Intended for healthcare professionals


An ethically defensible market in organs

BMJ 2002; 325 doi: (Published 20 July 2002) Cite this as: BMJ 2002;325:114

A single buyer like the NHS is an answer

  1. John Harris, Sir David Alliance professor of bioethics (,
  2. Charles Erin, senior lecturer in applied philosophy (
  1. Institute of Medicine, Law and Bioethics, School of Law, University of Manchester, Manchester M13 9PL

    The American Medical Association has just voted to encourage studies that would determine whether financial incentives would increase the pool of donor organs from cadavers.1 The association is only eight years behind a proposal that we made, outlining probably the only circumstances in which a market in donor organs could be achieved ethically and in a way that minimised the dangers of such a scheme. This is how an ethical market in live organs would work.

    To meet legitimate ethical and regulatory concerns any such scheme must have built into it safeguards against wrongful exploitation and show concern for vulnerable people, as well as taking into account considerations of justice and equity. If all this can be done then a market in human body products will be shown to be, at the very least, not prima facie unethical.2

    One way of attending to this need for prudent regulation would be to establish a monopsony, a situation where only one buyer exists for the products of several sellers.3 The one legitimate purchaser in the marketplace would be required to take on responsibility for ensuring equitable distribution of all organs and tissues purchased. This would prevent the rich using their purchasing power to exploit …

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