A Market for Human Organs?

Advances in medical treatments have resulted in a dramatic increase in the number of organ transplants performed each year. However, a limited supply of organs prevents many individuals from receiving transplants that could either save their life or drastically improve it. The National Organ Transplant Act of 1984 prohibited payment to those who provided organs for transplantation. Nonetheless, the growing imbalance between the demand for transplantable organs and their supply in the United States and other countries has fueled concerns about black markets in body parts and led to debate about the sale of human organs in a federally-regulated market. This issue is increasingly significant because thousands of people die every year waiting for an organ donation.

Jeffery M. Prottas, an ethics committee member of the United Network for Organ Sharing (UNOS), believes that organ donation and procurement should be more than "a moral enterprise" and "a mechanism for giving reality to altruism," but that it should also be defined as a not-for-profit "industry" engaged in "selling altruism," (Reich, 1930). Supporters of a market for human organs, like Prottas, argue that the chronic shortage of organs for transplant could be reduced or eliminated if donors, or their survivors, were paid for use of their organs. According to UNOS, in 2002, there were 12,801 deceased and living organ donors and 24,900 successful organ transplants, but there were still 6,187 people who died while waiting for organs. Supporters argue that the promise of money could motivate many people who otherwise would not consider donation to offer their organs. They claim that it would provide income to someone who needs money and an organ to someone who needs a transplant, creating a win-win situation.

A second argument in favor of the purchase and sale of human organs is the issue of personal autonomy, which sets forth the presumption that individual personal health choices should be left up to the individual to make. Moral justification for allowing financial incentives is rooted in the claim that individuals should be free to sell bodily organs if they wish to do so without pressure or coercion. The selling of blood for profit is not only legal in the United States, but it is actively encouraged to increase the available supply of blood for medical purposes. The ultimate question is whether or not it is consistent to allow individuals to sell one element of their body, specifically blood, but not allow them to sell other parts, such as kidneys.

The last argument in favor of creating a market for the sale of organs is that it would sharply curtail the present international black market. The countries that have a surplus of organs are generally those in which there are the least restrictions on trade in organs. Since the quality of the surgeons and hospitals in these countries is much lower than in developed countries, this greatly reduces the quality of the organs used and how well they are matched to the organ types of recipients. Allegations of human rights violations associated with the acquisition of transplant organs in these countries are not uncommon. Numerous, well-supported allegations have been made suggesting that China has executed prisoners to satisfy the demand for organs.

Opponents of a market for human organs argue that individual income and wealth would determine who receives and who provides the organs. They argue that decisions concerning who should receive a transplant should be based upon medical criteria rather than on income and wealth. Such a system, they believe, would favor the wealthy, who can afford to pay for organs, while putting undo pressure to donate on poorer people. In the article, "The Consequences of Public Policy to Buy and Sell Organs for Transplantation," Jeffrey Kahn writes "policies that allow the selling of organs...make exploitation of the worst off a societal-endorsed rule and represent