Is it ethical to buy organs for transplant outside official system?

[Clark]

http://www.mlive.com/opinion/grand-rapids/index.ssf/2014/10/is_it_ethical_to_buy_organs_fo.html

Is it ethical to buy organs for transplant outside official system? Ethics and Religion Talk
By Rabbi David Krishef

Our question this week follows up on a column earlier this year
http://www.mlive.com/opinion/grand-rapids/index.ssf/2014/02/should_donors_be_allowed_to_se.html
about the ethics of selling organs for transplant.

One reader wondered, “Is it ethical for a wealthy person to go outside the organ procurement system and essentially buy an organ for transplant?”

The Rev. Sandra Nikkel, head pastor of Conklin Reformed Church, responds:

“I don’t think this is unethical. What is unethical is that only a limited number of people have the freedom to do that. Greed has turned justice upside down and the poor always seem to be holding the “short end of the stick.” No wonder why Jesus was so attracted to the poor, the marginalized, and the weak. He spent his life befriending them and helping them and his life truly made a difference. What about our life?”

Fred Wooden, the senior pastor of Fountain Street Church, responds:

“Our instant reply is 'no,' as it reeks of selling and buying lives, something repugnant to almost everyone. On the other hand, we clearly accept drugs and healthcare that are so expensive only a few can buy them. It used to be said that illness and death were the great levelers, but not so today; therefore maybe it is OK if only by default.  If we think buying a kidney is wrong, we should be asking why buying other lifesaving options other cannot afford are not?  The problem is not that buying organs is wrong, which we clearly see, but that we do not think other healthcare disparities are just as wrong.”

Fred Stella, the Pracharak (Outreach Minister) for the West Michigan Hindu Temple, responds:

“There is no scriptural injunction that I can point to for this question. But there is a strong ethic of equal access to those essentials of life and health. There is nothing wrong with the wealthy living in mansions as long as others have even modest shelter. But health care is a different subject. Chapter V of the Bhagavad Gita explains, “He who sees the priest with his sanctities and scrolls along with the pariah as equals has attained divine sight.” Such practices lead to the very destitute selling their own organs to simply survive. We would condemn this.”

David Spearman, the senior pastor of the Faith Ministries Center Church, responds:

“It is not always necessarily a wealthy person who may be trying to buy an organ. When it may be a matter of life or death, wealthy or not, many would try to procure an organ for themselves or a loved one, even if it meant selling all that they had. The point of the official system is that there is a standard to ensure that these donated organs are suitable for transplant. If more of us donated our organs then the waiting list would not be as long for those in need of them.”

My response:

I’d like to set aside the question of whether it is ethical for a wealthy person to obtain higher quality medical care, and focus strictly on whether buying organs outside of UNOS, the United Network for Organ Sharing, is ethical. UNOS exists so that organs may be distributed fairly - so that the sickest people most in need have priority.

Transplant surgery is expensive. It’s hard to fault a hospital for preferring patients who can pay a bill, either privately or along with health insurance. Hospitals will go out of business if they cannot cover the costs of their operation. If an urban hospital closes, wealthy people will easily travel to suburban hospital. People who rely on public transportation may lose some access to health care. If a hospital closes in a remote area, both wealthy and poor will suffer consequences.

On the other hand, because health care is a limited commodity, the ethical distribution of heath care demands that the sickest individual are given priority. It would be unethical for a person who could have been healed to die because a wealthier, less sick person, was treated first. Therefore, it is unethical for a wealthy person to jump in front of a sicker person in the UNOS distribution system. But the system is by no means perfect. To take one example of the disparity, our country is divided into regions, and organs are shared within regions. The coastal regions have a lower percentage of the population willing to be donors, so therefore there are fewer organs available for those in need. The system prevents organs from being taken exclusively by the wealthiest individuals, although nothing prevents such a person from moving to an area which the organ he or she needs is in greater supply, an option not available to those of lesser means. The UNOS rules are periodically changed in order to address such inequities.