The Ethics of Buying and Selling Organs for Transplantation
Today in the United States, we only allow organs to be obtained through donations. There have been arguments to make the buying and selling of organs legal to make them more available for those that need one. We will start by looking at both sides of the argument regarding the buying and selling of organs for transplantation. There will also be ethical theories integrated from the readings to define each side of the argument. I will argue that the buying and selling of organs is not permissible as it treats rational human beings, capable of autonomy and self-determination, as a commodity and as a means to another end, and therefore, should not be legalized.
There are a number of ethical related arguments on each side of the organ transplantation debate regarding the buying and selling of organs. Advocates for the buying and selling of organs name three concerns they have with the current system for obtaining organs. These concerns include: “(1) that compensating for organs is no different from many other permissible forms of body commodification; (2) that it is hypocritical to prohibit an activity that you would wish to engage in were you in a similar situation; (3) that it is unethical not to do everything possible to increase donation because so many die for the lack of an adequate supply of organs” (Joralemon & Cox, 2003, p. 283). These advocates argue that there are too many lives put at risk to not pursue this as an option. One option they suggest is creating a free market in which living donors can sell their organs to make up for the shortage of organs needed for transplantation. The risks for live donation are relatively low and living donor organ transplants have a better prognosis. Also, a living donor is more likely to be fit and healthy; unlike a cadaveric donor (Erin & Harris, 2003, p. 281). A utilitarian, such as John Stuart Mill, would agree with the buying and selling of organs because it would lead to the greatest amount of happiness for the greatest number of people. Their goal is to maximize happiness no matter how they get there, indicating that “the results of actions are the only relevant feature in assessing actions” (Steinbock, Arras & London, 2013, p. 9).
As for the free market they suggest pursuing as an option. Advocates believe that regulation is the best means of protection against the free market getting out of control. Their belief is that if there is only one buyer of organs who determines a fair way to distribute them that this option can work. Another claim, in relation to this, is that there will be no sales or purchases that are direct and also no exploiting low-income countries or people. One idea they suggest that is more likely to draw people in, is that only those that are citizens within a certain state or union will be able to sell into the system and therefore, their family members will be eligible to receive organs if needed. They also state that they would encourage the testing of organs to ensure there are no diseases such as HIV, which would then be transferred to the patient (Erin & Harris, 2003, p. 281). Other ideas suggested are having screening process and counseling to assist those that are looking into donating their organs to help them understand all the financial and health risks. Having these safeguards in place is something they deem as important for regulating this free market (Radcliffe-Richards et al., 1998, p. 278-279).
The biggest argument against the buying and selling of organs is that it will lead to people objectifying the human body. This would allow people to view each other as commodities that are for sale and that would result in the compromising of one's dignity (Joralemon & Cox, 2003, p. 283-284). Here Immanuel Kant would argue his ethical belief of deontology or Kantian ethics. He believes that humans should never be treated or used as if they are a “means” or a product and therefore, selling one’s organs would be wrong (Steinbock, Arras & London, 2013, p. 16). Kant would also argue against a utilitarian perspective, by stating that even though an action may lead to the greatest happiness and good consequences it does not make it right, therefore, “the ends do not justify the means” (Steinbock, Arras & London, 2013, p. 14).
Another argument that those against the buying and selling of organs make is that we do not have an obligation to help someone, according to the United States courts. They believe that having no obligation is what allows donating to have such a powerful moral statement when it occurs. If we would have an obligation to give our organs there would be no moral statement for the people who have their organs taken (Joralemon & Cox, 2003, p. 285). Would this go against our autonomy and self-determination as rational human beings? Alan Goldman would argue here that this would definitely go against our autonomy and self-determination as a human being. We place a lot of value onto these concepts and they are necessary to the development of us as rational human beings (Goldman, 1980, p. 68). He would also argue that this is a form of medical paternalism in which a medical professional takes away one’s right to make decisions for themselves for their own good, and this would be wrong (Goldman, 1980, p. 60).
There is claim that the deceased are “no longer intertwined with a person,” and therefore, are protected as property. But this is not in accordance with the way many families respond to the death of a relative. Social scientists have actually made a distinction between social and biological death, stating that a person’s identity actually stays with their body for a certain amount of time after physical death (Joralemon & Cox, 2003, p. 284).
I will be arguing against the case for allowing the buying and selling of organs on a free market for transplantation. Many poor or low-income people and families are more likely to be targeted for their organs because they do not have as much money. They are more likely to ignore the risks for their health because they need the money for expenses. What also goes along with this is that the only people buying these organs would be the rich because they are able to afford them. But what if a poor person needs a new kidney? If organ selling were to become legal there would need to be a system in place so that those who are truly in need are the ones who receive these organs.
An argument made, that I completely agree with, is that the buying and selling of organs leads people to objectify the human body and see it as a commodity that is for sale. This in turn will compromise one’s dignity and self-worth (Joralemon & Cox, 2003, p. 283-284). Immanuel Kant states that, “Persons have intrinsic worth and must be treated as ends in themselves and not merely as a means to some other end” (Steinbock, Arras & London, 2013, p. 14). If buying and selling organs would become legal, people would be viewed as a product or commodity that is for sale which is not right, in regard to Kant’s argument. This will in turn make human beings feel as if they do not matter and will compromise their dignity and self-worth. Kant also states that, “Rational beings possess dignity, as opposed to a use-value” (Steinbock, Arras & London, 2013, p. 14). Therefore, human beings should never sell their organs because this would be considered as being “used” as a means to another end.
Is organ transplantation everything people say it is? Many people who are unable to acquire a new organ before they die are actually very likely to have died within a few years even if they had received a new organ. For those who do receive new organs, their quality of life is likely to be overestimated and the toll of the anti-rejection medications long-term is likely to be underestimated. Along with this is that many times high tech medical procedures are not available to those with inadequate insurance status or bank accounts (Joralemon & Cox, 2003, p. 286). Many who receive an organ transplantation may be unable to afford these medications long-term and therefore, it is more likely that their replacement organ could be rejected. Although there are some that are very much in need of a new organ, I believe that these transplants should be carefully regulated to make sure that these organs properly match the recipients so they do not need to take anti-rejection medications for a long period of time.
Would it go against our autonomy and self-determination to have an obligation to give up our organs? I believe so, because we are rational human beings and should have the right to make this choice. Alan Goldman would also agree with this statement because as rational human beings we have the right to be autonomous and self-determine our lives (Goldman, 1980, p. 68). Another argument that Goldman holds is that this is a form of medical paternalism, which would be wrong, as it is taking away ones right to make decisions for themselves (Goldman, 1980, p. 60). Many people place a lot of value on the ability to make choices for themselves and also hold their own personal set of values. Goldman (1980) states that, “His dignity demands a right to make personal decisions that express those values…” (p. 68). This will also go with the argument that buying and selling organs would lead to people to objectify the human body and result in the compromising of one’s dignity and self-worth (Joralemon & Cox, 2003, p. 283). Also, when people do donate their organs it holds such a positive moral value, and that would be compromised with having an obligation to give our organs (Joralemon & Cox, 2003, p. 285). Here Kant would argue that as rational human beings we have autonomy, therefore, we have the right to choose what we pursue or do not pursue. With that being said, no rational human being should have an obligation to pursue this. This would again go back to Kant’s argument of treating a rational human being as a means and not as “ends in themselves”, which would be wrong. He also believes that if a possible action, such as buying or selling an organ, would be wrong if done in general, then that action is wrong and therefore, cannot be universalized (Steinbock, Arras & London, 2013, p. 15-16). Kant (2013) clearly states that, “if a proposed action fails either the universalization test or the respect for persons test, then it is contrary to duty and must not be done” (p. 16).
Another part of this argument is that many believe that the person’s identity stays with them for a certain amount of time after they have passed (Joralemon & Cox, 2003, p. 284). I do believe that a person should not have their organs taken if that was not in accordance with their personal or families wishes. Although this was not included in our readings I deem it as an important topic to discuss. If the buying and selling of organs were to become legal it is possible that criminal behavior such body snatching may increase. Many know that there is a black market out there already where people buy and sell organs. There is a much higher possibility that people will dabble in body snatching if there are companies that specialize in buying organs for transplantation, as they may be able to earn more money from these companies than from the black market. This would again go against one’s autonomy because they are not giving permission to have their organs extracted. Also, this would be treating someone as a commodity and, according to Kant, as a means to another end (Steinbock, Arras & London, 2013, p. 14).
This paper discussed the reasons for and against allowing the buying and selling of organs for transplantation. Through the arguments discussed on each side, certain ethical theories were integrated to define each side of the argument. As I argued against allowing the buying and selling of organs transplantation, I brought in an argument that body snatching could be a possibility if this became a legal option. I argued that the buying and selling of organs is not permissible as it treats rational human beings, capable of autonomy and self-determination, as a commodity and as a means to another end, and therefore, should not be legalized.