Legalizing Sale of Organs

Organ Sales

When it comes to the sale of organs from one party to another, there are usually two "camps" that people fall within. Those camps are inclusive of people that rae entirely against the practice in any form and then there are those that feel that some level of person-to-person sales should be allowed for so long as the parties involved face certain rules. Even with the concerns about organs going to the highest bidder, there are diametrically opposed concerns and assertions including the right of an owner of a kidney being able to sell to who he or she wants and the fact that the proceeds from such a transaction can be life-changing in nature. While it may be controversial and problematic to some, there is a middle ground to be had between allowing organ sales between people with no limitation and never doing so under any circumstances.

Analysis

To be clear, what is being suggested in this report is that the current framework seen whereby there is a singular acceptable organ sales/receipt framework and where all other sales are disallowed is not a fully viable solution. This paper shall argue that there should be the ability for some autonomous markets that allow for and facilitate organ sales but there should also remain a firm ban on organ trade frameworks and transactions that cross too many ethical and legal lines. The argument against autonomous but legal organ sales is a strong one, that generally being the idea that organs should not go the highest bidder and that allowing such a paradigm allows the rich and powerful to be able to procure organs even if they might be better served going to someone else. For example, many people can and would make the argument that a billionaire in his 80's and with a drinking habit should not ever get a new liver over someone that is in their 20's and has a problem that is hereditary or otherwise not his/her fault. Even so, the organ in question does not belong to anyone but the donor person in question and there is the alternative argument that the donor, and only the donor, should have the final say on who gets the liver portion and why. Even with the idea that the organ is his/hers to gives, there are many people that say that the ethics and money stakes involved pollute the situation entirely too much and that equity will never win out when greed or even good faith concerns about money are part of the situation. Further, there is the argument that while many people will give a life-saving transplant to others for no remuneration, there are others that assert that such compensation is more than fair to at least consider. As such, to only side with one extreme of the argument is not fair as there is not the maximization of benefit to everyone involved, both donors and recipients.

A good and real-world example of why neither extreme is acceptable is seen in the case of Alberty Jose de Silva. It became known to him that he could sell one of his kidneys and receive a rather large amount of money for doing so. Beyond that, the large amount of money was actually more than a decade's worth of wages since he would often have to slave and toil just to receive a dollar a day. In the case of a kidney, he could receive six thousand dollars in one fail swoop. Of course, there are the arguments that the two people involved, the person who needs the kidney and the prospect donor, are being "exploited" by an organ trafficking ring. The person who needs the kidney is obviously face death and shoddy quality of life. The person who has the kidney to give is in rather horrible poverty and the amount of money that he would be paid would be life-changing in an instantaneous way. Even with that all being the case, the people that were facilitating the trade were not doing so blindly and without any regard to details. Ivan Bonifacio de Silva and Gedalya Tauber, the creators of the deal, made it a point to have medical exams and other tests so as to "weed out" people that would not be fit as the donor for the person that they were seeking the kidney before. This may very well be due to not wanting to kill their customer. Even so, it is clear that they were not being entirely brazen and uncaring about the results so long as they money was there. They truly wanted to find a viable donor and pay the person who gave the kidney so that the donor and the recipient both yielded a clear and obvious benefit. However, Silva and Tauber were arrested for what they were trying to do. While some may root and cheer for such a result, there are people in world-renowned organizations and groups, even ones like the World Health Organization (WHO), that assert that many bioethicists and philosophers see the system that Silva and Tauber were trying to wield were instead an extension of the idea of autonomy. The fact that exploitation on a scale that almost rivals that of sex trafficking and similar endeavors is a very dangerous part of the paradigm scares away many, but not all, people when it comes to organ markets and sales frameworks (Rohter, 2004).

One country that has legalized autonomous organ trade that has gotten the attention of even some scholars in the West is that of Iran. A study was done about the subject in a 2008 academic journal article. It is openly suggested in the headline of the journal that Iran's pattern of paying kidney donors should perhaps become the norm in other parts of the world. As noted before, donors are commonly not compensated. However, this leads to people only giving organs upon their death or in the case that they can do so for a person they are aware of and that does not kill themselves in the process, such as the person in Brazil mentioned earlier giving one of his kidney's and then presumably getting by with the one that remains. That is precisely the centerpiece of the argument made for donations in Iran. Indeed, people that give a kidney are often just fine with one kidney rather than two and the person who receives the donor kidney is able to be restored to a normal life. The aforementioned WHO makes the case for compensated donations due to the fact that of the 660,000 people that need a transplant ever year, only about ten percent actually receive one. That is a scant 66,000 out of the 660,000 that need them. Even if the proverbial "skids" need to be greased in the form of paying the donors, the use of regulated and legal organ trade frameworks is seen as a way to bridge that huge gap while at the same time incurring people to give an organ when they otherwise might not do so (Major, 2008).

As partially noted before, the main counter-argument when it comes to the organ trade is that it is ethically and legally dubious, and with good reason. Another reason, however, that the organ trade should be abolished is seen in the form of what is coming on the horizon in terms of organs being available for people that need them. Indeed, there is the prospect that organs can be created and replicated using stem cells, thus negating the need to have donor people in the first place. Rather than having to allow on the misfortune and/or grace of others, there is the possibility that the stem cells of the person who needs the organ or a compatible peer could be used to manufacture a replacement organ. The one main roadblock when it comes to this option is that while it is very intriguing and promising, it is not a viable solution as of yet. This will possibly or probably change in the months and years to come. However, until it is something that can be done at will and when needed by the medical community, some modicum of organ trading and sales will be necessary to even come close to providing organs for those that need them (McGowan, 2014).

There are even voices in the American and Western sphere that suggest that organ sales should be permitted. As noted by others, including in this report, the donor only framework does save lives but there are also many other people that go uncured and not helped due to a shortage of donors. This goes against the grain (not to mention the law) that is commonly in place. For example, selling an organ (at all) is an illegal act and encouraging any sort of payment or "donation" as part of a donor situation is also illegal. As seen with Da Silva in the earlier article, a major qualm that people have about people at large being able to sell organs is that the poor would be lining up in inordinate numbers to do so. A more high-level concern is that allowing the sales or organs would lead to people being kidnapped and butchered so as to harvest and then sell their organs. An answer provided to that argument is that under the current framework, absolutely everyone in the chain is being paid in some way except for the person giving the organ. After all, the doctor, nurses and other people are making money but the person giving the organ, alive or dead, is not getting any sort of pay because doing so is illegal. Further, changing that situation and allowing for legal sales would not make it legal to steal the organ, even if there are some valid concerns about what would be created on the black market if organs became more viable as currency and something that could be paid for without immediate and complete retribution from the authorities. Once again, there are two extremes to the argument in question and neither one is itself the "right" or complete answer. Both sides have arguments but both sides also have gaping flaws and issues that trouble them (Hall, 2015).

There is another part of the paradigm that has to be considered, and that would be the point made by Alexander Berger. Berger makes reference to the fact that people that give organs to save or prolong lives of others are "deified" and are made to seem to be like saints. A tangential and related outcome to this is that it is perceived that giving organs is not normal or something that should be considered by other people. There was perhaps a time and place where organ donation was quite dangerous and could absolutely lead to the death or disability of the donor and/or the recipient. However, times have changed and that is simply not the case when it comes to modern medicine. Sure, there are still concerns about the organ being rejected or there beign complications for the donor or the recipient after the procedure. Even so, a person can often live a normal life with just one kidney and that applies to a giver and taker of such an organ. In the case of a liver, the portion of one person's liver can be moved to another patient and the two portions usually grow to become whole livers for both patients. Berger argues that this bestowed sainthood complicates the organ donation framework because while it is fairly selfless to give an organ, it is not the life changing even that it used to be. Beyond that, it is not happening nearly enough and there is the argument that the organ giving/sales paradigm must change due to the very high amount of people that have to wait longer than they should, assuming they do not die before getting said organ that they need. Even if there are ethical and other landmines that could arise, there are some that suggest that Congress in the United States (as well as other countries) banning the sales of organs is misguided and should be done away with to help save as many people as possible even if a few abuses arise out of the process. As such, creating a legal and autonomous market for kidneys and other organs is seen as a way to improve outcomes for everyone involved. It is not a panacea and there will surely be people that exploit and harm others. However, that is already happening in different ways and it needs to be mitigated or stopped, in the eyes of advocates for sales (Berger, 2011).

Yet another argument against banning sales are the sometimes vexing and perhaps silly rules that exist when it comes to the donor/recipient model that is currently in place. An example of these odd rules can be seen in the case of Riley Hancey. Hancey was in need of a lung transplant. A lung became available but it was denied to Hancey because he tested positive for marijuana. It is true that Hancey was told up front that using marijuana or other drugs was not allowed and that doing so could lead to him being denied a lung even if it was available. This ended up being precisely what happened and Hancey was passed over for the first lung that became available. A second lung became available but Hancey died before it could be put in place. There are a few arugments aginst the decision to deny the kidney to Hancey. First, there are many that hold that having marijuana being considered a schedule I drug, that meaning no legitimate use, is not in line with reality. Indeed, many states allow for medicinal use while others even allow recreational use. Beyond that, THC being present in Hancey's system does not mean he was smoking marijuana. Even if he was smoking marijuana, marijuana is commonly held to be less cancer-causing or aggravating even when smoking of marijuana is involved. However, many people vape or use edibles to ingest THC and there is the argument that Hancey was just trying to mitigate his symptoms. In any event, there would surely be someone out there that would believe in Hancey's right to use marijuana/cannabis and that would also sell a kidney to him. However, Hancey was subject to the donor network and the rules involved. Hancey's family even conceded that a case against the deceased Hancey could be made if he was a thirty-year smoker or something like that. However, Riley was 20 years old and simply had a rather nasty case of pneumonia that ravaged the lungs he was born with. There are many that hold that the rules that seemingly contributed to Haney's death are soulless and that the man would be alive today if the proper ethical rules were in place, even if that did not include allowing for organ sales (Miller, 2017).

Given the totality of the arguments that have been discussed, this report shall conclude with an overview of the pros and cons of allowing for legal organ sales as an addition or alternative to the donor networks in place now and the associated rules that commonly have to be followed. Upsides and "pros" of allowing organ sales include the legal involvement of qualified medical professionals, it would address the fact that the organ/sick person ratio right now is about 4:1, safety to the donor is almost always assured, it would cut down significantly on the amount of dialysis treatment needed, the donor would receive about $5,000 per organ, having a legal market would help prevent people from being cheated and victimized, sales done outside of the new and legal frameworks would still be illegal and so forth. To be fair, there are also downsides. They include the fact that a market for organs would benefit the wealthy, that same market would unfairly target and affect the poor, the amount of payment could vary and might not be fair or as life-changing as it should be and a lot of the proceeds from a donation could be eaten up by brokers and other middlemen. Further, there are other concerns including that many doctors and surgeons hold that such a market would not be regulatable, there would be the emergence of "transplant tourism" and legalizing the market of organs would produce further debate about prices based on the age, health and so forth of the potential donor. Even worse, there are those that hold that the donor market would dry up as many people would presumably want to sell their organs rather than just give them away for nothing. Finally, there is the concern that treating body parts like a commodity is less than optimal or good and human life would itself become more of a commodity than it already is.

Conclusion

Perhaps the most maddening part of this discussion is that there is no singular and clean solution that addresses all concerns, both ethical and legal. Keeping sales illegal may seem like the best course but the amount of deaths is going to remain high. At the same time, sales of organs would help a lot more people but would likely create or aggravate problems. There are viable solutions in the works but they are not present yet. When stem cells are an option to produce the needed organs, a lot of the ethical and legal problems that exist will go away. Money might still be a concern but the exploitation/harvesting angle will largely be done away with. Only time will tell what will be done. However, the status quo as well as the viable alternatives are all fraught with tradeoffs and opportunity costs. The best solution, of course, is to have people getting the organs they need while at the same time not favoring the rich and/or exploting the poor.

References

Hall, A. (2015). Let People Sell Their Organs. Forbes.com. Retrieved 28 April 2017, from https://www.forbes.com/sites/realspin/2015/12/14/sell-organs/#118e9c0726e4

Major, R. (2008). Paying kidney donors: time to follow Iran?. PubMed Central (PMC).

Retrieved 28 April 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322914/

McGowan, K. (2014). Scientists Make Progress in Growing Organs From Stem Cells |

DiscoverMagazine.com. Discover Magazine. Retrieved 28 April 2017, from http://discovermagazine.com/2014/jan-feb/05-stem-cell-future

Miller, J. (2017). Man who was denied lung transplant over marijuana use dies. New York Post.

Retrieved 28 April 2017, from https://nypost.com/2017/04/24/man-who-was-denied-lung-transplant-over-marijuana-use-dies/

Peers, R. (2017). Pro/Con Selling Organs. prezi.com. Retrieved 28 April 2017, from https://prezi.com/ujelpfbdbe5u/procon-selling-organs/

Rohter, L. (2004). THE ORGAN TRADE: A Global Black Market; Tracking the Sale of a Kidney

On a Path of Poverty and Hope. nytimes.com. Retrieved 28 April 2017, from http://www.nytimes.com/2004/05/23/world/organ-trade-global-black-market-tracking-sale-kidney-path-poverty-hope.html