A Legal Organ Market: Should it Exist?

Organ transplant. Source: theglobalpanorama is licensed under CC BY-SA 2.0

For those of us who have obtained a driver’s license, there is an option to mark oneself as an organ donor upon death. However, for kidneys, living donors are also a possible option. Afterall, everyone has two and most people can function well with only one. Even so, live donors are few and far between. In the United States, donations are the only legal option for people to obtain organs and often those donations fall short of actual demand. For example, One source states that the amount of kidney transplants able to be administered in a year within the US is about 20,000, far less than the 100,000 a year that would be needed in order to meet the demand. Furthermore, the same source explains that under the current laws, some people have to wait nearly 10 years in order to receive a kidney transplant, and often people on the waiting list die before they are able to receive a transplant. There are many arguments as to why organs should only be acquired through donations. However, there is also compelling evidence as to why making the buying and selling of organs a legal practice is the best way to save the greatest number of people.

One of the arguments against making the buying and selling of organs legal is that it would likely lead to a society where only the rich would be able to access life saving organ transplants and the poor would be the main contributors of those organs. Currently, the US system wards against this inequality by not paying or charging people for organs and only granting people organ transplants by putting them on a first come first served waiting list. This means that regardless of whether someone is rich or poor, an individual will have the same chance of receiving an organ transplant as the next person. When there is an organ market, it creates an exploitative dynamic between the rich and poor where the poor sell their organs and are often not compensated fairly. This is a big reason why the World Health Organization implored states to put an end to “Transplant Tourism.” Transplant tourism has caught the eye of the international community as a deeply exploitative practice due in large part to the process of it. This is because it often happens in such a way where the poor sell their organs cheaply to a middleman who then sells those same organs for large sums of money to rich buyers. For example, one source points out that in Pakistan, people will give up their kidneys in order to be released from slavery. However, the same article states that when people sell their organs their health often plummets and this can cause them to be further plunged into a life of poverty. Therefore, while more organ transplants may be performed under a more capitalist system, it would likely only benefit the upper classes, creating a deeply exploitative and unequal system.

However, systems like the one within the US and similar ones, such as those within the United Kingdom, are not the only viable options. Even though they are the more globally accepted ways of dealing with the demand for organs, they are not the only ways; Iran has its own method for handling the demand. Starting in 1988, Iran began a program in which donors were compensated for giving up their organs, thus removing the waiting list for kidney transplants. Within the current system, buyers and sellers are able to buy and sell kidneys for a fixed price of $4,600. While exploitative side deals have been struck outside of the government regulated system, Iran has been able to avoid many of the ethical problems that often arise from the selling of organs. For instance, one study found that while the majority of kidneys sold in Iran came from people from lower socioeconomic backgrounds, everyone whether rich or poor was able to have equal accessibility to kidney transplants because of funding from charitable organizations. Additionally, as previously mentioned, when a financially desperate individual donates organs, it often results in poor health outcomes, causing that person to become only more economically unstable. However, in Iran’s system, donors obtain healthcare coverage for at least a year after the operation and discounted coverage for additional time following the end of that coverage. While the system is not perfect, it allows those in need of kidneys to gain access to them with relative ease and reduces the exploitation of the poor that is prevalent in countries like Pakistan and the Philippines. It is estimated that if the US set up a similar legal market for the selling of kidneys and paid donors $45,000, it would not only eliminate the waiting list for kidneys but also save tax payers $12 billion annually.

In essence, the pros and cons are hard to weigh in the argument for a legal organ market. Monetary rewards for organs cause problems where the poor are at a disadvantage. Even so, compensating donors is an easy way to drastically increase the supply of organs, potentially saving thousands of lives every year. In either situation there will be ethical dilemmas. However, it is obvious that if the US wants to eliminate the current waiting list, something will have to change. If highly regulated, it is not impossible to have a system that both eliminates the waiting list for kidneys and protects donors from being exploited. Iran is a prime example of this; building off of their foundation, the US, as well as other countries currently struggling to meet the demand for organs, could use Iran’s model to meet the demand and reduce the risks of exploitation often associated with the organ market. It seems hopeful that in the coming years, as research continues to be made on the topic, a more viable solution to the demand for organs will be implemented within the US.