Organ markets in the United Nations and European union are currently illegal, but with black markets evident in other countries and our current low supply of human organs for transplant, there’s been an increase in support for legalising the buying and selling of organs. This raises an interesting question: could it be morally acceptable to buy and sell organs for human transplantation? It’s easier to focus on a particular case-study, so let’s examine in detail whether it is morally acceptable to buy and sell human kidneys first.
At present, without a market in kidneys there is currently a shortage for kidney transplants. The consequences for those in need of the transplant are known: immense suffering and, eventually, death. Before addressing whether it is morally permissible to legally trade in organs, and since the desired result is more organs available for transplantation, we must consider whether a ban on organ markets decreases the supply of available organs. People may be more adverse to voluntarily donating organs if they are offered money in exchange for their organs. If this were the case, an organ market – irrespective of whether its morally permissible – would go against our desired outcome of increasing the number of available organs for transplantation incentives (i.e. cash incentive), however, may have the opposite effect, increasing the supply of available organs, thus reducing or preventing the suffering and death of those left waiting on the transplant list. If what we ultimately desire is the reduction of unnecessary immense suffering and death, it follows that this is a good thing and we ought to do it. Let’s bracket this question for now and assume for the sake of argument that people acting on cash incentives will be more likely to donate organs than voluntarily donate them. It must then be examined if, all things considered, the “good” consequences of organ markets outweigh the “bad”.
If we shift our focus to think about issues concerning bodily autonomy for a moment, why do we think there should be external limits imposed on what we can do with our own bodies? Each person has the right to decide what happens to their body, and if some decide to give some of it away in return for an agreed price, then that is something they have a right to do, regardless of consequences or rewards. Currently, people are free to donate their kidneys if they wish – and that’s considered acceptable. In fact, we routinely praise people that voluntarily donate their kidneys to others. So what extra harm is caused by introducing a monetary reward for doing the right thing? However, having a market in kidneys may have such negative unintended consequences that it would be wrong to allow people to sell and buy kidneys: sometimes, the social consequences undermine a putative right.
It must also be considered whether kidney markets are truly examples of free exchange. Most people that sell blood plasma today do so out of a sense of desperation or as a last resort. We must consider whether these choices done in desperation are well-informed or if the seller is capable of understanding the risks. There’s something morally troubling about an individual selling part of one’s body in order to survive. And this is exasperated when we consider how dangerous it is to undergo surgery to remove a kidney. However, it is not clear whether organ donation over a regulated organ market would avoid this problem of weak agency. As Satz (2008, 278) notes, ‘Regulating a legalized kidney market, rather than relying on a black market, would arguably go some way to redressing the worries about exploitation and one-sided terms of sale. If properly regulated, for example, an organ market might be structured to discourage sales from extremely poor donors.’
Certain kinds of markets may have consequences which may unfairly affect some people over others. Poorer people are more likely to sell whilst richer are more able to purchase the organs. Again, Satz notes (2008, 279), ‘Some critics have charged that organ markets will turn desperately poor people effectively into ‘spare parts’ for the rich.’ Kidneys, if allowed to be bought and sold, would mean that the allocation would not be to those who may need it most, but instead those who are willing, or have the ability, to pay more, thus creating further inequality. It may be argued, however, that inequality is present prior to the buying/selling of the kidney: ‘Moreover, kidney sales do not cause the inequalities in our world between the haves and the have-nots. Rather, like a mirror they reflect the current underlying inequalities in our social world.’ (P280, Satz, 2008)
So where do these concerns leave us standing? Unless the markets can be regulated through governmental control, with agreed-upon rules that limit coercion, and providing care and ensuring full awareness of risks for all parties involved, then the moral consequences on the exchanging of organs for human transplantation, all things considered, outweigh the good.
Satz, Debra. “The Moral Limits of Markets: The Case of Human Kidneys.” Proceedings of the Aristotelian Society, vol. 108, 2008, pp. 269–288. JSTOR, www.jstor.org/stable/20619386.
Holly Connolly is a second year BA philosophy student at the University of Hull. Her philosophical interests are AI, transhumanism, consciousness, personal identity and ethics. She is a mother to a toddler, Maximus, and likes to play rugby in her spare time.
What do you think about the moral permissibility of buying and selling human organs for transplantation? Leave a comment below.