(some of) the ethical dilemmas in allowing or prohibiting trade in vital organs

I've been fascinated by this issue for some time-- as you can tell by my blog record.

It's particularly interesting to economists, because the shortage is caused by the government "price ceiling" of zero. In other words, one cannot sell an organ, even in death. Since there is no financial incentive, the overall incentive to give is reduced-- and absent sufficient altruism, the result is a policy that kills thousands of people each year.

Thus, whatever ethical reservations one might have about the selling of organs-- must be tempered and sobered by the ethical consequences of killing people through policy.

My friends at Touchstone are more taken by arguments on the sanctity of the body. But even there, the logic is terse and insufficient. After all, our Savior gave His body in sacrifice to crucifixion-- in fulfilling John 15:13's "no greater love has man than this"...

In any case, here's a thoughtful letter to the editor from Denver's James M. Small in First Things on the topic...

The article by Gilbert Meilaender (“The Giving and Taking of Organs,” March) discusses the shortage of organs for transplantation and the ethical implications of donating, opting out of, or buying and selling organs. He concludes that a system that depends on altruistic donation is the best. What he does not cover in this short article is the fact that criminals and governments around the world are already taking or buying human organs in large numbers. The very system he recommends causes crime and governmental misbehavior, which calls into question the validity of his ethical argument.

It is clear that the current voluntary system does not supply enough human organs to meet the transplantation demand. According to UNOS—the United Network for Organ Sharing—there are 98,000 patients on the waiting list, and only 28,000 patients received organs in 2007. A good friend of mine, a pastor, received a liver earlier this year, about ten days short of his predicted death; this is not merely a theoretical question for me.

Why people do not donate is an open question. Some fear getting substandard care if it gets out that they are organ donors....Some just don’t get around to it....In any event, despite public relations campaigns, voluntary donations have just not taken off.

What is the inevitable consequence of a shortage of organs? Supply-and-demand economics, because, in our efforts to be ethical, we have made regulated economics impossible. And so some of our fellows have turned to illegal and immoral activities: black markets, assaults, and exploitation of the poor and powerless.

We were shaken by the India kidney-transplant racket earlier in the year, when people were assaulted and organs forcibly removed. In some European countries, hospitals were rewarded for organ donations and so fell to the temptation of ignoring patients’ wishes. In China there are persistent rumors of prisoners being executed at such a time when their organs can be sold for transplantation—with government assent. In Thailand and in the United States, there are cases of doctors arrested for hurrying the deaths of patients to get organs.

All over the world, poor people sell their organs to get enough money to feed their families. It is said that in some parts of India a kidney is worth about $900 to the donor and up to $200,000 to the procurer. That sort of profit margin reminds one of the illegal drug trade.

Meilaender argues that moving to an opt-out or (heaven forbid) market-driven system cheapens our nature. I agree with him. But the question is not that simple. Which cheapens us more—a well-regulated, well-run opt-out system with informed consent, or a thriving black market? Which cheapens us more—an open market with disclosure, or gangs of thugs assaulting the poor and innocent of the Third World for massive profits? It seems clear that an unanticipated and inevitable consequence of organ transplantation is that we will be cheapened.

Donating is clearly the morally superior way to get human organs for transplantation. It engenders a spirit of charity in the donor and family and can provide a sense of meaning at the end of life. Similarly, for the recipient, knowing that the life-saving organ came from a volunteer can lead to humility and gratitude.

Would-be recipients far outnumber donors, however. A larger ethical analysis is needed that takes the darker side of our nature into account. It may turn out that an opt-out system with careful controls, or even a market-driven system, has fewer toxic side effects than the current volunteer/black-market system.