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The public sale of organs has been a hotly contested issue in recent times. The idea that someone can pay money to jump to the top of the organ donor list is clearly something that is controversial and worthy of discussion. Furthermore, the idea of putting a price tag on human body parts is a topic filled with dispute. Many ethical decisions and theories come to play in this scenario, whether we are all egoists, whether we believe in utilitarianism and what actually is the best for all, and more. In this paper, I will be arguing in favor of a free market for organ selling and buying. I will argue that egoism is the core feeling behind most, if not all, people and thus doing something that will clearly benefit both sides immensely (either getting a significant amount of money or receiving a lifesaving organ) is ultimately the best model and serves the utilitarian standpoint the best.

The most apparent problem with the current system of organ donors is the wait time, between 2003 and 2004 3 – 5 years was the average wait time for a kidney, the most common organ transferred between donors and recipients (US Department of Health and Human Services). An egoist would believe that all humans have their own interests in mind first and foremost and when there is a way to clearly improve their circumstances or situation they will do it, especially when it involves a potentially life saving/altering organ transfer. Psychological egoism is a descriptive form of egoism and describes what people are like, it says that people are basically self centered or selfish and do what is best for themselves. Unfortunately, there are many people living in poverty in the modern world, if they had an opportunity to sell a kidney to help themselves financially I believe they would. Fundamentally, people’s desires and will to survive/live overcomes any others and if they have an opportunity to sell their organs to make money for themselves they will, and they ought to have that choice.

Utilitarianism also takes a role in this controversial topic. Jeremy Bentham, a big initial promoter of utilitarianism, said that you should do whatever will increase your happiness the most and decrease your unhappiness the most. When that idea is applied to both sides of an organ transaction, the buyer and the seller, it makes sense to allow it. In the current system, only the receivers of an organ donation are attaining maximum utility. Furthermore, the average wait time for a kidney (the most popular organ donation) is 3 – 5 years (US Department of Health and Human Services) and many of those people are probably living extremely uncomfortably so happiness as a measure of utility is most likely not being maximized. The best way to maximize utility is to have people on both ends of the transaction receiving it. If someone selling a kidney receives 50 thousand dollars (a completely arbitrary number but commonly referenced) he or she could have just made three or four years worth of salary. That person clearly has produced a high net utility for him or herself. An important part of calculating maximum utility is to consider pain or unhappiness (pleasure – pain = utility of happiness). There are many misconceptions about the negative impacts towards the person that gives up their organ. For example, you usually only have to stay in the hospital for about a week after donating a kidney and within a month you can participate in most activities (National Kidney Foundation). This dispels the common misconception that you are completely unable to participate in athletic activities after donating or selling a kidney. Different people will face the negatives of donating an organ differently but in general its been widely accepted that it is a fairly safe and non troublesome procedure.

Evaluating the utilitarian argument of the sale of organs demands a view towards those who don’t benefit from a new system, those whose utility of happiness may go down as a result. A common argument against the sale of organs is that it punishes those who cannot afford to pay for an organ. That it would benefit someone who’s rich and wealthy and may have done serious damage to themselves (such as drinking constantly) and then buying themselves a cure compared to somebody not as well endowed who needs a new kidney or other organ for no reason they could control. I think there are several ways to combat this argument, first we must again look at the idea of utilitarianism and try and decide what will maximize happiness for as many people as possible. If the sale of organs were legal, yes, some of the less wealthy people on the list might not receive an organ as quickly as before, but it would also be helping those less fortunate by allowing them to sell their organs for money. There will never be a situation where everyone will be maximizing utility, it is a case of what is the best that can be done and what can maximize happiness for the most amount of people. Furthermore, its not as if those less wealthy will never receive the organs they need. There are several different options that could be enacted to make sure that they still get organs. The government, or private health care companies, could subsidize the cost of paying for an organ if an individual or family makes less than a certain amount of money or something along those lines. Also, I believe that there will still be a significant amount of people who are willing to sell an organ for significantly less or even nothing on a situation-to-situation basis. As said previously, there are sacrifices and costs to any decision that is made, the idea is to maximize the positive outcomes.

Another ethical theory that can be discussed is contractarianism. Thomas Hobbes view of contractarianism was that of a radical individualist who said that individuals come before society. A contractarian would argue in favor of the sale of organs because it serves to benefit individuals, either the seller or the buyer, rather than the overall public opinion or outdated rule of law of the sovereign. Kant’s Moral Theory can also be viewed as supporting the public sale of organs. The act of selling an organ is a two-fold action, both to benefit the seller (monetary benefit) and to benefit the person buying the organ. Kant would say that the intended meaning of the sale would make any unintended consequences ok.

While I believe that the public sale of organs is the ethically better decision, the current system of organ donation has its merits. The thousands of people who donate organs to complete strangers make it hard to argue that we live in a completely egoist society and that there are situations where people think of others before themselves, commonly referred to as altruism. Kant’s Moral Theory can also be adjusted to complement the current organ donation system as well as a new organ-selling scenario. It is clear that a person donating an organ has good intentions and any possible negatives or problems associated with the transfer ought not to be blamed on the donor.

The sale of organs does have negative influences and there are significant cons. A popular negative factor is the effect that selling organs would have on poorer people and how their position on the current organ donor list would be undermined because of their inability to pay to move up. We have already discussed that particular con, however some argue that selling organs dehumanizes those people who are the ones giving up their organs, especially those in troubled financial scenarios. The argument says that, “by permitting the sale of organs, society would make the parts of human beings and, by extension, people themselves, commodities” (JD Kunin Journal of Medical Ethics). This is an understandable argument but quick and easy counter arguments can be made. Primarily those that we have already made; it allows a legitimate way for those less fortunate to make money, the transfer of organs literally save lives, and the supply of available organs should theoretically increase. Altruism is another popular argument, and is discussed in length in a Stanford essay “The Sale of Human Organs” (2011). In this paper, the author mentions the argument that altruism – the principle that we act out of care for others rather than ourselves – could be diminished with the legalization of the sale of organs. I think that altruism would still exist and that people would still give and donate organs for free (or significantly lesser costs). Furthermore, I don’t believe that the only people that would sell organs would be completely for monetary reasons. They will clearly have the knowledge that they are potentially saving another human being’s life and that will be a profound and meaningful experience, whether or not their primary motives are to make money. So the lessening of altruism would not be such a negative thing if it were being replaced with feelings of satisfaction for saving someone’s life.

In conclusion, I think that there are multiple ethical arguments that can be made in favor of the legalization of selling organs. Primarily, utilitarianism comes to play because utility will be achieved on both sides of the transaction – happiness to both the person who is making money from selling an organ and the happiness of the person receiving an organ. This primary argument overcomes many of the disadvantages and problems with the sale of organs, at the most fundamental level selling organs would maximize happiness and benefit to the largest amount of people. Egoism also ensures that the selling of organs is something that the public would be attracted too. There is always a stigma against new things, but our egoist nature of doing what is best for us and nothing else will rise above all on both sides of the transaction. Lewis Burrows says in his paper Selling Organs for Transplantation, “But for the time being, while my patients are dying for want of an organ, I have accepted this libertarian, utilitarian approach. We do not live in ivory towers. In life, we have to make hard decisions and accept the consequences when all of our options have serious flaws. The current circumstances beg for a change and improvement in the availability of organs for the thousands of people who need them.” Arguments against the sale of organs such as the dehumanization and the disappearance of altruism are valid and worthy of discussion, but do not overcome the overwhelming positives that a society where you could buy and sell necessary organs would provide.

Bibliography

  • MacKinnon, Barbara. Ethics: theory and contemporary issues. 7th ed. Belmont, Calif.: Wadsworth Pub. Co., 1995. Print.
  • Friedman, EA, and AL Friedman. “Payment for donor kidneys: Pros and cons.” Kidney International 69 (2006): 960 – 962. Print. – Just a short 2-page paper listing some pros (shorter wait time, more availability) and cons (unethical, high prices, dangerous).
  • Kunin, J D. “The Search For Organs: Halachic Perspectives On Altruistic Giving And The Selling Of Organs.” Journal of Medical Ethics 31.5 (2005): 269-272. Print. – Discusses the Jewish legal position on selling organs.
  • Cohen, I. G.. “Can the Government Ban Organ Sale? Recent Court Challenges and the Future of US Law on Selling Human Organs and Other Tissue.” American Journal of Transplantation 12.8 (2012): 1983-1987. Print. – In December 2011, in Flynn v. Holder the US Court of Appeals upheld the National Organ Transplant Act of 1984 from a constitutional challenge, but interpreted the act such that its prohibition on sale did not encompass “peripheral blood stem cells” obtained through apheresis.
  • “The Sale of Human Organs” (2011) – http://plato.stanford.edu/entries/organs-sale/ – Another paper that lists the pros and cons of human organs. Spends significant time discussing altruism and how it affects the argument.
  • Wilkinson, S. and E. Garrard, 1996, “Bodily Integrity and the Sale of Human Organs”, Journal of Medical Ethics, 22: 334–339. – A position that is in favor of organ selling. Discusses the risks that people will take to get money and says that if we can figure out how to mitigate the risk of selling or receiving an organ then it’d be good to do it.
  • US Department of Health and Human Services – Organ Procurement and Transplantation Network Kidney Kaplan-Meier Median Waiting Times For Registrations Listed : 1999 – 2004 http://optn.transplant.hrsa.gov/latestData/rptStrat.asp
  • National Kidney Foundation Q&A On Living Donation – http://www.kidney.org/transplantation/livingdonors/infoQA.cfm?id=7#7a