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ISO healthy kidney; top dollar paid

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

If some people have their way, the title to this column may be the sort of classified ad we'll see one day. But not today, since it is against the law in most countries to buy or sell human organs for transplant.

That doesn't mean organ sales don't happen -- there is increasingly open discussion of an international black market that connects eager-to-buy patients with ready-to-sell donors. This shadowy market exists because of increasingly desperate patients who can't afford the years it takes to make their way up waiting lists for cadaver organs, but who are willing and able to spend many thousands of dollars to circumvent the allocation system. With a chronic shortage of available organs, and patients dying while they wait, why not allow a market for the sale of organs?

The problem of exploitation

There are two compelling reasons to object to the sale of organs, whether from living donors or the families of patients who have recently died. The first one is exploitation, that is, when one person takes advantage of the misfortune of another for his or her own benefit. There are many people in the world who live in settings with limited opportunities to improve their lives, and for whom $5,000 or $10,000 offers truly life-changing possibilities. But it is only because of existing social conditions that selling a kidney for what seems to be an impossibly large sum becomes attractive. Organ donation has always relied on the altruism of donors and their loved ones, with the hope that whatever risk is involved is balanced by the benefit of the good deed of donation. But most people have a price that will encourage them to ignore whatever qualms they have about donating an organ. And that changes the relationship from giving a gift to being paid enough to ignore risk. A market allows this shift, and it is a change we have been loath to accept up to now.

Second, the sale of organs gives an advantage to those with the means to pay for them. Whatever problems exist in the current system of organ allocation in terms of shortages and waiting times, it is at least fair. Rich patients can't pay to jump to the front of the queue. But that is exactly what happens in the case of a market for organs -- those who can pay the most get organs first. We may accept such a free market approach with other commodities -- the newest car or the latest electronic gadget -- but it is much less defensible to allocate scarce lifesaving medical technology in the same way.

Commodifying the system

Moving to even a limited market approach to organ donation -- for instance, setting the price paid to living organ donors or the families of patients who have recently died -- risks turning organs and their donors into commodities. And even if we were to leave the current cadaver system in place and only allow a limited market in living donation, we would still face the prospect of commodifying not just living donors who agree to sell organs, but the entire system of organ transplant. This could have the backlash effect of driving away donors who would gladly volunteer either in life or death, but would neither consider selling their organs nor agree to be part of a system that would allow it.

While the existing system of organ donation is far from perfect, it saves thousands of lives every year. It is a system built on a fragile trust that took long to develop and needs constant attention. It is a trust that cannot withstand the prospect of classified ads and online auction sites for human organs, alongside antiques, art and sporting goods.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.



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