Ethical dilemmas surround those willing to sell, buy kidneys on black market

Excerpted from “Ethical dilemmas surround those willing to sell, buy kidneys on black market,” CBS News. November 1, 2013 -- Government estimates show 18 people die each day waiting for a transplant, and every 10 minutes someone is added to the transplant list. The need for kidneys is especially high. As of October 25, 98,463 people were waiting for a new kidney in the U.S., the most requested organ by far. Thus far this year, only 9,708 kidney transplants have been completed.

The beauty of kidney donation compared to other organs is that people are born with two of them, making possible donation from a living person. But, the fact that people can live a normal life with one kidney has helped the black market kidney trade flourish.

Some argue that if the donor is made aware of all the potential risks and still consents, he or she should be free to sell a kidney. Advocates say if people are able to sell other body parts like hair or eggs, they should be allowed to get money for their organs. And recent research suggests paying for organs could reduce societal healthcare costs long-term. An Oct. study showed that if people were able to pay $10,000 for a living kidney donation, medical costs -- such as related to dialysis treatments -- would go down overall and patients would get additional quality years of life compared to the current system. However, the practice of getting paid for an organ is illegal everywhere except Iran.

Caplan believes that the current opt-in system of organ donations should be changed to an opt-out. Now, Americans select on their driver's licenses if they'd like to donate their organs, but they're calling for a system where everyone by default is a donor. The bioethicist noted that data show that most people are willing to be an organ donor, so the system should be changed, so the few who are against it can have their decision respected.

Commentary

Trauma Surgeon and CMDA Member Christine Toevs, MD: -- “This article touches on many of the current ethical issues related to organ procurement. The position offered by the organ procurement organizations (OPO) is as follows: organ transplantation is good and many people are waiting for organs; therefore, anything that increases organ donation is inherently good.

“The main solution provided to increase organ donation is to pay for organs; if we pay for organs, more will donate and we will save more lives. The problem with this argument is that studies have shown that paying for organs exploits the poor and very little of that money actually reaches the organ donor, most taken by brokers and middlemen. Since most of the organ donors would likely be poor, the risk of coercion and lack of informed consent increases. The aging of the population has resulted in an increase in chronic renal disease, and this increases the long-term potential health issues of the organ donor. When their kidneys fail, do they now go to the top of the recipient list? Who takes care of the organ donor and their complications when, which although rare, do occur?

“The OPOs have consistently demonstrated a lack of informed consent at any step of organ donation (is checking the box on your driver’s license really informed consent?). It is unlikely that even regulated markets for selling of organs will result in safer protections for the organ donors. People are not commodities with extra superfluous organs that should automatically go to others. There is great need for organs, but that need doesn’t allow for exploitation of others.”

Resources
Organ Donation Ethic Statement
Human Organ Transplantation Ethic Statement