By George Stremplis
The organ transplantation process has increasingly become an important issue that needs to be tackled by not only healthcare providers, but society in general. Organ failure has spiked over the years, creating the need for a constant source of new viable organs. According to the Organ Project, there are 4,500 people waiting for an organ donation in Canada with the number of organ failure-related deaths to reach 260 people every year due to the fact that they did not receive the necessary viable organ. Although the number of donors in Canada is considerably lower than other countries (e.g. Spain, the United Kingdom, the United States), it is not the only country that suffers from an inadequate supply of organs available for life-saving medical interventions. This lack of available organs has prompted a salient and ongoing conversation between the medical community, patients, bioethicists, lawmakers, and the general public. While many solutions have been proposed, few have sparked such a heated debate as making organs available for sale.
The severity of the organ transplantation shortage has prompted some healthcare analysts and providers, as well as bioethicists, to declare the need to change the established rules and move towards a market of human organs. In 1998 the International Forum for Transplant Ethics concluded that trade in organs should be regulated rather than banned. Bioethicists Charles A. Erin and John Harris proposed a single purchaser system like the National Health Service (NHS) or Medicare that would undertake the responsibility of creating a fair system of medical priority for the recipients of purchased organs. Erin and Harris noted that this system should be limited to fixed geographical areas (e.g. the European Union) in order to avoid the exploitation of low-income countries, while simultaneously creating a condition in which organ vendors would know that their organs would have a higher chance of being donated to family or friends. Under this system, the organ vendors would be compensated for donating, but they would be forbidden from managing the sale of their organs themselves.
Julian Savulescu, a prominent bioethicist, expanded on the above argument by suggesting that people have an intrinsic right to sell their body parts. Additionally, he recommends that as long as the personal risk involved in the organ donation process does not outweigh the benefits for the person and/or society in general, then there is no reason to ban an organ market. Furthermore, Savulescu notes that people should be able to make free and informed decisions about their bodies even if such decisions are motivated by a state of poverty. In fact, Savulescu says that it is an injustice to not provide impoverished persons with an opportunity to change or escape their position in society by selling their organs.
However, is it safe to assert that the legalization of an organ market may help to improve social poverty and at the same time resolve the lack of available organs for transplantation? Can persons in extreme conditions of poverty make the autonomous and free choices that are required when it comes to the commodification of their body parts? Moral philosophers over the years, like Aristotle and Immanuel Kant, have argued that our choices are not truly free and autonomous when we are in an impoverished state insofar as our free will can be affected by our circumstances. Based on this perspective, it is typically thought that trading one’s organs for money as a means to escape an impoverished state cannot justifiably be considered an entirely free choice. At the same time, Erin and Harris’s suggestion to confine organ trading systems to fixed geographical areas is unlikely to eliminate the issue of exploiting low-income populations since higher earning classes will have little-to-no incentive to sell their organs. Consequently, a market of underprivileged people that harvest their body parts in order to escape their circumstances is likely to occur.
At this point we may be bound to ask: how do we solve the issue of needing organs if we do not make organ transplantation a trade commodity? The answer may be found in some combination of short-term and long-term proposals. It will likely be important to use and combine modern and emerging biotechnologies (such as stem cells, implantable devices, organogenesis) in order to shape a new way of replacing organs in the future. At the same time, we have to raise awareness of the need for available organs and clarify the processes required for transplantation. More than that, it would be helpful to advocate for better available nutrition and healthcare in order to prevent some of the diseases that cause organ failure in the first place.
George Stremplis holds a Master’s degree in Moral Philosophy and Bioethics from Aristotle University of Thessaloniki, Greece.
