The Sale, Donation, and Trade of Human Organs

The Sale, Donation, and Trade of Human Organs

Introduction

The subject involving the ‘sale, donation, and trade of human organs’ elicits mixed reactions whenever discussed by healthcare professionals or ordinary citizens, as seen in a 2008 article by the New York Times titled “What’s Wrong with Selling Kidneys.” This was the exact question that was posed by the British Medical Journal, pitting two doctors against each other; an Australian nephrologist (against the sale of human kidneys) and an American transplant surgeon (in favor of). The American doctor rooted for organ sale and trade by arguing that the world is now ready to legalize the sale and trade of human organs because relying on altruism to define or as the standard for organ exchange – which has been the case – can no longer suffice the growing list of patients whose life depends on getting a willing donor. The American Transplant Foundation in 2019 estimated that approximately 114,000 citizens are at every moment on the waiting list for a life-saving organ transplant countrywide. Besides just one more being added each passing 10 minutes, 20 more succumb to organ failure due to inability to access their desired organs.

However, the Australian nephrologist opposed the commercializing of human organs on the basis of ethics, insisting that legalizing the sale and trade of human organs would create an ‘economic class war.’ Several other experts in recent years have voiced their support or opposition to the sale of human organs. For instance, Bramstedt (2014) opposed the sale of human organs, arguing that “if all patients have equal value as humans, then they should have equal access to health care.” But, this rule tends to crumble when organs can be traded, sold, and bought in a free, unregulated market. The consequence is that rich patients will have access to all organs, meaning that they will be given the power to purchase life, while poor patients will die from the inability to compete with their wealthier counterparts in a similar market.

In this paper, I intend to argue that the sale, donation, and trade of human organs should not be legalized because it abates all the moral principles attached to organ donation, including fairness, respect for persons, altruistic principles, and the establishment of a fair organ transplantation system. I will specifically use these criteria to argue that the case involving the jailing of four doctors in China for illegally trading organs of their patients breaches the rules of fairness, altruism, justice, and respect for human dignity and worth.

The Case

As reported by the BBC, Chinese authorities sentenced six individuals, including four high-ranking physicians, for 10-28 months in 2020 for engaging in unlawful and unethical organ harvesting and trafficking. The six illegally harvested organs from accident patients and sold them on the black market without following the proper procedure of organ donation, including informing the family members as well as seeking their consent to perform the procedures. According to the BBC, the group duped family members of deceased patients, most of which were involved in accidents, into thinking they were making certified or authorized organ donations. The criminals illegally removed and sold kidneys and livers from a total of 11 accident patients at a health facility in Anhui province. They primarily targeted car accident victims who suffered from brain damage, especially cerebral hemorrhage, in one of Anhui’s leading hospitals, Huaiyuan County People’s Hospital.

Yang Suxun, the facility’s head of the ICU, would approach family members of the victims of car crashes to ask if they would append their signatures to allow their loved ones to donate their organs. These would later be revealed to be fake consent documents after the organs have already been harvested and sold. The secret was exposed in 2018 by Shi Xianglin following the death of her mother. The whistleblower discovered several months after her mother’s demise that the forms his family was given to allegedly show that her mother consented to organ donation were not official; they contained some discrepancies, such as blank spaces in some parts. Xianglin discovered that there were no records showing that her mother appended her signature or consented for her organs to be harvested and given to patients who needed them. When he contacted Yang about these discrepancies, he was quickly offered a huge cash reward for his silence (BBC, 2020).

Definition of the Boundaries or Criteria for Disallowing or Illegalizing the Sale and Trade of Human Organs

Ideally, the concept of organ transplantation has been anchored on four primary ethical tenets, criteria, or boundaries: fairness, respect for persons, acceptable intrigues or appeals for organ transplants (such as altruism), and a universal stake in a trustworthy framework. Therefore, allowing the sale and trade of organs in a market regulated by the forces of price and demand, as well as the bargaining power of the buyer and the bargaining power of the seller, contravenes these four ethical principles that were traditionally set to define organ transplant and donation.

The first principle, a call for the establishment of a common or universal stake in a trustworthy framework, primarily implies that each person has a common pledge or participation in the creation and protection of a trustworthy and effective system that provides prompt access to transplant organs. Thus, in the case of organ scarcity, every individual has a similar role in improving the availability and fair distribution of these organs.

The second principle, suitable appeals for the distribution of organs, denotes the established practices, guidelines, and policies intended to persuade people to donate organs. One of the ethically accepted persuasion appeals that guide organ donation is altruism rather than reciprocity. Altruism simply refers to the act of selfless and disinterested concern for the welfare of other citizens. This simply implies that organ donors give out their organs even to strangers without expecting financial or any kind of reward from them, including recognition. Reciprocity, on the other hand, is a term used by proponents of organ sale and trade to denote ‘a mutual exchange’ of benefits and privileges. This liberal thinking calls for rewards to be given to donors for their decision to donate their organs, a term that antagonists challenge for lack of self-sacrifice, humanity, and selflessness, perhaps because these actions are motivated by monetary rewards.

The third moral criterion that should guide the process of organ donation and transplantation is ‘respect for people.’ The term respect is traditionally inherent in the healthcare ethical principles, in addition to autonomy (giving people the right to make independent choices), beneficence (doing what benefits other people), and non-malfeasance (avoiding actions that could harm or jeopardize the well-being of others). Respect for persons is a criterion that requires people involved in the organ transplantation process, including organ recipients and brokers, to respect the right of each donor to know all the procedures surrounding the disposition of their organs, including the risks and benefits.

The last criterion is fairness or justice for the donors or their family members. Apart from respect for the dignity, worth, feelings, and wishes of donors, the organ donation process must be able to serve all parties fairly, justly, and equitably. This guideline requires that practices and policies created to meet the rising demand for organs by increasing supply must be fair in the distribution of burdens and benefits. A particular concern is, however, placed on the negative impacts of these processes on vulnerable or disadvantaged populations. Coercion has been one of the malpractices critics of the legalization of the process have often cited as likely to propagate exploitation of the disenfranchised people (Taylor, 2006).

How the Case Meets the Definition Boundaries/Criteria

The illegal harvesting of the organs of unconscious and mentally challenged patients without their consent should be banned because it breaches all the moral principles attached to organ donation identified above, including fairness, respect for persons, altruistic principles, and the establishment of a fair organ transplantation system. For example, the principle of altruism states that the process of organ donation or transplantation should not be monetized or done for any gains; the donor simply gives out willingly some of their organs for humanity or kindness reasons and out of goodwill. This is evidently not the reason why the Chinese doctors harvested the organs of 11 individuals at Huaiyuan County People’s Hospital in Anhui province. Their actions were hugely driven by an appetite for profits by harvesting organs of unconscious or dead car crash patients and selling them for a profit in the black market.

In addition, the Chinese doctors and the other two brokers failed to respect the life, worth, wishes, and dignity of those people who illegally harvested their organs, particularly because they never consented to them when removing their organs. As narrated by Xianglin, the individual who blew the whistle following the demise of his loved one, there were no records showing that her deceased mother appended her signature or consented for her organs to be harvested for life-saving or medical reasons. Similar to other cases, the rogue physicians presented fake consent forms to families of the victims of accidents, especially those who suffered a severe brain hemorrhage, duping them into believing their family members truly signed them.

The term ‘respect for individual rights’ is often an issue in the open market because physicians and brokers have the tendency to lie and dupe donors – who are majorly the poor – into giving out their organs, claiming that their donated organs will grow back after a short while, which is not the case. Another ethical concern has always been to respect the dignity and worth of donors, as well as the feelings and wishes of their family members, especially if these individuals are mentally incapacitated and cannot make sound decisions. This is the case for children or mentally challenged individuals and is clearly one of the reasons why the six Chinese people, including four physicians, were jailed for 10-28 months in 2020.

In recent years, several other cases across the world, especially in Asian countries, have shown how unscrupulous and greedy physicians have conspired with a ring of brokers in the black market to defraud poor and ignorant individuals and families for their organs, as well as the promised compensation. Even legal avenues to have them receive the fully-agreed money – as well as justice for malpractices during these procedures, some of which resulted in death or incapacitation – have been futile because of corruption. As Taylor (2006) puts it, these greedy individuals often engage in unethical practices, including coercion, to convince the poor to sell their organs, and sometimes even fail to fairly and fully compensate them the agreed amount of money. It is estimated that recipients can pay as much as $100,000 and more for a kidney in the U.S., and donors often receive as little as $1,000 in poor countries like Pakistan. The United Nations (2018) also estimates that nearly 10 percent of all organ transplants done globally are from the black market.

However, this position does not mean that there is no convincingly overarching code that might justify the sale and trade of human organs: the principle of beneficence requires doing what benefits others (Lauerer, Kaiser, & Nagel, 2016). Based on this moral code, society needs to take actions that benefit other people, and this includes designing and implementing policies and procedures that save lives. Passing laws that permit organ sales and trade can be one of the ways people can benefit from the good deeds of others.

Conclusion

The sale, donation, and trade of human organs should not be legalized because it abates all the moral principles attached to organ donation, including fairness, respect for persons, altruistic principles, and the establishment of a fair organ transplantation system. From the case involving the illegitimate organ harvesting and sale in China that led to the incarceration of six individuals, including four physicians, it is evident that legalizing the sale of organs in an open market not only violates the rights of patients to fair compensation and access to information about the risks involved but also defies the principle of altruism. Regardless, this does not disqualify the fact that it is increasingly getting hard for patients to get donations from altruistic actions because very few people are willingly ready to donate their organs freely. However, if the trade or sale is to be legalized, the market should be organized and overseen by authorities to cut off deceitful, corrupt, and unethical cartels that often involve healthcare professionals.

References

American Organ Foundation. (2019). Facts and myths. Retrieved from https://www.americantransplantfoundation.org/about-transplant/facts-and-myths/#:~:text=Almost%20114%2C000%20people%20in%20the,of%20available%20organs%20for%20transplant.

BBC. (2020, Nov. 27). Chinese doctors jailed for illegal organ harvesting. Retrieved from https://www.bbc.com/news/world-asia-china-55097424

Bramstedt, K. (2014, Aug 21). Buying and selling organs would create an economic class war. New York Times, https://www.nytimes.com/roomfordebate/2014/08/21/how-much-for-a-kidney/buying-and-selling-organs-would-create-an-economic-class-war

Lauerer, M., Kaiser, K., & Nagel, E. (2016). Organ transplantation in the face of donor shortage – ethical implications with a focus on liver allocation. Visceral Medicine, 32(4), 278-285.

New York Times. (2008, June 20). What’s wrong with selling kidneys? New York Times, https://www.nytimes.com/2008/06/20/opinion/20iht-edsatel.1.13856658.html

Taylor, J. S. (2006). Black markets, transplant kidneys, and interpersonal coercion. Journal of Medical Ethics, 32(12), 698-701.

United Nations. (2018). Global Report on Trafficking in Persons. United Nations Office on Drugs and Crime. Retrieved from https://www.unodc.org/documents/data-and-analysis/glotip/2018/GLOTiP_2018_BOOK_web_small.pdf

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Write a 1,500-1,750-word essay using five to seven academic resources in which you argue that a contested “case” involving the sale, trade, or donation of human organs fits (or does not fit) within a given category. A case may include a specific news article, story, or incident illustrating a dilemma or controversy relating to the exchange of human organs. The case does not need to be a court case.

 Directions

Follow these steps when composing your essay:

1. Start by selecting a controversial case found in the media involving the sale, trade, or donation of human organs. For example, an appropriate case might include a story in the news about an organ broker, and the term to define might be “criminal.”
2. Decide what category you think your case belongs in, with the understanding that others may disagree with you about the definition of your category and/or whether your chosen case matches your category.
3. In the opening of your essay, introduce the case you will examine and pose your definition question. Do not simply summarize here. Instead, introduce the issue and offer context.
4. To support your argument, define the boundaries of your category (criteria) by using a commonly used definition or by developing your own extended definition. Defining your boundaries simply means naming the criteria by which you will discuss your chosen case involving the sale, trade, or donation of human organs. If you determine, for example, that an organ broker is a criminal, what criteria constitute this? A criminal may intentionally harm others, which could be one of your criteria.
5. In the second part of your argument (the match), show how your case meets (or does not meet) your definition criteria. Perhaps comparing or sizing up your controversial case to other cases can help you to develop your argument.

This essay is NOT simply a persuasive essay on the sale, trade, or donation of human organs. It is an argumentative essay where the writer explains what a term means and uses a specific case to explore the meaning of that term in depth.