Compensation for Organ Donation Essay

Introduction

Organ donation can be described as the act of giving away an organ to save or improve the life of someone who needs a transplant. Organs like the kidney and part of the liver can be donated while you are alive, but most tissue or organ donations will come from people who are dead. Although this is a nice concept, the reality is that, due to a shortage of organ donors, there are hundreds of thousands of people on waiting lists worldwide (with the U.S. alone amounting to 107,000 people ). This issue is not helped by the fact that in most jurisdictions (e.g., and USA ), the outright buying and selling of human organs remains a criminal offence. A commonly suggested solution is to simply provide a legalized market for organs so that more potential donors can be encouraged by financial rewards. However, due to the nature of where the organs will come from (human bodies), this area of applied ethics is particularly polarising. This essay seeks to first analyze common ethical arguments against compensated organ donation (commodification and exploitation) before analyzing common arguments in favor of compensated organ donation (organ trafficking and assistance of the poor) while providing input on why I lean more towards the side of legalization of organ sales.

Commodification and Human Dignity

This is one of the more noteworthy arguments against giving compensation to organ donors which is based on the first principle of the Universal Declaration on Bioethics and Human Rights. This states that human dignity, human rights, and fundamental freedoms should be fully respected. It refers to the Kantian idea that every human has an inherent value that makes us intrinsically valuable. Therefore, humans should be treated as valuable individuals, and never just as a means towards some other end. Challengers of compensated donations then argue that the simple act of collecting monetary compensation for donating an organ means that you are being treated merely as a means, a collection of useful parts, and not a valuable individual that should be wholly respected, therefore making it an unethical action. Also, it is argued that the process of compensated donation turns humans into 'things' by objectifying their parts as commodities, i.e., goods that can be sold on the market. Furthermore, Sandel argues that this process of commodification is a corruption of the human person since it promotes an objectifying and degrading view of the human person. He claims that this is corruption because of the act of adding market value to a non-market product, so placing a human body in the market is akin to corrupting the very integrity of the human person.

On the other hand, it can be argued that receiving monetary compensation for an organ does not deny the dignity and worth of human beings because there are other situations whereby money is given to others without the narrative that the monetary exchange causes a loss of dignity (e.g., when you give a friend money as a birthday gift or when you give money as a baptismal gift). Also, de Castro claims that the argument is not grounded in reality, since the 'commodification' of human organs is something that already happens in the world, drawing attention to the black market for human organs which already exists. I agree with him, and it is clear that donors and recipients have always negotiated organ transfer terms, with or without legal sanction.

Exploitation and Consent

The argument for exploitation is based on the global ethical principles of consent and respect for human vulnerability. It requires consent to be gathered from patients of any medical intervention while taking into account, human vulnerability, especially when dealing with traditionally vulnerable populations of society. Throughout history, a particularly vulnerable population that has consistently been taken advantage of is the poor, and they are the focus of the exploitation argument. This argument is usually also broken into two parts, which are exploiting the poor and doubting the voluntariness of organ sales.

About the exploitation of the poor, it is argued that if there is a compensated donation, the relationship between the recipient and the donor will pit the rich against the poor, thereby making it unethical. This is because the donors would most likely be vulnerable (poor) people who are more in need of money than an organ, which leads to a situation whereby the rich recipients exploit them. Therefore, for challengers of compensated donation, inequality would be a defining part of the organ market, and a market based on that concept cannot be ethically justifiable.

About consent, it is argued that compensated donation would force poor individuals into an almost impossible situation i.e., either they keep an integral part of their body, or they sell it to pay bills. Therefore, informed consent cannot be achieved since the voluntariness of the decision (the third step in the process of informed consent) is missing. According to Sandel, 'market exchanges are not always as voluntary as market enthusiasts suggest. A peasant may agree to sell his kidney or cornea to feed his starving family, but his agreement may not be voluntary. He may be unfairly coerced, in effect, by the necessities of his situation. This act of coercion therefore makes compensated donation unethical and unjustifiable.

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However, while I do agree that compensated donation could lead to the exploitation of the poor, the disadvantages do not outweigh the benefits and these disadvantages can be minimized by implementing safeguards. Some of these safeguards can be seen in jurisdictions where compensated donation is legal, like in Iran. In Iran, recipients are first put on a waiting list with the hopes of receiving an organ from a dead donor and if the organ does not become available, a team of doctors screen potential donors to find the right candidate. Lastly, as de Castro argues, the prevailing system of uncompensated donation fosters even greater exploitation of the donors and I agree with him. This is because the prevailing system rewards everybody but the donor; 'the surgeons and medical team are paid, the transplant coordinator does not go unremunerated, and the recipient receives an important benefit in kind. Only the unfortunate and heroic donor is supposed to put up with the insult of no reward, to add to the insult of the operation'.

Organ Trafficking

While a global shortage of organs is usually used as the main argument for supporters of compensated donation, the existence of an organ black market and its organ trafficking system should be considered a close second. According to the Declaration of Istanbul, Organ trafficking is defined as the use of force, abuse, deception, or coercion to recruit, harbor, and transfer humans or their organs. This means that it either takes the form of trafficking humans so their organs can be transplanted or trafficking the already removed organ. It is estimated that illegal organ trade generates around 1.5 billion dollars annually from roughly 12,000 illegal transplants and the fact that this number grows yearly means that organ trafficking is a real problem that must be addressed. Organ trafficking thrives in jurisdictions where organ trade is illegal because provides incentives for a black market of organs to be created. This has led to supporters of compensated donation arguing that the best way to remove these incentives is to decriminalize compensated donation.

It could be argued that this will be achieved once a highly regulated, globally agreed upon, and nationally run system of compensated donation is created to enact regulations and penalties so that hospitals and transplant centers are restricted from receiving organs outside of regulated trade. Therefore, if organs are only accepted from approved agencies, the practice of organ trafficking could be greatly decreased. Lastly, regulations and processes can be enacted to ensure patients can provide informed consent. This could include steps of disclosure of information, assurance of adequate understanding, and the attainment of express, formal consent since these are all essential in the process of informed consent.

However, some common arguments against legalization are that organ trafficking will still exist and regulations wouldn't necessarily tackle the problem of exploitation. Firstly, while I do agree that organ trafficking will still exist, it should be noted that proponents of compensated donation do not claim that legalization would completely stop all cases of organ trafficking because, frankly, wherever there are laws, there will always be people who break those laws. Therefore, a legally regulated system would, at the very least, reduce the amount of organ trafficking cases. Also, I agree that issues of exploitation will persist, however, vulnerable populations are even more at risk of exploitation and abuse in jurisdictions where there are no regulations. Lastly, in a regulated system, issues of exploitation can be officially addressed, and there can be attempts made to lessen the problem.

Assistance of the Poor

The potential financial benefits compensated donation offers to the poor cannot be understated. Proponents of compensated donation argue that every individual should be able to exercise their autonomy and situation in life by selling their organs for economic relief. Also, while objections to the idea of poor members of society receiving monetary rewards for donated organs are usually focused on factors like protecting them from evil practices and exploitation, supporters of compensated donation argue that these objections limit the poorer populations' ability to better their situations unnecessarily. This ultimately leads to them getting harmed in an unjustifiable way, which then ties in with the principle of non-maleficence. According to the principle of non-maleficence, humans should avoid harm when possible and only the least amount of harm should be performed when necessary. This principle can be broken up into two parts to be used when arguing in favor of compensated donation. Firstly, similar to the pro-compensation argument of human trafficking, the principle of non-maleficence obligates that we act in ways that produce the least amount of harm when possible, and since it has been shown that organ trafficking thrives where organ trading is prohibited, the principle obligates us to legalize and regulate the organ market to produce the least amount of harm possible. Therefore, according to the principle of non-maleficence, a compensated donation system can be forged ethically to reduce the harm from organ trafficking and the black market.

The second way this principle can be used to justify compensated donation is by claiming that the prohibition of compensated donation harms the poorer population because it takes away an option for them to better themselves financially. Lastly, according to Veatch, it is unethical for the state to prohibit poor people from receiving compensation for donated organs while simultaneously refusing to provide the goods of life to those same poor members of society. I agree with him, and this further backs the argument that a prohibition on compensated donation is a violation of principles of autonomy and non-maleficence due to the harm it causes.

Conclusion

To conclude, it is unclear if it will ever be legal to receive compensation for organ donations globally. What is apparent is that a model for compensated organ donation may never be perfect because both sides will continue to raise issues with one another. However, while issues of commodification, exploitation, and lack of informed consent may persist, I believe that these are not enough to constitute a global ban on organ trade due to the potential benefits of reducing global organ waiting lists, reducing organ trafficking, promoting principles of beneficence and non-maleficence, and providing financial assistance to those who need it most. Moving forward, a revised version of the Iranian model of compensated donation may be the best way to go. This version should, of course, have more sufficient safeguards put in place to better protect the vulnerable members of society.