(photo credit: Michael Ainsworth/Dallas Morning News/MCT)
The willingness to donate organs is very responsive to inducements.
manifestation of this responsiveness was when tens of thousands of Israelis
rushed to sign organ-donor cards in return for being moved ahead in the line for
transplants if they should need them.
This week the Israeli National
Transplant Center reported a dramatic increase in donations from living donors,
following recent legislation that gives benefits to donors, similar to those
given to people with disabilities, for a period of years. The increase in
donations also mirrors the increase in the number of desperately ill Israelis
who are able to obtain a transplant that gives them a chance for a normal life
and life span.
It is obvious that the tens of thousands of shekels given
to the donors is a pittance compared to the revolution in the well-being of the
recipients. Why then don’t we offer donors even more benefits, until we close
the gap between supply and demand for organs? Opposition to this approach tends
to adopt one of three main arguments:
• “The gift relationship
”: An influential
1970s book of this name suggested that perhaps people are less likely to donate
blood if they are offered monetary incentives. People are not motivated to give
something so personal by market incentives; the “gift relationship” with the
needy recipient is actually more effective.
The claim could perhaps be
extended to organ donations. The argument is interesting, and the original
book’s research was careful. But since then, the claim has been subject to
rigorous tests, and the unambiguous result is that monetary incentives do a
great deal to motivate organ donations – as the Israeli experience
: A frequently heard claim is that organ
donors mainly will be poor people who really need the money; recipients
“exploit” their poverty by obtaining kidneys or other organs for a pittance.
Part of the argument may be that the donation is such a great sacrifice that
there is not true informed consent. It is likely true that poor people will find
the monetary incentive more tempting, and rightly so.
Poor people are
also more likely to accept menial jobs or to go looking for bargains, but that
doesn’t mean that employers and discount stores take any kind of unfair
advantage of them. At any rate, if this argument has merit, the solution would
be to increase, rather than decrease, the amount of money offered to donors to
ensure that they are not unfairly duped.
argument, the most persuasive in my opinion, starts from the premise that people
are not merchandise or commodities. After all, we don’t allow people to sell
themselves as slaves, and we don’t allow parents to sell their babies to the
highest bidder and so on.
If a healthy middle-aged person were to make
the calculation that by submitting to dissection to sell his heart, lungs,
kidneys, liver or corneas he could provide financial security for his children
(as well as save the lives of several fellow human beings), we would not permit
the operation, and a surgeon who performed it would probably be convicted of
first-degree murder. Utilitarians can go blue in the face demonstrating that the
benefits of such a procedure exceed the losses, but few could be persuaded to
Kant, who is the main philosophical exponent of this ethical
approach, felt that just as it is unethical to sell a human being, so is it
unethical to sell body parts, which are an essential constituent of our
humanity. Kant gave the example of teeth (evidently the only practical organ
transplant in the 18th century).
We can accept Kant’s basic
disqualification of human commodification but reject its extension to organ
sales. Today we do not view our kidneys as essential constituents of our
humanity. Part of this is precisely because of the possibility of organ
transplants and the knowledge that a person can live perfectly well without one
of his kidneys or with the kidney that formerly belonged to someone else. Kant
would likely have equally denounced organ donation, but today we allow and even
The encouraging reaction to the modest incentives of
current law should spur us on to broaden even further the monetary benefits
given to those who donate email@example.com Asher Meir is
research director at the Business Ethics Center of Jerusalem, an independent
institute in the Jerusalem College of Technology (Machon Lev).