Kidney for Sale by Owner: Human Organs, Transplantation, and the Market

Introduction

To dismiss the idea of paid donors as the ethics of expediency is to deny these patients the right to live. We serve only the corrupt and the unscrupulous if we deny the patient benefit of a transplant that is medically indicated because of our fear that the paid donation process is too complex to be regulated. —Dr. K. C. Reddy, “Unconventional Renal Transplantation in India” In the United States, more than 44,308 patients died while waiting for organ transplants from 1992 through 2001.1 An additional 6,385 patients died in 2002, and 6,509 in 2003.2 Many others endured painful, life-sustaining measures, while queuing for available organs. Despite the significant potential of commercialization to increase the efficiency and effectiveness of organ procurement and distribution, to shorten waiting time, and thereby to reduce human suffering—while expanding the number of available organs—the possibility of creating a market in human organs for transplantation provokes in many feelings of deep moral repugnance, conjuring up nightmarish images of spare parts medicine. Others simply pronounce offense, anathema, and fear at the very possibility.3 Indeed, an apparent global “consensus” holds such a market to be morally impermissible, if not fully indefensible , and actively promotes worldwide prohibition. In Kidney for Sale by Owner: Human Organs, Transplantation, and the Market, I critically reassess the arguments and assumptions that purportedly ground this alleged consensus. Various policy statements have been broadly influential in shaping the global “consensus” against such a market. The Transplantation Society,4 the World Health Organization,5 the Nuffield Council on Bioethics6 and the U.S. Task Force on Organ Transplantation7 each has issued pronouncements condemning the creation of a for-profit market in human organs. The U.S. Congress , the National Kidney Foundation, the United Network for Organ Sharing (UNOS), the American Medical Association, the American Society of Transplant Surgeons, and the World Medical Association have similarly denounced proposals to broker human organs for transplantation. Professional organizations have, at times, resolved to expel members who were involved in such dealings.8 ix Introduction Condemnation of commercial organ markets is perceived as grounded in basic moral principles, such as “human dignity,”9 “respect for persons,” and the “sacredness of human life.”10 Such possible moral costs are believed to belie any potential the market may possess for increasing access to life-sustaining transplants and the concomitant reduction in human suffering. The underlying, taken-for-granted, but usually unexamined, assumption is that certain uses of human tissue are morally impermissible because they injure human beings, treating persons and their bodies as mere things, as less than fully human. A central and apparently forceful line of reasoning is that the unscrupulous would exploit the fact of poverty to compel or intimidate the poor into selling their redundant internal organs, which, given better circumstances, the poor would not have done. Whereas such conclusions purportedly evaluate the moral, social, and political theoretical parameters, as well as the medical costs and benefits of a market, human organ selling is often simply viewed with horror as gruesome. Critically assessing such commonplace conclusions against commercialization , this study explores the underlying moral arguments and philosophical assumptions, as well as political and moral rhetoric that purportedly support this global consensus. Is such a global consensus and its promotion of worldwide legal prohibition morally justified? Sympathetic articles and editorials exploring the various types of incentives (often even including financial remuneration) that might significantly alleviate the current organ shortage, while not necessarily leading to the purported laundry list of potential horrors, have begun appearing in many of the foremost medical journals—including the Annals of Internal Medicine, the New England Journal of Medicine, Transplantation, the British Medical Journal, and The Lancet.11 Some commentators have begun suggesting that incentives to provide organs for transplantation need not lead to inappropriate treatment of body parts or to exploitation of the poor. Others have urged that insofar as one sets aside emotional reactions , most of the arguments put forward against even financial incentives do not stand up to careful scrutiny.12 Consider, for example, that the American Medical Association’s Council on Ethical and Judicial Affairs adjusted its policy against all financial incentives, arguing that it is permissible for competent adults to enter into a futures contract, in which one agrees to the harvesting of organs after death, with one’s family or estate receiving financial remuneration only once the organs are retrieved and judged medically suitable for transplant.13 In 2002, the American...