QUESTION: Should there be a market in human organs?

[Clark]

http://kenan.ethics.duke.edu/good-question/kieran-healy/


Kieran Healy
Associate Professor in Sociology and the Kenan Institute for Ethics
from the Good Question: An Exploration in Ethics series presented by the Kenan Institute for Ethics

QUESTION:
Should there be a market in human organs?

ANSWER:
In the early 1970s, organ donation was an experimental therapy often seen as posing the same sort of dangers as genetic engineering or human cloning. Against this, transplant advocates developed the idea of organ donation as a sacred “gift of life.” It worked. Most people now think of donation as a straightforward moral obligation, or at least an obviously good cause. Over time, organ donation as a gift exchange became the ethical standard, and the idea of trading in a market for organs anathema.

But what is really wrong with having a market—a system for buying and selling—our own organs? Certainly, there’s little doubt that it would have some unpleasant aspects. There would be many cases where a wealthy individual bought a kidney from someone much poorer. The prospect of the poor literally giving up their bodies to the rich is enough to make many people recoil in disgust.

If such market exchange of organs is exploitative, there are two solutions: you can ban it, or you can try to ensure people aren’t in a position where they feel forced to sell their organs. A ban may consign people to an even worse fate (death) than being exploited. The second solution, meanwhile, raises big questions of social justice that go well beyond a market in kidneys.

In the end, there is less of a division between gift-giving and market exchange than we might think. Incentives are not incompatible with the kind of moral obligations associated with donation. We may wish for a bright line between virtuous gifts and selfish markets, but the boundary is constantly crossed, in both directions.

For example, gifts can be easy vehicles for getting people in your debt, or obtaining something for free, and people calculate very precisely what the “right” amount to spend on a present is when birthdays or holidays come around. On the other hand, markets routinely have strongly moralized aspects, as we take care to pay people in ways that signal our esteem for them. We discreetly reimburse people for their time, or give them an honorarium, say, rather than paying them in cash by the hour.

A lawful market in organs would probably be considered more legitimate if it resembled a gift exchange, as we see already taking place in the case of human eggs, where the language of donation predominates even though the eggs are bought and sold and prices are widely advertised. However, even today, with the exception of kidneys, you can’t get a transplant unless you have the insurance to pay for it, despite others’ willingness to donate their organs. So why should people feel any obligation to give to a system that serves those who need it so poorly?