life expectancy of five years should be placed on the lower list of the recipients than a 10-year-old girl, who can be expected to live long if she is operated. The shortage of organs has also created the black market for transplantable organs. Cases of stolen organs from living people have also been reported. They argued that if the market for organs could be regulated, it would solve many problems in the medical field (Roth, A., Sönmez, T., & Ünver, M. (2005).
The market for human organs is destroying lives.
However, despite their campaigns on organ transplants, Becker and Alias have faced opposition from many people. From a Washington post "the market for human organs is destroying lives," Nancy Scheper-Hughes a professor of medical anthropology at the University of California, advice people that donation of organs is morally and socially unethical (Scheper-Hughes, N. (2009). Further, she states that organ donation has largely damaged many families of the sellers and their communities especially in less developed countries such as Syria, India, Sri-Lanka, Moldova, Brazil, Egypt, and Ukraine. Donation of organs has been misused in these regions to the extent that people earn their freedom by donating their organs which has largely been caused by political conflicts and long periods of draught. In other cases for example in Manila, the sale of kidneys for financial gains has been passed from father to his wife and later their children and has been a rite of passage (Sanner, M. (2003).
Professor Hughes continues to say that, despite the compensation from organ donation, they should not be used as spare organs stating that being in the field for a long time, she came across donors who later in their lives suffer from the negative effects caused by the operations in their minds, bodies, and lives. The post also stated that many medical journals do not report the actual long-term medical conditions, psychological and social consequences as a result of selling a kidney. It reported that many people suffer from chronic pain, depression and suicide thoughts, self-hatred and the sense of an empty body after an organ donation (Scheper-Hughes, N. (2009).
The professor also stated that from many years of interacting with sellers, she found out that economically, kidney sellers normally exhaust their money after a year. She based her arguments on the fact that most of the sellers are poorly educated and unskilled people who rely on their body strength to earn a living. After the operation, many of these sellers are excluded from their duties especially those that involved lifting heavy materials. In Bangladesh for example, people who sell their kidneys refer to the removal of the kidney as "the day of my death" referring to their economic and social decline (Surman, O., Saidi, R., & Burke, T. (2008).
The situation is further worsened by the existence of underground markets run by organ brokers exploiting desperate buyers and sellers. Kidney hunters collaborate with surgeons and hospitals to ply their trade on deceitful ways. Such a case was reported in the United States where an international brokering scheme trafficked poor kidney sellers from Israel to the American citizens. In conclusion, Professor Hughes stated that cash for kidneys was not the major issue; rather it is the irresponsibility and the hostility towards kidney sellers.
Conclusion
I have argued that having a competitive, free market in human organs would be a great improvement over the current system which prohibits the sale of human organs almost universally. Allowing a free market would reduce the evils associated with black markets. Further, it would significantly increase the supply of the organs, improve the quality of matches, and increase the likelihood of successful transplants for both donors and recipients thereby saving lives and reducing the sufferings. It would permit people to trade their organs for money or voluntarily giving them the satisfactions they want. In the long-term, a free competitive market ethically accepted would even lower the cost of transplants.
Despite the good things associated with organ transplants, it has faced much opposition from different groups. I have however considered the major philosophical objections to a free organ market and have shown that some of the claims lack merit. I have also shown that people who are opposed to the idea of a free human organs market like Nancy Hughes, do so out of the concern for human welfare, especially the well-being of the poor.
Questions for further research
How can technology be used to solve the organ shortage? This could be argued by how cloning could be used to solve the organ shortage. Further, most people are on organs waitlist due to preventable diseases. In the US, diabetes is one of the leading causes of kidney failure accounting for at least 50 per cent of the cases. High blood pressure was reported to be the second cause of kidney failure. These two are examples of preventable diseases with proper diet, exercise; limited alcohol consumption and reduced smoking can help prevent these diseases. Therefore the question lingers, how can the government intervene to reduce the cases of kidney failures in return reducing organ transplants?
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