Organ Failures

Organ Failures November 17, 2008

In a recent speech, Pope Benedict addressed the subject of organ donation:

If we turn our gaze to the entire world, it is easy to confirm the numerous and complex cases in which, thanks to the technique of organ transplantation, many people have overcome extremely grave illnesses, and in them the joy of life has been restored. This would never have happened if the commitment of the doctors and the competence of the researchers had not been able to count upon the generosity and altruism of those who have donated organs.

Unfortunately, the problem of the lack of available vital organs is not a theoretical one, but a considerably practical one; one can see this in the long waiting list of those whose only hope for survival is linked to the small number of non-useful donations.

Regarding the technique of organ transplants, this means that one can only donate if this act doesn’t put one’s own health and identity in serious danger, and if it is done for a valid moral and proportionate reason. Any reasons for the buying and selling of organs, or the adoption of utilitarian and discriminatory criteria, would clash in such a way with the meaning of gift that they would be invalidated, qualifying them as illicit moral acts. Abuses in transplants and organ trafficking, which frequently affect innocent persons, such as children, must find the scientific and medical community united in a joint refusal. They should be decidedly condemned as abominable.

In the above passage, the Pope notes two problems with the current situation regarding organ donation: 1) there aren’t enough willing donors to meet the need for transplants, and 2) there is a black market in organ trafficking, which often harms involves innocent persons, including children.

Both of these problems could be easily solved, at least in some cases, if one were to allow payment in exchange for of donation. Kidney transplants, for example, can be done by a living donor. Most people are born with two Kidneys. Only one, however, is needed for survival, and unlike someone who only has one lung or one eye, the loss of a kidney does not result in the loss of any functionality (and since most kidney ailments will affect both kidneys simultaneously, donating a kidney does not mean subjecting yourself to greater health risks other than those typically associated with surgery). There are currently more than 60,000 people in America on a waiting list for a kidney, and thousands die waiting every year (many from suicide). Some are so desperate that they seek organs abroad or on the black market, where donors are often not willing. Allowing payment for donation would increase the supply of willing donors, saving literally thousands of lives a year, and would dry up demand for black market kidneys, eliminating abuses much in the same way that the end of alcohol prohibition put an end to the violence associated with the booze business.

Granted, the Pope does say that the buying and selling of organs are “illicit moral acts.” But not every immoral act need be illegal. As St. Thomas says, attempts to suppress a particular evil sometimes lead to outbreaks of yet greater evils, and where this is so the just statesman will not attempt to suppress it, but will focus his energies elsewhere. Attempts to prohibit the buying and selling of kidneys have led directly to a shortage of willing donors, thousands of deaths each year, and a black market in which unwilling donors, often including children, have their organs forcibly removed. A prohibition on the sale of kidneys, therefore, would seem to fall within the realm of legal toleration advocated by St. Thomas.

No doubt an unregulated market in kidneys is not politically feasible. But this is no reason to assume that some compromise on the issue couldn’t be reached. Many people, for example, seem to be open to compensating donors for some of the costs associated with donation (e.g. travel and medical expenses, lost income due to time away from work, etc.), even if the find compensation for other costs (e.g. the risks associated with surgery or the ordinary fear of going under the knife) morally repulsive. I don’t happen to see the difference myself, but many do and there may be a wisdom of repugnance argument here. All donations could still be done through the Organ Procurement and Transplantation Network, and could include whatever safeguards are deemed necessary to prevent the sorts of abuse and potential for exploitation that make people wary of a “pure” kidney market.

(HT: ZippyCatholic)

UPDATE: It looks like Singapore will soon be allowing compensation for kidney donation along the lines of my proposal. Previously only Iran allowed such payments.

(HT: Marginal Revolution)

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  • Zak

    Isn’t facilitating the buying and selling of organs through a state-run (or aided) donor network contrary to the common good, in the same way as state distribution of condoms or sanctioning of homosexual activities is contrary to the common good? After all, I am the state, right?

    It seems to me that it is insufficient to refer to Aquinas and then make a utilitarian argument about the good of organ transplantation. Setting up a market in which people are able to sell their organs fosters the notion that our bodiexs are mere instruments that can be sold in our service, rather than integrated parts of ourselves. To separate part of one’s body from oneself should only be through an act of charity – a sacrifice, and not something done for profit.

    That does not mean that one ought to take on extra hardship, from losing the money one would have made through working, or through paying for the cost of the transplant procedure. Compensation for those financial expenses seems of a different nature than compensation for the intangible factors: risk, fear, stress, pain.

  • Blackadder


    Payment in the sort of system I’m contemplating would presumably limited to compensating people for travel and medical costs, and other sorts of compensation that aren’t considered morally objectionable. The idea is to create a system that achieve the given end while meeting typical objections regarding abuse and the (im)morality of straight selling.

  • Zak

    I think I misinterpreted what you were saying then. I think I would also support the “implied consent” regime for donations common in Europe, assuming protections are put in place to prevent its abuse. But that’s for organs from dead donors, and recent debates about brain death could affect that consideration quite a bit.

  • blackadderiv

    Yeah, even if everyone were to sign a donor card, this wouldn’t solve the kidney shortage. I find it curious, though, that people are so much more friendly to the opt-out idea than they are the idea of donor payment. To the extent one opposes payment based on the symbolism involved (i.e. that it fosters the notion that our bodies are mere instruments that can be sold in our service), an opt-out provision would seem to raise similar symbolic concerns (i.e. your body presumptively belongs to the state).

  • jpf

    I’m not a big believer in organ transplants. I admire this little girl and her family

    It is a decision that flies in the face of societies current view that we should cling to life at all costs.

    Some British Catholic groups have denounced this decision as promoting euthanasia, but I don’t see where rejecting an extreme procedure like this is against Catholic teaching – I don’t recall ever being taught rejecting an organ transplant is suicidal.

    but here is an interesting article supporting the sale of organs by Nobel winner Gary Becker:

    Compensating donors just for transportation costs and their medical expenses will not accomplish anything – I assumed that living donors already had those costs covered.

  • jpf

    On a similar note. Would the same folks (including the Pope) oppose opening up the adoption process to the market, i.e., allowing mothers to sell their unwanted children, if it would decrease abortion?

    Similar arguements are made against child selling as are made against selling organs – subject to abuse yada yada yada – and it is something that is far better if done altruistically rather than done for profit (BS). Judge Posner in another article makes the arguement for baby selling: