The Hidden Cost of Organ Sale

Abstract

The idea of establishing a market for organs is now the subject of unusual controversy. Proponents emphasize the concept of autonomy; opponents invoke fairness and justice. The controversy, however, has given sparse attention to what it would mean to society and medicine to establish a market in organs and to the intended and unintended consequences of such a practice. This article addresses these issues by exploring the tensions between 'extrinsic' and 'intrinsic' incentives, suggesting that donation might well decline were financial incentives introduced. It also contends that social relationship and social welfare policy would be transformed in negative ways and that a regulated market in organs would be extraordinarily difficult to achieve. Finally, it argues that organ sale would have a highly detrimental affect on medicine as a profession.

Does the ethical appropriateness of paying donors depend on what body parts they donate?

“…The idea is that would-be providers who seek financial gain have an incentive to hide potentially disqualifying medical information, in contrast to providers who have the recipients' interest at heart. This concern has been raised in relation to blood donation (Titmuss 1970) and kidney donation (Rothman and Rothman 2006), but in principle it applies more broadly. Can body parts be distinguished on such grounds?…”

“…This assumption is far from unquestionable. A standard concern about paying providers is that doing so may discourage unpaid donation, causing an overall decrease in supply (Titmuss 1970, Rothman andRothman 2006) -a concern that is supported by a large body of empirical evidence showing that financial incentives can have unexpected effects and even be counterproductive (e.g. Gneezy and Rustichini 2000).…”

Kidney Sales and the Analogy with Dangerous Employment

“…In The Gift Relationship, Richard Titmuss (1970) famously challenged that assumption, arguing that markets in blood were less rather than more efficient than systems relying on unpaid donation because they discouraged altruistically motivated donors. Analogous concerns have been raised about buying and selling other body parts, including kidneys (Zutlevics, 2001, p. 301;Rothman and Rothman, 2006). Insofar as such concerns can be given adequate empirical support (which arguably they currently lack; NCB, 2011), they provide a possible non-paternalistic rationale for banning kidney sales.…”

Key issues in transplant tourism

“…It also undermines altruistic donation of cadaveric organs, encourages exploitation of kidney donors by unscrupulous middlemen and endangers the lives of donors undergoing nephrectomy in poor, unregulated conditions [74,76,77] . Rothman et al [78] speculate that the introduction of cash payments may weaken the moral obligation to donate. There are concerns about justice and fairness as well as it is felt that a market system rewards the better-off [75] .…”

“…Because dialysis is so much more expensive than a transplant, compensated donation could be cost-neutral to the healthcare system in developed countries. Despite this, the warning that a regulated market could be counterproductive to efforts to increase altruistic donation [78] must be considered carefully. The reported decrease in the proportion of living donor transplants in Hong Kong following the transfer of sovereignty from Britain to China may support this contention [77] .…”