Intended for healthcare professionals

Analysis And Comment Controversy

Payment for living organ donation should be legalised

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38961.475718.68 (Published 05 October 2006) Cite this as: BMJ 2006;333:746

Is consistency enough?

This was an interesting paper, but its central premise seems faulty.
Throughout the paper the author gives three main arguments for the
introduction of paid organ donation. These are:

1. The reduction of people heading overseas to buy organs

2. The financial and other benefits of more people getting organs for
transplantation

3. A consistency with other practices like tissue donation, embryo
donation and commercial surrogacy.

Considerable weight is put on this third argument, with it being used
to rebut several significant objections to the introduction of paid organ
donation. Thus I will focus on this argument, after briefly examining the
other two.

Argument 1.
While it is the case that the introduction of commercial organ donation is
likely to reduce the number of people heading overseas to procure organs
for transplantation, it is likely to only reduce it, not eliminate this.
This is simply a function of supply and demand, while introducing new more
convenient organs will reduce the demand for overseas organs it will not
eliminate the demand as long as those overseas organs remain significantly
cheaper to procure than home based organs. Furthermore, making organs
commercially available implicitly endorses traveling overseas to purchase
organs since it removes the stigma associated with purchasing organs.
Transplantation tourism seems here to stay.

Argument 2.
The economics of commercial organ donation are likely to be very complex
and we should not rush into making a judgment about the financial benefits
of this without further consideration. While this is likely to lead to an
increased supply of organs this increase may be offset by significant
decrease in non-commercial organ donation. In other words it may be the
case that paradoxically costs will over all increase. While what is being
discussed is only living organ donation might there not be flow on effects
to non-living organ donation? How long will it be before someone demands
payment before they allow their family member’s organs to be taken?

Furthermore simply because something will reduce economic costs is
not enough to legitimize it morally. For example the using of the organs
of those who are sentenced with the death penalty would be more
economically viable than commercial organ donation, but clearly this would
not make it right.

Further there is an economic worry here as well. John Stuart Mill
argued that one powerful reason to outlaw slavery is that if we allow it,
then it would become a standard condition of defaulting on contracts. In
other words sometimes giving us an option actually reduces our choices.
Likewise might not the donation of organs in lieu of or to underwrite
payment become an aspect of common contracts such as mortgages?

Argument 3.
As I said earlier this is the crux of the argument given in Professor
Friedman’s paper, both in terms of suggesting that we are inconsistent if
we allow payment for tissue donation but also crucially in defending
against objections such as the exploitation objection.

Unfortunately consistency based arguments have a crucial weakness,
namely they rely on what is currently practiced being morally acceptable.
If it is not then the argument cuts the other way, what it shows is that
current practice ought to be banned, not expanded.

It is noted by the author that many present commercial human tissue
donation practices are exploitative; this ought to be a reason to question
those practices, not to add another one to the mix.

Competing interests:
None declared

Competing interests: No competing interests

08 October 2006
David Hunter
Lecturer in Bioethics
University of Ulster, Northern Ireland, BT52 1SA