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Debate: Sale of human organs for transplants

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Should the sale of human organs be legal?

Background and context

Advances in surgical and diagnostic techniques have substantially increased the success of organ transplant operations. In 2000, a total of 22,827 organs were transplanted in the United States. However, in the preceding decade, the discrepancy between the number of available organs and the number of patients requiring a transplant operation has increased significantly. A British Medical Association (BMA) report has indicated that in the period between 1995 and 1999, 1,000 patients in the United Kingdom died whilst waiting for a heart, lung, or liver transplant. An average of 15 patients die every day in the US whilst awaiting an appropriate organ. The genuine figure will likely be inflated by the deaths of patients that are never waitlisted for a transplant. In addition, substantial numbers of patients die annually on account of the absence of both kidney donors and the lack of dialysis machines. The sale of human organs can be considered as a possible solution to the crippling shortage. The black market trade in human organs is already thriving. Entrepreneurs offer the opportunity for British patients to receive privately financed transplant operations in India and Malaysia. An American citizen was recently arrested in Rome for offering human hearts and pancreas glands for sale to Italian doctors. In February, two Chinese government officials were charged with the sale of the organs of executed prisoners. In 1983, Dr. Barry Jacobs requested that the U.S. government create a fund to compensate the families who donate the organs of deceased relatives, or ‘cadaveric donors’. Dr. Jacobs also proposed to set up a business that would buy kidneys from living donors for transplantation in American patients. The proposal raised popular opposition. The National Organ Transplantation Act in 1984 still prohibits the sale of human organs from either dead or living donors.[1]


Contents

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State budgets: Is private sale a better approach than expensive state provision?

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Yes

  • An organ market will reduce state costs. The expense of palliative care for an individual requiring a transplant operation will be eliminated.
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No

  • The state is able to afford costs of providing state-funded organs to those in need.[2]


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Individual responsibility: Is the individual, not the state, responsible for purchasing an organ?

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Yes

Individuals should be responsible for their own lives with their own money. We already accept the ethic of private healthcare. It is not unreasonable that the seriously ill be entitled to spend their own money on saving their own lives. This point is all aided by the fact that there is a spurious equality in everybody dying.[3]


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No

  • The state should provide for its ill. The notion of universal health care is premised on the notion that the state has a responsibility to provide for the health of its citizens. The state's role in funding organ transplantations should be no different.[4]


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Equality: Will a organ marketplace uphold principles of equality?

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Yes

  • The wealthy will not be the sole beneficiaries of a policy of organ purchase.[5]


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No

  • The expensive price of organs is likely to make the sale of them highly discriminatory. It is believed that a single kidney has a black market price of $20,000. Consequently, the sale of organs will condone the most gross discrimination between rich and poor. The opportunity for those unable to afford to purchase to receive a donated organ will be eliminated. Which family, if prepared to donate the organs of a relative, would decide to decline an ex gratia payment of tens of thousands of pounds? There will not be a two-tier market consisting of sale and donation. The donations will disappear and only the rich will survive.[6]


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Responsible marketplace: Can the marketplace be regulated properly?

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Yes

  • Individuals and families should be trusted to act rationally in the sale of organs. The donor of an organ, or his family, will stand to benefit considerably from the sale. Yet, even the most impoverished individual will not choose to donate their heart or lung and thus die. Neither would a surgeon be prepared to conduct such an operation. Yet, both a kidney and a piece of liver can be removed without significant detriment. It is patronising to consider that the individual cannot make a reasoned decision to donate or sell these organs. The family of a relative recently deceased ought also to be able to choose to save the life of another and simultaneously receive some remuneration.[7]
  • The legalization of an organ marketplace would close organ trading black markets, and open the door for broader oversight. Legalisation of the sale of organs will eliminate the corruption that has led to reported executions and ‘thefts’ of organs. A successful transplant operation is dependent upon knowledge of certain characteristics of the donor. Therefore the origin of the organ must be known. The black market cannot be regulated, but its purpose would be defeated once the sale of organs became lawful.[8]


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No

  • The significant opportunity for profit will lead to market failures and results such as organ-trafficking. It is already apparent that the black market flows in one direction; from the Third World to the First. The relative absence of regulation, and the comparative value of the rewards means that healthy individuals in Asia and Africa are victim to scavenging organ merchants. The financial rewards make the decision to sell an organ one of compulsion rather than consent. Where colonialists raped the land, the neo-colonialist surgeon steals from bodies.[9]
  • The opportunity for individuals and governments to gain considerable capital for organs sold will lead to human rights violations. Chinese judicial officials are reported to execute prisoners on account of the black market value of their body parts. The lawful sale of organs would legitimise human sacrifice.[10]


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Other solutions: Is an organ marketplace better than the alternatives?

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Yes

  • In an organ marketplace, the greater availability of organs will reduce the pressure on doctors to unethically remove organs from the deceased without consent. "Presumed consent" is a situation in which a doctor presumes that a dead person would give consent to the removal of some of their organs for transplantation in another human. Some people call "presumed consent" a euphemism for robbery. In the wake of the public outrage in early 2001 following the practice at Alder Hay Hospital of removing organs from deceased children without the consent of the parents, it is evident that a system of presumed consent would be unacceptable. The victims of the system would be a family already grieving for the loss of the relative. Yet, any improvements to the efficiency of the donor and transplant arrangement cannot compensate for the simple absence of organs. The sale of organs would help by increasing the number available at home and allow surgeons to search for the parts overseas.[11]


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No

  • The proposed system of ‘presumed consent’ is sound and ethical. This scheme would allow doctors to assume that the organs of a deceased patient can be used for transplant unless the patient or his family have made a contrary request.[12]
  • The BMA has advocated radical revision of the inefficient system by which patients are matched to donors. The U.S. Department of Health and Human Services (HHS) has proposed the development of a website that would link patients, surgeons and donors nationwide.[13]
  • Multi-organ retrieval teams. The BMA also envisages the deployment of ‘multi-organ retrieval teams’ led by hospital consultants, in order to ensure that any available organs are not lost from cadaveric donors.[14]


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Law: Is an organ marketplace consistent with the law?

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Yes

  • A legitimate market in human organs would not be inconsistent with either public or private healthcare services. The transplant surgeon, the nursing staff and even the pharmaceutical companies producing the anti-reaction drugs receive payment for each operation performed. Why should the donor of the organs, arguably the most important actor in any transplant, not also receive remuneration ? The United States already tolerates markets for blood, semen, human eggs, and surrogate wombs. Is there a moral difference between a heart or a lung and an ovum ? It is remarkable that a lifesaving treatment should apparently have no financial value.[15]


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No

  • The market in body parts in the United States is neither successful nor legally welcome. The sale of embryos, eggs and sperm in the United Kingdom is prohibited by the Human Fertilisation and Embryology Act 1990. Surrogacy arrangements are not permitted. Blood is collected by voluntary donation. The US regularly suffers the donation of infected blood, given by diseased citizens compelled by the available reward. The paternity and maternity litigation concerning egg and sperm donors, and surrogate mothers is pervasive and persistent. Putting a price on the human body only invites exploitation by the unscrupulous.[16]'


See also

External links and resources

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