As per November 2016, 12,678 persons were waiting for organ transplants to save their lives in the United States. Out of these patients, 100,791 were awaiting kidney transplants. For the kidney transplant, the wait time is usually above 3.4 years due to compatibility in addition to issues associated with availability of organs (National Kidney Foundation, 2017). The statistics of 2014 shows that majority of the kidney transplants come from deceased donors as 11,570 kidneys were from deceased donors and 5,537 from living donors (National Kidney Foundation, 2017). According to the National Kidney Foundation (2017), more than 3,000 patients are included in the waiting list every month and approximately 13 people die daily while waiting for the kidney transplant. That is, every 14 minutes a patient is added to the list of individuals waiting for kidney transplant. Similarly, the National Kidney Foundation notes that 4,761 patients died in 2014 while waiting for their transplant whereas 3,668 became severely sick to undergo kidney transplantation. The statistics of 2017 demonstrates that the issue worsens with time. For instance, it is stated that more than 114,000 persons were in the waiting list for organ transplantation as per August 2017. Only 34,770 transplants were performed, evidencing that 20 patients die every while waiting for a transplant (organdonor.gov, 2018).
Based on these findings, it is apparent that the world continues to experience organ shortage because the increase in number of persons that require organ transplants does not correlate with the number of donors. Many patients will continue to die if all hopes for containment of the chronic problem are bestowed on donors. Although many people support the donation of organs, it is apparent that very few of them are registered as donors. Similarly, the donation of organs from ailing patients is often impaired by their relatives despite their willingness to donate their organs. Many lives can be saved if the selling of organs is legalized worldwide. Legalization will not only reduce the number of patients in the waiting list, but also help governments save more funds that are channeled to health-care expenses associated with treating diseases such as kidney diseases.
Theoretical Background
The marketing of organs is based on ethical principles. Some individuals’ decisions are altruistic as they are focused mainly on benefitting other individuals without considering the implications on oneself (Dalal, 2015). That is, some people consider the donation of their organs to other people in need as a moral duty. Altruistic behaviors often results in happiness to individuals who are willing to part with some of their organs. Equally, many ethicists claim that the default position for organ donation should be the desire of a person to donate organs because they will influence a positive effect to the society. Such decisions ought to be respected since a person has the right to autonomy (Hoeyer, Jensen, & Olejaz, 2015). Criminalizing the marketing of organs, therefore, violates this fundamental right as free societies are required to minimize their interference of the choices made by adults since they affect their lives without causing significant harm to oneself as well as others. Opponents of the marketing of organs, however, encourage individuals to consider the harms to sellers together with recipients who participate in secretive organ trafficking without understanding that the selling of organs in developing countries will not be economically viable, except for the increasing shortage of these organs in developed countries.
The increasing number of patients in the waiting for organ transplantation demonstrates increase in demand for organs. Many people rarely practice the organ donation culture as it is demonstrated by their unwillingness to donate their organs during death (Kiani, Abbasi, Ahmadi, & Salehi, 2018). This culture presents a big challenge to organ transplantation since there is sharp increase in demand for organs besides the experienced shortage in the available deceased-donor organs (Kiani et al., 2018; Tony, Chapman, Wong, & Craig, 2014). However, many studies indicate that financial incentives will influence occurrence of a steady supply of organs. According to Caplan (2018), providing incentives for individuals to trade their organs after death will encourage people to save the lives of other people through giving their organs willingly. Similarly, the signing of “donor insurance” will make many people to feel free to sign agreements with interested people as they will be convinced that payments will be made to their beneficiaries after donation (Dalal, 2015). According to Caplan (2018), the donation of organs by the poor is considerably low when compared with the rich. The low record of organs from the poor is attributed to the perception that only the rich can access transplants even when the organs are donated by the poor. Based on this, the proponents for embracement of market forces support regulated donor compensation arguing that it will solve organ scarcity (Tong et al., 2014). Likewise, some living donors shun from donating their organs because of the financial aftermath of the process. Majority of the people believe that undergoing the process will result in financial constraints due to staying away from the work, the likelihood of losing their source of income, and possible health complications due to having one kidney. Others site stress, pain in addition to physical risks of undergoing operation as some of the reasons for avoiding donating organs. Such concerns, according to Hippen, Ross, and Sade (2009), can be outweighed by providing the donors with an award like payment of health insurance or cash payment. Hippen, Ross, and Sade (2009) further note that use of such incentives can influence many people to donate the required organs to save lives.
Regarding the increase of organs market, Caplan (2018) notes that the involvement of the government in purchasing the organs as well as regulation of the selling process will make many people to donate organs as their families will be assured of receiving the incentives that will be agreed between the parties involved. Similarly, regulated organ markets are likely to be safer when compared with the current practice of living donation. The claim is attributed to the fact that the scope of the individuals who are willing to give their organs will increase, and as a result, limit donors to those who will experience minimum long-term harm from giving their organs.
The marketing of organs is associated with deterioration of moral values. Assisting individuals that are need is one of the values that are emphasized in most societies. By allowing individuals to sale their organs, crowding out will occur as many people will be influenced to sell some of their body parts instead of donating (Dalal, 2015). Others will stop donating, causing a significant decline in procured organs. Studies indicate that the world is experiencing organ scarcity because many people have shifted their preference from the donation to the incentive culture (Kiani et al., 2018). Equally, allowing the marketing of human organs will promote corruption. The process will make the selling of organs a profitable business, and as a result, lead to its continuity and expansion. Similarly, the incentivazation of organ donation will result in not only exploitation of people but also degradation of altruism as well as human worth (Tong et al., 2014). The assertion is linked to the grossly unethical approach employed by the China government to obtain organs for specific individuals. According to Caplan (2018), China embraces execution of prisoners to maintain a steady supply of organs. Although the marketing of organs is illegal, the trafficking in humans across many countries for organ purpose has also become very common. The practice is attributed to poverty that coerce many people to sale their organs.
Another moral issue associated with legalization of the selling of organs is the selling of body parts by specific groups and races. According to Caplan (2018), only the poor together with the desperate persons will embrace the marketing of organs. They argue that individuals will consider selling organs such as kidneys when they are financially challenged to afford basic needs. Watching the suffering of family members while lacking a job can influence a poor person to misuse his or her autonomy by accepting the wealthy person’s idea of buying organs. Apart from the opposition from major religious traditions on the ground that organs are stewards of human body, the marketing of organs increases the risks of obtaining unsuitable organs (Caplan, 2018). Payment may also influence people to kill as well as take organs from others to settle debts. In addition to all these, the marketing of organs violates the ethical principles of medicine. The primary ethical norm that guides medical profession is the code “do not harm.” However, the morally way of obtaining the organ from the donor is by instilling harm through surgery. Based on this, Caplan (2018) argues that the removal of organs from other people to satisfy the interests of other individuals presents securing of specific persons’ interest for the purpose of compensation as the primary goal of medicine and nursing.
Analysis
Some of the proposed reasons for supporting the legitimization of markets in donating human organs include saving lives outweigh the theoretical moral concerns and incentivization of organ donation will increase the supply of organs. According to Hippen, Ross, and Sade (2009), Iran has experienced significant outcome from pseudo-markets in organs for more than 24 years now. For over ten years, this country has not experienced a waiting list of individuals needing kidney transplantations. Similarly, the long-term outcome of the transplantation process is not significantly different between the recipients and vendors of the organs. Hippen, Ross, and Sade (2009) also claim that the legalization of markets in organs did influence attrition of the number of organs donated by individuals related to the patients. Moreover, they assert that the number of uncompensated organ donations from the dead people has also increased sharply since 2000 when the Iranian government considered brain-death as death (Hippen, Ross, & Sade, 2009). Although organ transplantation saves numerous lives globally every year, ethical presumptions about organ donation affects the acquisition of organs from cadaver sources. According to Caplan (2018), modification of public policy to default can contribute significantly to the donation rate. The claim is supported with the positive results in countries such as Belgium, Spain, and France with legislated versions of individual consent. A policy of default is the primary cause of the experienced failings in procurement of organs from cadaver donation.
Provision of incentives to people who are willing to donate their organs will increase the supply of organs for the patients. According to Caplan (2018), many people will allow their organs to be removed when they die if they are rewarded. Although statistics show that majority of the Americans are willing to donate their organs, it is evident that use of donor cards does influence reliable outcome. Equally, the use of voluntarism method has failed to encourage people to donate organs. Caplan (2018) asserts that the emphasis put on charity for organs results in insignificant effect as the language is not very strong to sway the views of the potential donors. He argues that gifts are the best forms of charity although they cannot be considered as an obligation as a person can break his or her promise. Studies show that use of incentives can contribute to the reduction of the kidney transplant waitlist. The assertion is supported by the events in Iran that has experienced a significant decline in number of patients waiting kidney transplants following the implementation of the program (Dalal, 2015). A similar result was also recorded in Philippines between 2002 and 2008. According to Dalal (2015), implementation of a regulated system of incentives proved effective in encouraging living donors to donate organs. In 2010, China also recorded an increase in number of available organs for transplantation as a result of launching incentives compensation policy.
Opponents of markets in donating human organs site “human trafficking for the purpose of organs,” rise in inequality, and violation of human rights as the main challenges associated with procurement of organs. For instance, the organ procurement practice contributes to violation of prisoners’ rights in China (Paul, Caplan, Shapiro, Els, Allison, & Li, 2016). The Chinese government procures organs without receiving the consent from prisoners as well as their families. Equally, the organs are often obtained from living prisoners. Similarly, Dalal (2015), notes that the selling of organs can influenced decreased emotional gain to the affected families in addition to reduction of sanctity for a person’s body. They also claim that the process results deteriorate the personal touch that is available in altruistic donation. The legalization in marketing for organs is also believed to categorize the poor as the market for the rich as they will be the only ones who will exchange their organs for financial gains (Dalal, 2015). Based on this, Dalal asserts that the human body for the poor will be turned into a commodity for buying, selling, and exchanging like other goods in the market. In support of Dalal’s argument, Hippen, Ross, and Sade (2009) note that the legalization of marketing of organs in Iran led to the mistreatment of the poor and the uneducated as they were exposed to impoverishment after selling their organs. Equally, they assert that legitimization of marketing in organs will violate the people’s autonomy, specifically the poor. According to the principle of autonomy, only a competent patient or person can make right decisions (Cohen, 2012). Providing poor persons with incentives for organ exchange will comprise this principle as their decisions will be based on their needs. Moreover, provision of incentives can influence a person to sale himself or herself to slavery. That is, an individual can decide to sale his kidney contrary to his interest because of miscalculation, coercion as well as because of undue influence (Hippen, Ross, & Sade, 2009). The legalization of buying of organs may also expose the recipients to danger as they may acquire infectious diseases from the bought organ. Similarly, the conduction of surgery in an individual to remove an organ for the person in interest violates the principle of beneficence that protects the patient from any harm. According to Hippen, Ross, and Sade (2009), the surgery process for removal of an organ from a person who is not sick can results in harm long-term harm. Lack of life-time compensation such as long-term follow-up may expose the organ vendors to serious complications.
Although “trafficking in human beings for the purpose of organ removal” (THBOR) as well as human organ trade is condemned globally, illegal practice of organ trade continues (Timothy et al., 2016). According to Timothy et al. (2016), majority of the people who are trafficked from their countries as organ vendors are rarely informed about the possible complications of the process. Surprisingly, the process affects more than 10% of the people that travel to other countries to undergo organ surgery (Caulfield, 2016). Similarly, donors are sometimes subjected to mistreatment as they are either paid poorly or murdered for their organs. In connection with this assertion, Campbell and Naoru (2017) note that payment is one of the critical issue that affect individuals that are trafficked for the purpose of their organs. They argue that most vendors rarely receive the quoted price after giving their organs to the persons of interest. Equally, they indicate that the recipient of the organs is often abused financially as the brokers include miscellaneous payments besides doubling the price of organs such as kidneys (Columb, 2016). The transplantation process for the trafficked persons is usually conducted in dirty places, subjecting both the donor and the recipient to other health complications. For instance, individuals that are travel to Egypt for organ transplantation undergo transplantation in private clinics that are poorly equipped (Campbell & Naoru, 2017). According to Columb (2016), majority of the poor persons that sale their organs because of poor socio-economic status are often abused in the presence of polices as they are bypassed as well as discriminated. They also experience social inequalities in the countries where they have travelled to have their organs removed. Equally, Columb (2016) asserts that the commercial donors are often coerced into allowing their organs to be removed. Although transplantation of human organs is considered a crime in Egypt, Columb (2016) notes that the practice is very rampant. He notes that the strictness associated with accessing organs contribute significantly to the advancement of the buying and selling of organs. Based on these arguments, it is apparent that legitimization of markets in organs will lead to sharp increase in human trafficking.
Conclusion and questions for further research
In conclusion, legalization of the marketing in organs can help solve the organ shortage problem in the world. The decision will encourage many potential donors to offer their organs to save other people’s lives. Based on the reviewed studies, many people are willing to donate their organs in return of incentives. Equally, majority of the people can allow their organs to be removed to save lives after their death. However, the main source of the organs will include mainly the poor as they are the ones who are in need of money to support themselves and their families. The findings also demonstrate that legitimizing marketing of organs will reduce the black marketing of organs that subject many ignorant organ vendors to harm and mistreatment. Currently, the world is experiencing a continuous increase in human trafficking because of the laid policies against the selling of organs. Change of these policies to allow a regulated marketing of organs will protect both the organ vendor and the recipient besides promoting an increase in supply of organs.
Some critical issues, however, need to be answered to determine the effectiveness of making markets in donating human organs morally legitimate. For instance, what kind of compensation will the organ donors receive from the government since the donation of organs can result in some complications that are lasting? What protective measures will be put in place to protect willing donors from potential harm considering the fact that the demand for the organs can influence increase in killing of individuals for their organs? And how will the poor and desperate people be protected from selling organs due to external influence such as the amount of the incentives in exchange for the organs?
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