The World Health Organisation states that there are 128,000 organ transplants performed around the world annually. The transplantation of organs has been a practical solution for those with end-stage organ failure. However, the increasing demand for organs far outstrips the supply. In the United States, 20 people die each day waiting for a transplant (Data). In Australia, there are five times more people waiting for organ transplants than there are donors (Marriner, Arlington, and Alexander). Two years ago in the UK, it was reported that roughly 500 patients died waiting while another 900 were removed from the list due to their feeble health, many dying afterward (Johnston). This universal problem has led to countries exploring ways to expand the organ donor pool. The ‘opt-out’ law is where consent is presumed unless the donor chooses to ‘opt-out.’ In Spain, this law has increased the donation rate albeit modestly.
At the same time, in Sweden, this law has not affected the donation rate per million (Berman). Additionally, the organ shortage has resulted in patients taking matters into their own hands, traveling to foreign countries to purchase organs, a process called transplant tourism. There are two situations in which transplant tourism occurs: 1) in well-developed countries where waiting lists are long and 2) in underdeveloped countries where regulations are nonexistent, but the people are indignant and must make money through the sale of organs (Broumand and Saidi). While organ selling is prohibited in most countries, its controversial legalization has been considered as a way to resolve the organ shortage. Supporters of this solution argue that everyone has personal autonomy.
An individual possesses the capacity to decide the course of action for their life (Autonomy). A regulated market would also ‘cut out the middleman’ thus lessening the possibility of exploitation. Where there are no regulations, donors are exploited to the greatest extent and frequently left without proper medical treatment and supportive care (Major). Critics of this approach argue that organ sellers face the risk of being stigmatized. They are often looked upon as ‘half people’ and ‘bodies without organs.’ Sellers and recipients are ultimately rejected, hated, and left isolated.
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Although stigmatization may seem to be a problem for just the illegal handling of organs, studies show that discrimination and stigmatization can be found in legal donation systems as well (Rheeder). As the transplant list grows and more lives are lost waiting, do the benefits ultimately outweigh the risks when it comes to the legalization of organ selling? Rupert Major, a Clinical Research Fellow at the University of Leicester, argues that a regulated market provided by the legalisation of organ selling would prevent exploitation. He states that these markets would ‘cut out the middleman’ as organ brokers often lure marginalised people into organ trafficking (Major).
Major references a particular study conducted by Nancy Scheper-Hughes, a professor of Anthropology at the University of California. In this study, it was discovered that people such as the homeless, refugees, undocumented workers, prisoners, and aging prostitutes were coerced into going under the knife in exchange for financial compensation. However, the means of this exchange is anything but safe with illegal surgeries performed in shady hospitals bearing a resemblance to ‘back-alley abortion clinics’ and ‘five-star hotels’ (Scheper-Hughes).
Major affirms that the risk donors are facing is unnecessary, using the Iranian system as an example. He explains that donors in Iran (where organ selling is legal) receive free health insurance in addition to payment from the government (Major). Therefore, the establishment of regulated markets would eliminate the problems of ‘inferior surgical, medical practice’ and manipulation of donors (Major). Furthermore, Major addresses the right of personal autonomy. Every individual possesses the freedom of self-governance in all aspects of life, in this case specifically health. If a person decides to donate their kidney to a related or non-related patient, according to Major they are by all means permitted to do so (Major). He supports this claim with the legality of payment for sperm and eggs in many countries.
Although this exchange disputably has greater long-term ramifications considering the possibility of new life, organ selling remains illegal nearly everywhere (Major). Additionally, participants in clinical trials receive compensation for putting themselves in harm’s way, and while organ transplantation may seem different than these examples due to its permanence, Major states that after the initial perioperative risk the donor faces no increased risk of death (Major). In most centers, the dangers connected to surgical procedures is very low at around 0.02% chance of mortality during surgery and less than 1% chance of other complications (Major).
Major’s argument is logical, and his use of credible studies and statistics aid in strengthening his claims. In his first main point, he reveals the dangers in organ trafficking as a result of the illegality of organ selling and uses Professor Scheper-Hughes’ study as evidence. In his second main point, he explains how the legalisation will directly combat these dangers. He also recognizes the opposing view. His straightforward cause and effect, problem and solution structure makes his overall argument convincing. However, the primary flaw lies in his use of the effects of Iranian system to represent the outcome of any country that decides to take this route. He fails to take into account other factors such as population or prominence of organ trafficking in how efficient this solution would be for other countries besides Iran.
Additionally, his use of statistics regarding surgical risks does not represent the medical practices globally. He doesn’t acknowledge the possibility of legal medical procedures being just as unadvanced and dangerous as illegal procedures. Rupert Major is a Clinical Research Fellow who works in the Department of Health Sciences at the University of Leicester. He has conducted research in Nephrology, Epidemiology, and Cardiology. His most recent publication pertains to the improvement in the care of patients with chronic kidney disease.
With his extensive background in medical research and his occupation, Rupert Major is a credible and informative source for the legalisation of organ selling. Riaan Rheeder, the chairperson of the Unit for Bioethics at North-West University assesses the dangers found in the illegal practice of organ trafficking, particularly the aspects of stigmatisation and discrimination, and how these translate to legal donation systems. His argument is similar to Major’s in the sense that it is based on organ trafficking since the sale of organs is only permitted in Iran. However, unlike Major, Rheeder proves that this problem cannot be eliminated with the legalisation of organ selling.
Rheeder states that organ trafficking is brought about by the negligence of the government, that there is a lack of national and international regulation as well as the enforcement of current laws (Rheeder). He implies that governments around the world are incapable of regulating the illegal practice. Therefore, they will be incapable of efficiently controlling the sale of organs if it were legalised. With this being said, issues in trafficking will continue to occur one way or another in legal practice. Non-related living organ sellers face the risk of discrimination and stigma. Rheeder asserts that these organ sellers are frequently marginalised in their communities. He references a study of kidney trafficking in Nepal where sellers are deliberately excluded from positions of authority and that non-governmental organisations provide ‘medical preference’ to those who are not sellers (Acharya). Discrimination and stigma also occur in legitimate transplant programs.
Rheeder cites Global Bioethics: The Impact of the UNESCO International Bioethics Committee, a book concerning stigmatisation and discrimination in medical practices. In this book, it is stated that these risks become especially dangerous when organ procurement and allocation programs do not follow the ethical guidelines established by international organisations such as the World Health Organisation (International). This relates back to the failure to enforce regulations as a result of a negligent government. Furthermore, they are considered ‘half people’ and ‘untouchables.’ Other derogatory names include ‘bodies without organs’ and for males sellers, ‘male prostitutes.’ The use of ‘untouchables’ relates back to the Caste system in traditional Indian society, where those with occupations involved with contact of the human body were to be avoided and looked down on (The).
This proves that the legality of organ sale cannot change the way societies steeped in religion or culture act towards sellers. Therefore, discrimination and stigmatisation will continue to transpire.Discrimination also takes presence against organ recipients. According to Rheeder, wealthy patients on the waiting list are given ‘almost exclusive preference’ thus resulting in discrimination against the ‘poorer vulnerable’ patients who may be in critical condition (Rheeder). Organ selling can also lead to wealthy patients exploiting the poor and other vulnerable populations.
Rheeder affirms that social conditions such as poverty and ‘power relationships’ paired with false information and the withholding of possible harms to their health make it easy to convince these people to sell their organs (Rheeder). Rheeder’s argument is primarily centered on ethics. He utilises reliable books and studies to back his claims. He reveals the complexity of the organ trafficking problem and how the solution cannot be as simple as legalisation, thus refuting Major’s first point. Rheeder’s argument is explicit; he uses the brutal truths of organ trafficking to evoke disdain for organ selling from the audience. His ethical approach to this topic makes the audience question whether efficiency outweighs ethics. His stance is more concerned with the treatment of others as opposed to personal autonomy. Rheeder’s argument is more compelling to the extent that his points resonate better with the audience.
However, its weakness lies in the lack of addressing the opposing view. Rheeder failed to mention any benefits of organ selling, unlike Major’s comparative approach. Riaan Rheeder is a professor at North-West University in South Africa. He is also the sub programme leader of the Moral Renewal of the Society in the unit: Reformational Theology and Development of the SA society. His leadership occupation makes him a credible source and further strengthens his argument.After analysing both arguments, I have concluded that organ selling should be legalised.
Although the fear that the problems in trafficking will cross over to a legalised market is legitimate, donors and recipients would ultimately be safer in a legalised system. Surgical procedures would be performed in hospitals as opposed to “five-star hotels,” “back-alley abortion clinics,” or any other dangerous setting used in the black market (Major). Sellers would receive proper post-operative care to ensure their health is in check and sufficient financial compensation. The regulations for these procedures would be in line with those in place for current medical procedures. In countries where organ selling is illegal, long waiting lists have compelled some to travel to foreign countries and undergo dangerous surgeries, thus driving up black market profits.
The legalisation of organ selling could meet the needs of countries with long waiting lists and poorer poverty-stricken countries at the same time. To ascertain whether the number of lives saved compensates for the potential risk sellers face, it is imperative to conduct further research. This would include an extensive study of Iran’s organ market, focusing on how legislation has affected the black market, how it has affected the transplant list, as well as a long-term examination of the health of sellers and whether this process perpetuates the need for organs. It is important to note that the result Iran has witnessed cannot represent that of any country who takes this step.
Therefore, to determine its effectiveness, more countries will need to follow suit to obtain a comprehensive set of data. With more and more countries legalising organ selling, the prominence of trafficking and exploitation diminishes.Legalising organ selling should be viewed as part of the bigger solution to combat the organ shortage. Future research and technology such as 3D printing organs could work along with legalisation to help eliminate the problem entirely.
