Should It Be Legal to Sell Organs?

There are more than 80,000 people in the U.S. on the United Network for Organ Sharing/Organ Procurement and Transplantation Network kidney transplant waiting list. Little more than 13,000 kidneys are donated—either by living or deceased donors—each year, not nearly enough to provide kidneys for all those on the list.

Last year, 16,517 people received kidney transplants, while 4,530 people died, though 1,600 of them were too sick to receive a possible transplant.

There is an international black market for organs that flourishes in many Third World countries and preys on the poor and desperate. The buying and selling of organs in the United States is banned under the 1984 National Organ Transplant Act, and medical organizations are united in their opposition to it.

There are, however, some doctors and ethicists who argue that a legal, regulated organ market would help solve the shortage of donor kidneys and save lives.

Advocates of legal organ selling say that a financial incentive would increase the number of organ donations by healthy individuals or the families of the deceased. Writing in a 2005 edition of Kidney International, Drs. Eli and Amy Friedman say that as many as 100,000 people could be saved annually by introducing a regulated kidney market.

“Introducing appropriate legalization to regulate and manage kidney sales through a national regulatory body would be a ‘natural’ extension of the present end stage renal disease network collaborating with United Network for Organ Sharing and the OPTN,” they write. “Eliminating black market brokers would divert funds to kidney sellers. Money saved by decreasing the number of dialysis patients might fund additional kidney transplants.”

“It should be noted,” writes Ronald Bailey for the libertarian journal Reason, “that in the United States we already have robust markets for blood, semen, human eggs and surrogate wombs. Extending markets to include non-vital solid organs such as kidneys and pieces of liver, which can be obtained with reasonable safety from living donors, is not such a stretch.”

However, many object to an organ market because it would exploit the poor. “Even in a regulated, government-run version of transplant tourism, ‘unethical realities’ lead to exploitation of the poor and the vulnerable,” argued Harvard Medical School professor Francis L. Delmonico at a 2008 Harvard symposium on the issue.

Virginia Postrel, writing in The Atlantic, contends, “A well-designed system could address the concerns about donor welfare by including educational programs, waiting periods, and follow-up care for donors, and possibly by allocating the payments over time rather than offering immediate cash.”

Delmonico also contends that a market “will virtually destroy altruism and deceased donations,” citing examples in Iran, Hong Kong and Israel.

Postrel counters, “Some volunteers would undoubtedly drop out, relieved to let someone else provide their loved one’s new kidney. But real incentives, rather than token rewards, would produce a net increase in the number of transplants.”

Harvard ethicist Nir Eyal said at the sympsosium that, though buyers and sellers would benefit in the trade of an organ, there was a potential for an organ market to cause “dignitary harm” to the organ donors and stigmatize the poor communities from which the majority of donors would come.

Claire Andre and Manuel Velasquez, in a 1988 issue of Issues in Ethics, took a similar stance: “We will have to choose between two sets of moral values: the value we place on preventing death and alleviating suffering, and the value we place on respect for human dignity and our commitment to meeting human needs in a fair and equitable manner.”