Organ transplant is a medical procedure where an organ is removed from one body and then placed in another. It’s the only form of treatment for many terminal organ failures such as liver, kidney and heart failure. A conservative estimate from the World Health Organization states that more than 60,000 transplantation’s’ take place every year. Recipients obtain the organs from three major sources, namely living donors, diseased donors and from the market. According to NHS, more than 450 patients waiting for a transplant die per year during the wait because families of the diseased are unsure of their wishes. The issue of consent of potential donors has always been a challenge to organ transplant due to various personal reasons, superstitious beliefs and cultural background. In this article, I will discuss whether legalizing the organ market results in the optimization of the donor and recipients’ welfare, as well as the moral issues behind it.
The libertarian principle of self-ownership is the most prominent account for permitting the buying and selling of organs. Prohibiting the organ market restricts people and corrodes their rights. If one owns their own body, they should be free to sell organs under their own discretion. In his book, ‘Anarchy, State, and Utopia,’ Nozick wrote that “The central core of the notion of a property rights in X… is the right to determine what shall be done with X, the right to choose which of the contained set of options concerning X shall be realized or attempted.” A supporter of the aforementioned notion is the Iranian government. Iran is the only state where organ trading is legal, and chose to legalize the market in 1988. Three decades have passed since the legalization and Iran has become one of the very few countries without an organ shortage. While critics claimed that most who sold their organs were coerced into the deal due to poverty, Iranian authorities said their system provided a safer alternative for the poor to earn money when saving lives.
In my previous report ‘Stop Stigmatizing Sexual Workers,’ I held that humans are autonomous beings, therefore, should have complete control of their possessions. However, I will now elucidate why the liberalist account is not pragmatic in the context of organ transplantation. Let us consider the following two cases:
C1: A was a poor miner who wished to send his critically ill son to the hospital. In order to obtain the money, he was willing to sell his kidney to B. He then sold his first kidney and lived healthily for another ten years.
C2: Ten years had passed and his second son fell critically ill, he was willing to sell his second kidney even though it meant he would die from the operation. C was an affluent businessman who had a peculiar interest in collecting human organs. He bought organs from different people and kept it solely for aesthetic pleasure. A, knowing of C’s interest approached B and offered to sell his last kidney. He did and passed away shortly after the harvest of his second kidney.
Intuitively, it seems that legalizing the market do create mutual benefits to both the donor and recipients. However, often overlooked, is the underlying moral issues behind the trade. C2 demonstrated two major concerns here. The first issue is whether organ transaction should be permissible even if it means the donor will lose his/her life. If not, how shall one draw the line between the permissible and the non permissible? Secondly, it comes the morality of the purpose of the trade. C was not suffering from any condition; his purchase was solely to satisfy his personal fetishism. Yet, B and C seem morally culpable because both of them paid and obtained the product from a free market. It does not matter how the product is produced. There are various issues involved which requires sophisticated consideration and are unlikely to be resolved.
Given the person was under debt and broke, the allegedly free choice was not autonomous at all. Also, poor sellers with limited access to medical care are more likely to develop complications. They bear much greater risks in the transaction and are prone to exploitation. “The donors are not better off in the end. When they are hopeless, giving that person a lump of money while lowering their self-esteem at the same time doesn’t help them. It is an act of desperation, not an act of love.”, said Gabriel Danovitch, director of the kidney transplant program at UCLA. Humans, as social entities, inevitably form bonds with people around them. Driven by his strong paternalistic instinct, A was left with no choice but to sacrifice himself for the well-being of his children. “Therefore, the liberalist account is not practical in reality because it is impossible for one to rise above and disregard all social and moral responsibilities that one shoulders.
In conclusion, there is no doubt that a legal organ market would alleviate the shortage of organs, but it’s difficult to regulate it. To tackle the shortage, governments can carry out more extensive education programs to educate the public regarding the benefits of organ transplant. In 2007, a Spanish research concluded that 50 percent of the respondents considered it a useful idea to provide a training course about organ donation and transplantation, so that trained personnel can respond to their inquiries and clear out misunderstanding regarding the procedure. Once the public is more open towards the idea, the state can slowly introduce opt-out programs where people are automatically on the donor list unless they opt out. Again, like many other controversial social issues, organ transplant involves many moral issues which are hard to reach common consent. The most important yet is the challenging question of how to strike a balance between individual rights and the benefits of a transplant so as to reach the optimum outcome.