As the demand for organs increases, waiting lists for transplantations grow ever longer, to a degree in which over 1000 people in the UK die every year waiting for a transplant. Overall, the median waiting time of those who wait for a kidney is 1088 days (just under three years). A proposed solution to this is to allow the free trade of organs, in order to encourage those to sell their organs by incentivising donation, thus potentially satisfying demand.
First and foremost, the consequences of the proposal have to be considered, in which an evaluation of the motion must be undertaken to prove whether the motion provides more good than it does harm, or solves the problems under the status quo. Secondly, the ethics of the motion being passed must be considered, i.e. whether it is necessarily ‘right’ to legalise the sale of someone’s bodily organs. And finally, does the motion fit the principles and criteria that a law’s passage provides, with those two fundamental principles being protection of the people and provision of freedom.
Answering the question “Should people be able to sell their bodily organs” requires an analysis of whether it is moral to allow for people to sell their own organs. Looking at this from a moral perspective within a Western liberal democracy, the moral convention is that people have bodily integrity. More specifically, a Western liberal democracy (which already allows people to have full bodily autonomy) provides the legal basis upon which people can give blood transfusions, donate organs or modify their body through plastic surgery. The element of bodily autonomy is incorporated in the legalisation of abortion in the UK. In allowing an abortion, one of the fundamental justifications for the passing of the 1967 Abortion Act was the fact people should have full control over the decisions they make with their own body.
When drawing a comparison to allowing someone to sell their own organs, there is no dispute over allowing people to have control over their organs; it is of course legal for people to donate their organs should they wish. However, if people have the control to give up their organs, is it not only fair to allow them to place a value over them, over which they have total control. People are given the freedom to place a value over their organ to a point at which they are happy to donate it, however, is it not only rational to give them the freedom to place a monetary value over their organ to the point at which they feel a trade is necessary?
Fundamental to the concept of bodily integrity, is the idea of self-ownership and individual sovereignty. This idea can be applied to the action of the trade by the vendor and buyer. The vendor has control over the decisions they make with the organ, and should be granted the freedom to give it away under certain conditions, in this case being a trade. The extent of governmental control should not continue to stand at a point in which the state restricts autonomy of the individual in the decision making of their physical form. The reason being that it is purely unethical for the state to exercise a tyrannical dominance over a person’s choice to make decisions over what to do with their body when it advocates a society of free will.
With a transplant like an organ, it is seen as a daunting process to undergo the operation. Many throughout the world have two kidneys and the majority of people can function with only a single kidney, which grows larger to compensate for the lack of two – yet if we can function with a single kidney and there are more than enough donors available to satisfy the demand, why do we not donate our kidneys? Of course everyone likes insurance in case later life serves us a horrific fate of kidney failure, therefore many may need an incentive to give up this ‘backup kidney.’ People feel uneasy giving something acting as a safeguard to their health for free and to someone whom they do not know. Therefore, a monetary incentive would encourage donation as people feel they have been reimbursed for an appropriate value. Operating in the terms of Pareto efficiency, the vendor is satisfied with the value and subsequent sale of their organ, and the demand for organs is met. Nevertheless, the externalities of a Pareto efficiency economy pose problems for those not involved in trade of the organ for a price.
The criticism of the ‘Pareto efficiency’ economy created by a free market is the high probability of an elitist market being created, in which those at the bottom of society cannot access organ transplantation. When considering the moral consequences of legalising the ability to sell organs, there is a fundamental flaw in a system formed. No matter what kind of mechanism is devised, whether the organ trade process is executed through a state run system or privately run system, a market of organs is created in which a certain group cannot access them. Currently, the system of organ trade in Iran allows for someone to sell their organ in return for a government payment of £531 ($1000) and payment from the recipient of the kidney of £1062 ($2000). The complication created by this system’s implementation is those who cannot afford to pay a total of £1593 ($3000) cannot access a kidney transplant. This has created an elitist market, in which the poor cannot have any access whatsoever to a kidney transplant. While this removes the waiting time for a transplant for some, it removes the opportunity of a transplant for others, as they can never garner the funding for their own transplant. The immorality of this system is that it builds its foundations among a Bentham-esque utilitarian principle of which the availability of organs is increased and transplants therefore increase; therefore the system is judged to be a good system as it provides more organs and saves more lives. When evaluating this judgment, the greatest good for the greatest number can be deemed immoral as the “greatest number” are those who have enough disposable income to spend on an organ, whereas the minority are granted no opportunity to even wait for a transplant, let alone get one.
However, in a free market economic world, there is always going to be something that the poor cannot afford, it doesn’t mean it should not be available for legal trading – even if an elite market is created. Private healthcare systems can leave the poorest with no accessibility to basic health treatments outside of an Emergency Room, however that does not create criteria for the entire principle to be deemed illegal. When declaring something as illegal, it is deemed as immoral or harmful to others. When measuring up these criteria to evaluate if organ trade should be illegal, it doesn’t necessarily fit them. The freedom of trade in a modern market is legal so long as a product is fit for sale and purchase, and the product is not a breach of patent law or stolen from another company or vendor (i.e. pirated films). When using the example of a kidney, an NHS health check can evaluate whether the ‘ware’ or ‘good’ is of a quality legal for sale, and the latter two criteria cannot apply to such a ware. Therefore, the trade of an organ can be regulated to create a safe free market.
However, there are further benefits to the creation of a regulated organ market, the first of these being how a regulated lawful free market can eliminate the problems created from an organ black market. As of 2012, between 15,000-20,000 illegal organ transplants were being carried out per year, whether carried out by bribed doctors or foreign crime syndicates, the operations result in long term negative health outcomes for the buyer and vendor. Due to poor conditions in which a transplant is carried out, those receiving the organ can contract hepatitis B, hepatitis C, or even an HIV infection. Generally without any medical regulation or legal body for an organ buyer to report their maltreatment to, doctors carrying out black-market transplants are able to rush operations or skip health and safety regulations, causing infections as seen above. Black market organ transplants are often carried out too hastily in which the body can reject the transplant due to the body tissue differing from the tissue of the organ. A market regulated by a government health service like the Iranian model, in which a doctor is under pressure from an organised body to adhere to the correct health and safety regulations. Overall it can eliminate the black market sale of organs, ending the exploitative action of organised crime groups and allowing those who sell to be in a healthy state post-transplant and those who buy to be with an organ sustaining their body for the foreseeable future.
To conclude, an evaluation of the motions fitting of the criteria must be undertaken. Fundamentally to evaluate whether a law should be passed is the key elements of a law’s purpose. Essential to the passing of a law is the question ‘does it protect the people?’ The legalisation of organ trade in a proposed free market between a vendor and buyer and Pareto efficient economy can be seen to adhere to this principle of law. The legalisation will provide a resounding agreement to this principle of law, when looking at the subsequently satisfied demand of transplants in which less are sitting around on a waiting list at a higher risk of death then undoubtedly the principle of protection through law obeys the action of legalisation. As an organ black market is rife with exploitation in the most desperate in society undergo risky operations resulting in infection of hepatitis or HIV. The legalisation of trade protects the people from these risks when carried out by a company or state run transplantation service, but also cuts the funding of organised crime groups who profit greatly from the illegal transplants, in which they tend to take bigger cuts than any buyer or bribed doctor carrying out the operation. Illegal transplants are some of the greatest influxes of funding for organised crime groups, one of many examples being the payment of £2500 to villagers and profiting up to £150,000 in total. Therefore the ensuing cut of organised crime income prevents other illicit activities of gangs, which are harmful to the people such as people trafficking and drug smuggling. Overall this law’s passage can be interpreted as an act, which protects the people and fundamentally meets the first criteria of a law and its purpose.
The second fundamental principle to which a law should meet is protecting the freedom of the people. When applying this to a Western liberal democracy, the legalisation of free organ trade can ultimately be seen to protect the principle of freedom amongst society. Firstly, the motion encourages a mind-set of autonomous bodily integrity, in which the people have the freedom to make the decision of controlling their body and deciding how they value it. The choice of selling one’s organ is therefore made entirely free, with no government intervention on how one should use their body, which supports the claim that this law can provide true freedom to the people. The law prevents a government from controlling the people’s actions concerning their body, something only they have true property over, and the government deserves no right to exercise control over. These two necessary principles are in correlation with the motion and provide adequate justification for the support of legalising the act of allowing people to sell their organs.
Words by Chris Paschali