Wednesday, March 30, 2011

Organs for Sale!?

I have been thinking about the fact that the field of American bioethics was established upon the principles emerging from the Belmont Report partially in response to the Tuskegee Syphilis Study. A study predicated upon overriding patient or subject autonomy.

When it comes to organ donation in the United States, truth is stranger than fiction. Almost 8000 individuals are on an organ donation waiting list in New York City alone. Although a few hundred fortunate individuals will receive organs in the span of a year, hundreds more will die waiting. Of late, economists have been exploring the idea of “adjusting the supply-and-demand problem through market incentives. Instead of asking people to donate their organs, why not just pay for them?” This practice would put a new face on neo-liberalism. In brief, I'm worried that this practice would leave us in ethical quicksand.

Emotional reasons, practical motives, and comparable situations inform the current discourse on moving towards paid organ donations and the need for caution.

First, critics of the current system argue that altruism as a motive hasn’t worked in alleviating the problem. On an average day in the United States, at least 110,371 people are waiting for an organ, and each day approximately 18 of those waiting will die before receiving a donation. Second, while the federal courts make it illegal to sell organs for many reasons, we don’t prohibit individuals from selling blood, plasma, semen, and eggs. Indeed, newspaper ads solicit Ivy League women to sell their eggs for $5,000-$100,000.

Third, in countries like India, organ sales are the norm, and kidneys are a hot commodity. These statements about the existing state of affairs seem to provide reasons for moving beyond what Leon Kass calls the “Wisdom of Repugnance” or the “Yuck Factor.” Yet let us look at these motives again and ask ourselves, as others have in the past, if “saving lives is [really] more important than abstract moral concerns.”

In a brave new world where the market ruled and individuals were allowed to sell their organs, our present ethical and practical dilemma would only worsen. To begin with, if altruism hasn’t motivated individuals to part with their organs, then should we appeal to baser human motives? I think not. In fact, one can imagine that paying for organs would increase the existing racial disparities seen among organ recipients of different races. According to a 2008 article in The Journal of the American Society of Nephrology, “black patients with end stage renal disease comprise more than a third of the kidney transplant waiting list but are 2.7 times less likely to receive a kidney transplant than their white counterparts.”

Purchasing organs sets up further barriers to egalitarian organ donation, “group[ing] life-giving organs with other most basic goods that should not be available to the rich when the poor can't afford them.” In addition, the possibility of exploitation and corruption arises from the commodification of the body, notably “exploitation of the poor and the unemployed, and the dangers of abuse—not excluding theft and even murder to obtain valuable commodities.” Research also reveals that in countries where organ transactions are condoned in order to help the poor get out of debt, the donors usually end up right back in their previous financial circumstances.

Clearly, one can find as many arguments against paid organ donation as for it. However, the temptation to err on the side of profit is too great to allow in the medical arena, where physicians should prioritize the care of the patient. While medicine is a lucrative field, organ sales would have a negative impact on vulnerable populations and sick patients.

We can imagine websites and personal ads soliciting healthy donors, and the poor seeking relief by selling their organs. Moreover, organ donation for profit would lead to new questions about end-of-life care that few of us are ready to address. Considering the difficulties that our government has encountered in regulating other industries, changing the law to allow the market to reign in organ donation programs will leave us slowly sinking in ethical quicksand.