[7/11] Should the sale of human organs be legal?

[Rok.C]

A.docx

A. Motion: THIS HOUSE WOULD LEGALIZE THE SALE OF HUMAN ORGANS

B. Related article: 

As our knowledge of surgical and diagnostic techniques has increased with time, so has the success rate of organ transplants. However, the number of patients who require organ transplants exceeds the number of organs available, particularly if the patient has a rare blood type[1] or belongs to an ethnic minority where organ donations are even lower than normal[2]. For example, although black people are three times more likely than the general population to develop kidney failure, and the Asian community has a particularly high demand for organs, organ donation within these groups is relatively low[3]. It is important for the donor and recipient to have the same blood type and similar genetic make-up in order to minimize the change of the receiver’s body rejecting the organ[4]. More than 10,000 people in the UK currently need a transplant, and 1,000 people die every year while on the waiting list[5]. In the US, over 100,000 people are still on the waiting list[6]. Although these figures are astonishing in themselves, the genuine figure is probably higher, inflated by the deaths of patients who are never waitlisted for a transplant. Some patients are never placed on the waiting list because they have certain habits – such as smoking[7] – and the precious few organs available are prioritised for patients who fit recipient categories.

The sale of human organs offers a possible solution to this crippling shortage of organs. There is already an established black market trade in organs[8][9]. Entrepreneurs offer British and Western patients the opportunity to receive privately financed transplants in countries such as India and Malaysia[10]. In 2006, investigators discovered that Chinese hospitals were providing organ transplants using the organs of executed prisoners[11]. In 1983, Dr. Barry Jacobs requested that the US government should create a fund to compensate the families who donate the organs of their deceased relatives.[12] He also proposed a business plan to buy kidneys from living donors to transplant to American patients[13]. However, these is still plenty of opposition to these ideas, and the National Organ Transplantation Act of 1984 still prohibits the sale of human organs from both dead and living donors[14].

The proposition line could argue that organs are the property of the donors, and so they have a right to do with them as they wish. In this case of buying human organs, it is much easier to argue that the profits would go to the donor rather than (for example) hospitals or governments which may not have a vested interest in those concerned. It would be useful to outline in the mechanism that these organs will be transferred through a unique medical group or business which has the technology available to match up donors to potential recipients and so avoid potential medical complications as far as possible. After this, it would be like any other financial transaction. This debate will focus on the United Kingdom, but the arguments would be relevant to most countries considering this policy change.

[1] Comprehensive Transplant Center,http://www.hopkinsmedicine.org/transplant/Programs/InKTP/blood_type.html, accessed 19/08/11

[2] Blood and Transplant. “Black and minority ethnic communities.”http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/black_and_other_minority_ethnic_communities/black_and_other_minority_ethnic_communities.jsp, accessed 19/08/11

[3] Ibid,http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/black_and_other_minority_ethnic_communities/black_and_other_minority_ethnic_communities.jsp, accessed 19/08/11

[4] American Association of Kidney Patients, http://www.aakp.org/aakp-library/transplant-compatibility/index.cfm, accessed 19/08/11

[5] Blood and Transplant. “Organ Donation.” http://www.uktransplant.org.uk/ukt/default.jsp, accessed 19/08/11

[6] United Network for Organ Sharing. http://www.unos.org/ accessed 19/08/11

[7] Cleveland Clinic.http://my.clevelandclinic.org/services/lung_transplantation/hic_lung_transplant_your_commitment_to_good_health.aspx, accessed 19/08/11

[8] MacKinnon, 2008, http://news.bbc.co.uk/1/hi/scotland/7493466.stm, accessed 19/08/11

[9] Havoscope: Black Markets. http://www.havocscope.com/black-market-prices/organs-kidneys/, accessed 19/08/11

[10] Kram, http://www1.american.edu/ted/prisonorgans.htm, accessed 19/08/11

[11] BBC News, 2006, http://news.bbc.co.uk/1/hi/5386720.stm, accessed 19/08/11

[12] Goodwin, http://law.slu.edu/healthlaw/journal/archives/Goodwin.pdf, accessed 20/08/11

[13] Ibid, http://law.slu.edu/healthlaw/journal/archives/Goodwin.pdf, accessed 20/08/11

[14] 98^th Congress, 1984, http://history.nih.gov/research/downloads/PL98-507.pdf, accessed 20/08/11

C. Arguments for pros(optional):

We already recognize the benefits of individuals who are able to pay for their healthcare doing so.

The ethics of private healthcare are not in question here; indeed, the UK government has stated that as many people as possible should be encouraged to pay for private healthcare in order to relieve the strain on national resources[1]. Critics have understood this as the government prolonging waiting lists until the patients ‘remove themselves’ either by going private, or dying[2]. There is, however, a general understanding that the NHS in the UK is overburdened and that increased private healthcare would help to balance this[3]. Meanwhile, in the US, private healthcare is the norm[4]. Allowing the sale of organs is merely an extension of this principle and provides utilitarian benefit. Not only would those who are able to pay for an organ enjoy a much better chance at recovery, but there would be more time, space, and resources for the people who could not afford to do this privately.

Legalising the sale of organs will eradicate the black market and ensure safer transplants.

Legalisation can help to eliminate the corruption currently associated with the organ market. It can also make it easy to regulate, and so safer. Given the mystery of the black market, medical complications are much more likely; it is necessary to match the donor and recipient together[1], but this cannot be easily done when every step of the organ collection and donation must be hidden for fear of prosecution. Legalisation could also stop the ‘theft’ or organs and abuse of people like Chinese prisoners[2] who are currently exploited for their organs[3] – authorities will become accountable to a publicly recognised and enforced system.

People should have rights over their own body and body parts.

The proposition is not concerned with live people trying to donate their hearts, or other vital organs which they cannot live without. No matter how impoverished that person might be, they will not choose certain death for a cash payoff. However, organs like kidneys, and sections of liver, can be and often are donated from a live donor without significant lasting damage[1][2]. It is patronising to forbid an individual to sell or donate an organ when it is possible for them to live without it. Similarly, the family of a deceased relative, as next of kin, should have the right to receive financial remuneration from their organs.

The donor should be able to benefit financially, rather than being expected to donate organs with no reward.

Given that the doctors, nurses and surgeons who work around organ transplants are all paid, it is nonsensical that the donor, the most important figure in the organ transplant, should be left out. The United States already allows markets for sperm[1], blood[2], human eggs[3] and surrogate wombs[4]. There is no good reason why organs should be excluded when these other human products are not; there is no moral difference between a kidney and an ovum. Moreover, organ donation is a lifesaving process, whereas sperm and egg donation are not. Simply put, incentivizing donations through payment will save the lives of many patients in need. The payment from these organs could also hugely improve the quality of life of the donors by lifting them out of debt, or allowing struggling individuals, such as students, to improve their career potential by paying for their university fees.

D. Arguments for cons(optional):

Allowing the sale of organs will harm state-financed health services and create a two-tier system

There is almost no chance that a state-financed health service will be able to afford the prohibitive cost of purchasing organs under this model. While it is difficult to track the exact price of organs on the black market, they often reach many thousands of pounds[1] and there is no reason to believe that the proposition’s model would suddenly reduce this price. In effect, this would turn essential organs into luxury items which the state cannot afford to provide, and so the poorest and neediest would be left to die. This would condone the most gross discrimination between rich and poor where a rich life, perhaps even despite a previously neglectful lifestyle (for example drinking and smoking), could be prioritised over a poor person’s life where their medical condition may not have been caused by their lifestyle choices.

Allowing the sale of human organs in the First World will impact negatively on the Third World.

The existing black market already shows a firm flow of organs in one direction; from the Third World to the First. Those who battle with poverty in poor countries will see the opportunity to sell their organs to the wealthy West; however, current disparities between how much donors are paid for their organs and how much these are then sold on for shows that the donors are already exploited[1][2]. Levy Izhak Rosenbaum, a New York City resident, was accused of paying poor donors in Israel $10,000 for a kidney but charging up to $160,000 to recipients[3]. There is no reason to believe, even if we legalize and regulate the organ trade within Western countries, that people in poorer countries will not continue to be exploited in this manner when they do not share the same legislation as us.

There are better solutions to the problems of organ shortages, such as the BMA system of ‘presumed consent’.

The British Medical Association (BMA) is pushing to introduce a policy of ‘presumed consent’, whereby organs may be taken from a patient who has died unless they expressly registered their objection to this before their death[1]. Given that a far larger percentage of people indicate that they would be happy to donate than the percentage who actually do donate[2], this scheme could combat apathy on behalf of the general society and encourage them to act rather than ignoring or forgetting the option to donate their organs. This is particularly true in the categories of people who said that they ‘didn’t know how to register’, ‘had never thought about joining’ or who ‘hadn’t got round to it’ – comprising a total of 53% of the participants in the NHS nationwide survey[3]. This scheme could have an enormous impact in saving the lives of others through a much greater number of available organs. Several countries, including Spain and Austria have already adopted an opt-out system, and studies have shown that this policy has caused a dramatic increase in the number of donations.[4] We can solve the organ shortage without all of the problems inherent in the proposition’s proposal.

Individuals do not have an inviolable right of property over their organs.

The notion of property over body parts is very complex, both legally and philosophically. Generally, judges have shown ‘abhorrence’ at the idea of defining human bodies or parts of, whether living or dead, as ‘goods or materials’[1]; if a right to property over the body could ever be exercised, it appears most strongly where the individual shows ‘no intention of abandoning or donating it’[2]. While this continues to be an incredibly complex issue, it essentially demonstrates that there is no absolute right of property over an individual’s own body parts; it is open to interpretation in each case. A proposition line that grants authority to any potential donor over the selling of organs assumes a right of property which does not, in fact, exist. As such it can, and should, be prevented.

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