A fine line between organ donations and organ sales

Ethics@work: Israeli National Transplant Center reported dramatic increase of donor, following recent legislation that gives benefits.

organdonation311 (photo credit: Michael Ainsworth/Dallas Morning News/MCT)
(photo credit: Michael Ainsworth/Dallas Morning News/MCT)
The willingness to donate organs is very responsive to inducements.
One 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 demonstrates.
Exploitation: 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.
Commodification: This 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 allow it.
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 encourage these.
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 organs.

Asher Meir is research director at the Business Ethics Center of Jerusalem, an independent institute in the Jerusalem College of Technology (Machon Lev).

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