Response Paper 2
In the world of modern medicine, there is no question that organ transplants are capable of saving countless lives. However, a problem exists because there are not enough organs available to meet the existing need. The buying and selling of human organs is illegal around the world, and this has resulted in the creation of a black market in order to meet the demand. Basically, this black market consists of rich patients from developed countries using “brokers” to arrange for the purchase of organs from poor people in underdeveloped countries. Although a great deal of the black market activity has centered on the buying and selling of kidneys, there has also been extensive trading in other organs as well as in human tissues. This paper will argue that the best solution to the problem is to create a system for the legalized, regulated marketing of human organs. Such a system would help somewhat in alleviating the current organ shortage, while at the same time reducing the opportunities for corruption and exploitation that are found in black market practices.
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At the present time, the demand for kidneys and other organs far exceeds the available supply. In Western Europe, for example, approximately 40,000 patients are on waiting lists for kidney transplants; however, it is expected that only about 1 in 4 of these patients will be able to receive the organs that they need (Erin and Harris 137). Because of the current situation, it is evident that many patients will die before receiving a transplant. In 2001, it was claimed that “an average of 15 patients die every day in the US whilst awaiting an appropriate organ” (Weekes n. p.). Medical experts have also pointed out that organs from living donors are much better than those provided by cadavers (i.e., recently deceased persons). Because the blood flow is disrupted as a result of death, “cadaver organs are always, to some extent, damaged” (Munson 115).
In spite of the urgent need, most of the world's nations have laws that prohibit the buying and selling of human organs. In the United States, for example, the 1984 National Organ Transplantation Act prohibits the sale of human organs by both live donors and by the families of the recently deceased (Weekes n. p.). Many developing nations have likewise banned the commercial trading of human organs. However, this practice “has come at the risk of driving the trade underground” (Nullis-Kapp 715). Although the buying and selling of organs is illegal in most places, the demand for such organs has continued. In addition, many impoverished persons have shown that they are willing to sell a kidney or other non-vital organ for the sake of increasing their income.
As a result of this situation, a global black market in human organs has developed. The problem of “transplant tourism” has emerged, in which wealthy patients travel to other countries that are lax in enforcing their laws in order to receive transplants using organs from desperately poor people (Scheper-Hughes 1645). For example, members of an international syndicate were arrested in South Africa in 2004 (McLaughlin, et al. 1). This syndicate had been bringing poor Brazilians to South Africa in order to buy their kidneys and then sell them to well-to-do Israeli patients. Many other illegal organ-trading rings are known to exist.
Organ Watch, a project founded by Nancy Scheper-Hughes and Lawrence Cohen in 1999, monitors the illegal organ trade in order to uncover the human rights violations that result from it. This is accomplished by tracing the “routes” through which the sellers and buyers of human organs make their transactions. As reported by Scheper-Hughes, “in general, the circulation of kidneys follows established routes of capital from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones, and from female to male or from poor, low status men to more affluent men” (1645). In other words, the black market for human organs is contributing to the exploitation of the poor. Clare Nullis-Kapp, writing in the Bulletin of the World Health Organization, has claimed that the illegal trade is based on the coercion of vulnerable Third World donors who are “frequently impoverished and ill-educated” (715). Organ Watch and other organizations have reported that more than 80 percent of the poor people who have donated organs in the international black market have experienced serious health problems as a result (McLaughlin, et al. 1). Furthermore, there is clear evidence that poor donors are greatly underpaid in comparison to the market value for their organs. There have also been allegations of unscrupulous doctors or authority figures abusing the system for their own profit. As an example, in 2001, “two Chinese government officials were charged with the sale of organs of executed prisoners” (Weekes n. p.).
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A proposed solution to this problem is to create a legal and tightly regulated system for the buying and selling of human organs. The advocates of this approach note that it would be a step toward meeting the demand that currently exists for organs from living donors. According to Ronald Munson, an expert in medical ethics, “the kidney shortage could be ameliorated, if not solved, by allowing people needing a transplant to pay a healthy and willing donor to supply a kidney” (116). In the Journal of Medical Ethics, Charles A. Erin and John Harris note that a legal market would help to increase the supply of other needed organs (and tissues) as well. According to these authors, “to meet legitimate ethical and regulatory concerns, any commercial scheme must have built into it safeguards against wrongful exploitation and show concern for the vulnerable, as well as taking into account considerations of justice and equity” (137). Erin and Harris further argue that the system should consist of a single purchaser (presumably a government-based agency) and that there should be clearly defined penalties in order to help prevent abuse.
There are various arguments in favor of having a legal, regulated system for the human organ trade. First of all, increasing the supply of available organs would help to save numerous lives. In addition, “legalisation of the sale of organs will eliminate the corruption that has led to reported executions and ‘thefts' of organs” (Weekes n. p.). If the sale of organs were legal, there would be no need for a criminal market to exist in that area. In turn, a legalized system would result in the donors being more fairly compensated for their organs. In the black market, doctors and brokers make hundreds of thousands of dollars in profits as a result of their efforts (McLaughlin, et al. 1). By contrast, the impoverished donors are offered only a tiny amount of money for their organs; sometimes this is as little as a few hundred dollars. In the current legal system, which depends on the voluntary donation of organs, the donors are not given any kind of financial compensation at all. However, the doctors, nurses, and transplant coordinators are all paid for the roles they play in the process. This raises the question: “Why should the donor of the organs, arguably the most important actor in any transplant, not also receive remuneration?” (Weekes n. p.).
One of the arguments against having a legal market for human organs is that it will do nothing to prevent poor people from being exploited by the processes of “financial coercion” (Munson 116). Scheper-Hughes, for example, has claimed that the poor, because of their desperation, are not in a position to make free and rational choices in such matters and that the legalization of organ selling merely creates “the semblance of ethical choice in an intrinsically unethical context” (1645). In fact, some opponents have argued that legalization would result in increased “discrimination between rich and poor” because “the opportunity for those unable to afford to purchase to receive a donated organ will be eliminated” (Weekes n. p.). In fact, however, poor patients as well as rich patients would benefit from a legalized system of organ purchase because “for each successful kidney transplant operation, valuable hours on a dialysis machine will be left vacant” (Weekes n. p.). Furthermore, it has been noted that it is “patronizing” to assume that individual donors (or the families of recently deceased persons) are incapable of making a reasoned decision about whether or not to sell their organs (Weekes n. p.).
Some opponents of legalized organ selling have claimed that such a system would take away the “psychological benefits that reward a voluntary donor” (Munson 112). According to this viewpoint, being a living donor should be based solely on having a sense of altruism, and not on having a desire for financial compensation. In actuality, however, “sellers of organs would know they had saved a life and would be reasonably compensated for their risk, time, and altruism, which would be undiminished by sale” (Erin and Harris 137). After all, as Erin and Harris point out, “we do not... regard medicine as any the less a caring position because doctors are paid” (137). Some have argued against the legalization of organ selling on the basis of the health risks that are involved. However, it is the illegality that increases such risks and, in a well-equipped hospital setting, “both a kidney and a piece of liver can be removed without a significant detriment” (Weekes n. p.).
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Yet another argument against a legalized organ trade can be seen in the claim of Scheper-Hughes that the legalization perspective is based on purely economic and rational claims as opposed to claims of “social justice.” According to Scheper-Hughes, the idea of an organ market creates “a medical, social, and moral tragedy of immense and not yet fully recognised proportions” (1645). Still others have expressed a sense of “revulsion” at the idea of buying and selling human organs (McLaughlin, et al. 1). Such moralistic arguments make use of emotional language (“tragedy,” “revulsion,” etc.). However, when the situation is viewed objectively, it can be seen that having a legalized, regulated system would be safer as well as making economic sense. As for the ethical issue, the black market shows that people are going to buy and sell organs anyway, despite the illegality of the practice. Obviously, it would be much better for the practice to be regulated, the donors fairly compensated, and the corrupt nature of the black market removed.
As argued in this paper, a serious problem is found in the fact that the demand for human organs is much higher than the existing supply. This has given rise to a black market in which poor people are lured into giving up their bodily organs at a price that is far less than the organs' actual “market value.” The best solution to this problem is to develop a legalized system for buying and selling organs, with various protections built into it. Although this would probably not result in the demand for organs being fully met, it would certainly be a step in the right direction. In addition, a legalized system would undermine the black market and help to prevent the types of abuses that can occur in an illegal trade situation. There is no good reason to not fairly compensate organ donors, especially in view of the fact that large sums of money are involved in the organ transplantation business. Some people have argued that poor people would be unjustly “coerced” by the financial incentives of selling off their organs. However, this is a decision that they alone should make; furthermore, the loss of a single kidney or other non-vital organ is not particularly risky if it is done by a competent surgeon in a legal setting.
Erin, Charles A., and John Harris. “An Ethical Market in Human Organs.” Journal of Medical Ethics 29(3), June 2003, 137-138.
McLaughlin, Abraham, Ilene R. Prusher, and Andrew Downie. “What is a Kidney Worth?” Christian Science Monitor, June 9, 2004, 1+.
Munson, Ronald. Raising the Dead: Organ Transplants, Ethics, and Society. Oxford: Oxford University Press, 2002.
Nullis-Kapp, Clare. “Organ Trafficking and Transplantation Pose New Challenges.” Bulletin of the World Health Organization 83(9), September 2004, 715.
Scheper-Hughes, Nancy. “Keeping an Eye on the Global Traffic in Human Organs.” The Lancet 361, May 10, 2003, 1645-1648.
Weekes, Rob. “Should We Legalise the Sale of Human Organs?” Debatabase - International Debate Education Association, October 4, 2001. Available: <http://www.debatabase.org/details.asp?topicID=141>