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Ethical Implications of an Organ Market

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Ethical Implications of an Organ Market Hammad Akbar HSS 404 – Biotechnology and the Law Introduction Medical technology involved in the transplanting of organs has improved drastically over the last one hundred years. The effectiveness and success rate in organ transplant procedures has continued to improve. What was believed to be impossible to accomplish is now highly possible with minimal complications. Many people are in need of organs every year but will be put on wait lists that can take up to 5 years to receive an organ. According to a national database made available by the Organ Procurement and Transplantation Network (OPTN), it is stated that in 2018, there were 124,732 people on the wait list for an organ in the United States alone. Only 17,555 donors were available to meet the demands of this huge wait list (OPTN 2018). This “small” concern is becoming a huge issue that needs to be solved. The United States of America should inherit the Iranian model of a market system that allows the sale of non-vital organs, so that organs can be bought and sold by all American citizens. Using this method, the amount of people on the transplant lists and the amount of deaths that result from waiting on these lists will be reduced drastically. The continued success of organ transplants allows it to be an option available for anyone in need. The problem with organ transplants however is that the demand far outstrips the supply. There are simply not enough organs to meet the needs of all those who need them. Due to this shortage people will travel to various parts of the world to obtain organs, a phenomenon called ‘transplant tourism’. In 2008, the World Health Organization estimated that out of the 660,000 people in the world that required any type of transplant, only 10 percent of patients received one every year. Of those ten percent, ten percent of them received their organs through ‘transplant tourism’ (Major 2008, 1). These organs however are sold on the black market and are obtained illegally. There is a great danger in gaining an organ this way. These illegal operations are performed by unqualified professionals and will result in a poor transplant which can cause further complications. If complications do occur, the recipient will then have to undergo further surgery when he or she returns home (Delmonico 2009, 1). In order to prevent problems like this from occurring, the United States must abandon the current system in place for organ transplants. When an organ fails, a transplant is the only option to live an enjoyable life and not be wired to machines. The most common transplants that occur are kidney transplants, as most people are capable of living with only one kidney and liver transplants since the liver has the capability of regenerating itself. In the United States, for transplants such as a kidney, liver, pancreas and intestinal, a living donor must be found and if none can be found then that person is put on the national transplant waiting list. In the case a donor is found, doctors will check for compatibility. They will examine the size of organs, body of both donor and recipients, condition of organs and also the blood type of the donor and the recipient (Erin 2003, 1). Both parties must be a match in all categories in order to minimize the risk of rejection. Due to the need of similar blood type between the two people involved, family members often donate a kidney or part of their liver to the patient in need. If the patient is in need of a heart, double lung, pancreas or cornea transplant then a cadaverous donor must be found. An acceptable cadaverous donor in these cases are those who are brain dead. This means that the brain is unable to function but their body and all other organs will continue to function with the help of life support (Miranda 1999, 1). Since organs deteriorate very quickly after death, the organs of a deceased person would be unusable. However, since there are very few generous living donors, the transplant waitlist is ever- growing. This is a fault in how America conducts transplants. Since the supply is unable to meet the demand, an increase in supply is necessary. One way to increase the supply would be to allow a free market in which people are able to directly sell their organs to those in need. Using this financial incentive many will feel far more generous with their organs. A Market to Sell Organs in Iran A market to sell organs has already been implemented and has been successful. This legal and government regulated market to sell kidneys was established in 1988 in Iran. Iranian citizens were able to have access to renal transplants with great success. The number of transplants completed had increased so drastically that in 1999 the waitlist for renal transplants was completely eliminated (Ghods 2006, 1137). The market originally functioned where donors would go to offices run by volunteers. The prospective donor would receive medical testing conducted by the Dialysis and Transplant Patients Association and then get matched with a potential recipient who has the same blood type. Further testing is still required but if successful, the kidney donation will proceed. The government assumed the costs if recipients were unable to pay and surgeries were performed in established hospitals or universities (Yanklowitz 2015). The market today is a free market with little government regulation and funding so that transactions can be done with minimal complications. With this market those who donate will also receive one full year of free healthcare paid by the government (Khosroshahi 2012, 3). Male donors are also granted exemptions from military service (Yanklowitz, 2015). Foreigners are banned from paying for transplants to avoid exploitation. Using this financial incentive many will feel far more inclined to sell their organs. There are however several flaws with this system. A lack of funding by the state has inhibited the transplant program. High inflation has caused government payouts to be drastically reduced and in some poor rural areas, due to depleted funds, donors lack proper follow-up care. In a country that has a larger amount of available funds were to implement this system, these flaws would be reduced. In the United States of America, the sale of organs is illegal. Donors must be voluntary and recipients are forced to wait on a waitlist in order to receive their desired organ when it becomes available. If America were to follow Iran’s model, the number of people on waitlists will reduce drastically. A proposed plan for allowing the sale of organs must first include a bill to allow the legalization of sale. After legalizing it, hospitals will perform the operation and reimburse the donor, and in turn be reimbursed through Medicare or private insurance (Yanklowitz 2015). The organ donated will then be supplied to hospitals which will deal with the transaction for the recipient. There will be set prices for each organ which will not change in order to prevent exploiting the recipient of the organ. The organs that can be sold will include one kidney, portions of the liver and intestines and even one lung. In adopting such a system, the problem of waiting lists can be reduced. Moral and Ethical Implications This discussion of a legal market in which organs can be bought and sold revolves around the morality and ethicality of implementing such a system. The ethical arguments regarding organ sales is centered around the issue of justice (Coro 2016). Arguments are linked to the long standing social paradigm in which ‘the rich get richer and the poor get poorer’ (Shelley 1965, 33). The implementation of a free market in which organs can be bought and sold would cause the poor to be exploited and the rich to benefit. Those encouraged to donate due to a compensation fee would be those who are in need of money. Allowing the sale of organs would be placing an “organ tax” on impoverished and desperate people. In the legal market established in Iran, 70 percent of kidney donors are economically disadvantaged (Hippen 2008, 7). Poor people would essentially be paid to take a permanent and increased health risk in order to reduce the health risk of another person. The group of people who would be most at risk to being exploited by potential purchasers are those who are economically disadvantaged, illiterate, bonded laborers and criminals sentenced for execution. These people are seen in a lower standing to the rest of society and therefore will be the target audience to create an organ supply. Another system to incorporate the sale of organs is a single payer market. In this market, there would be a single purchaser of the organs, some type of agency, and this agency would buy and distribute organs as needed (Erin 2003, 1). There is however an ethical issue with this type of system. Having a single entity distribute organs to the whole populace would cause an uneven distribution of organs across multiple class lines (Coro 2016). There are also issues in which compensation for donors would be uneven as well. This type of market system does not mitigate the disparity between the poor and rich but in fact enhances it as it gives a single agency the power to give organs to who they please and allows them to control the amount of compensation given. It is important to analyze the ethical and moral issues regarding an organ market. Proper ethical and moral behavior is important because it helps to make society better (McCartney 2015).
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