Selling or Sharing Kidneys?

The ethical debate over whether US law should allow a healthy person to “sell” a kidney illustrates how health care debates may involve only consequential reasoning.

Those in favor of a law that would permit a market in kidneys for transplantation offer the following consequential arguments. First, the demand for kidneys now so greatly exceeds the supply that many persons on the list to receive a donated kidney will die before a kidney is available for them. Second, a greater supply of kidneys would enable doctors to choose the healthiest donors, which is better both for donors as well as for recipients. Third, the cost of maintaining people on dialysis is greater than the cost of kidney transplantation. And fourth, the growing demand for kidneys is stimulating a black market that not only encourages illegal activity, but also increases the risk that a patient will receive a kidney not properly screened to prevent the transmission of an infectious disease.

Those opposed to allowing the sale of kidneys also rely on consequential reasoning, but emphasize negative rather than positive outcomes. First, such a market would necessarily be global and thus could not be properly regulated. Second, without regulation the risks of transmitting diseases would increase. And third, such a market would likely increase unethical practices, such as exploiting poor persons and harvesting kidneys from unwilling “donors” who are not legally protected against such a theft.

An article appropriately entitled “The consequences of a donor kidney market” in the Los Angeles Times (http://www.latimes.com/health/la-he-pro-con-kidney-donors-20110328,0,4492170.story) presents these arguments. In this article the health professional who opposes an open market does support removing financial “disincentives” from the present system of kidney donations by providing health and life insurance to living donors who do not have this coverage. 

It is worth noting that this debate often ignores arguments for intrinsic values. In the Times article there is no consideration of the ethical argument for the intrinsic value of encouraging persons to allow their kidneys to be harvested after their death. This argument values the character of a giving person and also resists the notion that our organs are “ours” even after we die. It urges us to see our organs as gifts that should be shared when we are no longer able to live and make use of them. 

This sort of ethical argument may be raised to support changing US law that now presumes the healthy kidneys of a deceased person cannot be harvested unless the person has indicated in writing that she wishes to make such a donation. Viewing organs as gifts to be shared, rather than as rightful possessions or as commodities that may be sold, would be reflected in changing our legal presumption to allow the harvesting of any usable organ from the body of a deceased person, unless he has explicitly rejected organ harvesting.

With hope . . . Bob