Human organs are vital for proper functioning of the body and can be the difference between life and death. They have therefore become the most valuable possession in the contemporary world. Organ transplants have saved and extended the lives of more than 1 million patients in the past decade (Veroux & Veroux, 2012). This is because of the improved medical technology, increased creativity of medical professions as well as the kindness of both living and deceased donors. However, the demand for human organs has grown dramatically to outstrip the supply and cause a massive shortage (Jha & Chugh, 2006). As a result, there has been global human trafficking for vital organs. Thousands of kidneys have been purchased from the destitute from all over the world for transplantation into the social elite in advanced countries (Ogilvie, 2009). There are concerns as to whether kidney trade should be allowed by the law. Although legalization would reduce human organ trafficking, it challenges core ethical principles and tarnishes the reputation of organ transplantation. It also harms the existing, voluntary donation programs leading to an ineffective supply of organs. This paper analyzes the cause and effects of legalizing the sale of kidneys.
The major taboo issue addressed by the transplantation community is the legalization of payment for body organs. Currently, euphemisms like "rewarded gifting" or "compensated donation" are used to conceal it. The primary reason for the proposal to legalize payment for organs such as the kidneys is to curb illegal trafficking (Ogilvie, 2009). This is a hotly debatable issue requiring rational decision making and an evaluation of the consequences. It is true that the legalization of kidney trade would to a greater extent reduce the illegal organ trafficking by availing the much-needed organs to the patients. Surgeons also believe that this would save a lot of lives. On the other hand, legalizing kidney trade would be wrong for some reasons. It would fail to solve the current shortage of kidneys but rather change the focus of the problem to create new ones. There is a need to address the reasons for the intensification of advocacy efforts to legalize kidney trade as well as address the other problems that would be brought by such legalization.
At any given time, it is estimated that there are 146, 000 Americans are on the national organ transplantation waiting list. 67.85% of all these patients involve transplantation of the kidney amounting to 99,000 patients in need of a kidney as of 2015. Additionally, advances in medicine coupled with the sudden increase in type II diabetes and heart disease as a result of the modern lifestyle changes has widened the pool of patients waiting for a kidney (Veroux & Veroux, 2012). At the same time, the adoption of seat belts and extended long-term care for patients with terminal diseases has led to fewer good kidneys. This has fostered the illegal buying and selling of organs with no signs of the end. Most illicit kidney sales take place in developing countries. This trade goes far beyond the violation of medical ethics to gain entry into the world of international organized crimes (Ogilvie, 2009). Most kidney brokers are human traffickers with cut-throat deals to make increased profits using whatever means necessary. The organ traffickers usually recruit candidates from poor communities or from a pool of new immigrants and refugees who have difficulties in making ends meet. Therefore, most of the sellers are coerced by their needs.
Another reason that has promoted kidney trade the lack of standard judicial procedures to bring the culprits to book. Most countries have declared the trafficking of human organs to be illegal (Jha & Chugh, 2006). However, the specifics of the law in different countries differ. Therefore, prosecution involving three countries is marred by complexities that hinder the sentencing of the culprits. For instance, it is illegal in to sell a kidney in America but not to purchase one. Therefore, Americans who buy kidneys are not subject to any law while the judiciary has no power of sentencing the foreigner for organ selling. Additionally, kidney trafficking is seen as a life-saving ordeal leading to reluctance in the justice system (Jha & Chugh, 2006). All these have resulted in a vicious cycle with little recognition of the collateral damage inflicted on the vulnerable populations. Therefore, as long as there is a gap between the waiting list patients and the donors, together with the high poverty levels all over the world and a gap in international law to limit kidney trading, the cycle will continue. This calls for urgent interventions to curb the illegal trade.
However, legalizing kidney trade would undermine core moral principle of the sanctity of life by putting a price tag on a persons life. Allowing the business would turn kidneys into commodities undermining human value, dignity, and integrity (Stockman, 2012). Human organs should not be sold in the market like any other commodity. Life is given freely as no one pays for life. Therefore, organs should also be given freely if available and not to the highest bidder as this could be very demeaning to the sellers by making them take their bodies as a means of making money (Jha & Chugh, 2006). The monetization of kidneys would also open up black markets for the same promoting illegal trade for the organ. Criminal gangs would establish themselves through kidnapping and coerce people to sell their kidneys for profits. Also, it would be impossible to regulate such a trade leading to exploitation and injustices against the sellers. For instance, the legalization of kidney trade would produce further debate and disagreements about the prices based on the age, health, economic status, and genetic history (Jha & Chugh, 2006). The amount of compensation given would vary and may be very insignificant putting the health of the donors at risk for little gain.
Legalizing kidney trade would also set the precedent for medical transplant tourism which would increase the health risks faced by Americans. Once the initial supply of domestic donors is exhausted, there would be the globalization of kidney trade whereby sellers from all over the world would migrate in large numbers from the developing countries to the advanced economies. This would prompt some states to sanction unethical and unjust standards in a bid to earn revenue from the sale (Jha & Chugh, 2006). Most patients would also seek to have the transplant in the countries with the lowest prices thus promoting global transport tourism which would have several unanticipated consequences by increasing the risk of contracting infections such as hepatitis and HIV. Despite the good intentions of the trade, the market would also allow brokers to establish themselves as it is highly impossible to regulate the organ trade market. Such dealers would take home a significant portion of the donors compensation.
Kidney trade would also undermine core ethical principle of justice and equality (Stockman, 2012). It would be unfair to the poor people who are usually the victim sellers. The poor would be coerced by needs to sell their kidneys and not by their desire to save lives. Kidney buying would also be unaffordable to the lower and middle class owing to their expensive nature. The trade would create an increased availability of kidneys in the market since most people in need of money would donate as a result of the compensation (Matas & Hays, 2014). However, the price would limit the number of people able to acquire the donated kidneys to the social elite. The wealthy would have greater access to the donated kidneys as they can pay the high price. The poor, on the other hand, would have no access to the donated kidneys despite being on the waiting list for long as they cannot afford to buy one (Jha & Chugh, 2006). Ideally, kidneys should be given to those in greatest need regardless of wealth or power status. However, legalizing kidney trade would create a healthcare imbalance between the rich and the poor. Such inequalities undermine healthcare delivery by placing the life of the wealthy as more important than that of the poor (Stockman, 2012).
Legalization of kidney trade would also harm the existing voluntary donation programs (Jha & Chugh, 2006). It undermines the efforts to create a robust program of voluntary unpaid donation from living and deceased donors. The financial incentives would crowd out voluntary donations nullifying the reasons for the government to put up extensive infrastructure and public support for voluntary donation. Also, patients would have no need to turn to relatives while a kidney is easily obtainable from poor strangers (Jha & Chugh, 2006). The only financial incentive should be based on the costs incurred by the donor during the donation process. He/she should be compensated for the lost wages during recovery, transport and healthcare costs as this would act as an incentive to promote donations rather than a fortune to get rich. Additionally, enhancing financial neutrality by meeting all the expenses of the donors should neither be dependent on the donors nor the recipients wealth (Matas & Hays, 2014). This would result in more transplants as compared to selling and buying of kidneys like a free market. Nevertheless, legalizing kidney trade would reduce the number of operations because donations would be harder to get as more people would prefer to sell their kidney rather as opposed to donating (Jha & Chugh, 2006).
In conclusion, the increased need for healthy kidneys has resulted in proposals of legalizing organ trade. Despite the need to improve kidney donations, allowing free sale is not the answer as it will cause more problems than it solves. It creates a series of challenges such as inequality in the access to healthcare. It also undermines the current voluntary and free donation programs as well as violates core ethical principles of equity, justice and sanctity of life. Allowing free kidney trade would open the door for massive exploitation of the underprivileged by the wealthy. However, the government shouldnt stop looking for an answer to the current kidney shortage. It should focus advocacy efforts on the promotion of self-sufficiency through efficiency in the maximization of organ harvesting from deceased donors. Progress in stem cell research to repair damaged organs should also be considered as well as biotechnology efforts to use animal organs that are genetically tailored to match the immune systems of humans thus prevent rejection. Also, the creation of workable artificial organs could play a significant role in meeting the increased demand for kidneys in the future. Therefore, efforts should be centered towards medical research and promotion of efficiency in the current transplantation programs rather than the legalization of kidney trade.
Jha, V. & Chugh, K. (2006). The case against a regulated system of living kidney sales. Nat Clin Pract Nephrol, 2(9), 466-467. http://dx.doi.org/10.1038/ncpneph0268
Matas, A. & Hays, R. (2014). A Regulated System of Incentives for Living Kidney Donation: It Is Time for Opposing Groups to Have a Meaningful Dialogue! American Journal of Transplantation, 14(8), 1944-1945. http://dx.doi.org/10.1111/ajt.12814
Ogilvie, J. (2009). Kidney transplants: Pros and cons of creating a donor kidney market. LA times. Retrieved 20 May 2016, from http://articles.latimes.com/2011/mar/28/health/la-he-pro-con-kidney-donors-20110328
Stockman, J. (2012). Regulated Payments for Living Kidney Donation: An Empirical Assessment of the Ethical Concerns. Yearbook of Pediatrics, 2012, 190-193. http://dx.doi.org/10.101...
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