Authored by Amina Khan, Biological Sciences '22
Art By Ishani Chopra, Biological Sciences and Information Science '24
Thousands of patients are added to the transplant list daily, but many more die while in pursuit of new organs [1]. Organ transplantation is cost-efficient and leads to optimal healthcare outcomes compared to other forms of treatment, yet presents one of the greatest dilemmas in healthcare at the moment. Why? The supply of organs is nowhere close to meeting the demand. Transplant surgeons and activists have suggested introducing financial incentives to tackle this issue. Although this would directly increase the number of donors that are available, there will be quite a few negative consequences. These include ethical issues regarding social justice, safety of patients including principles of beneficence and doing no harm, and the commodification of body parts by treating an individual as an end to themselves and not a means.
Four forms of prominent financial incentive markets are considered: unregulated current market, regulated current market, payment for consent futures market, and family reward futures market. The unregulated current market allows non-vital organs to be sold by living donors. ‘Current’ refers to the removal of organs following the agreement to sell. ‘Unregulated’ refers to low government regulation and leaves price determination up to a free market. Regulated current market entails the sale of organs from living sources in a state regulated monopoly [2]. The payment for consent futures market involves conducting futures contracts in which an economic agreement is made where a fixed price is determined by the buyer and seller for a specified time in the future such as after death [2]. Family reward futures market includes an agreement about the rights to remove organs after the seller dies, and the payment goes to the family of the seller. This system involves government intervention and a state-based monopoly of organs.
Many ethical considerations are raised by the addition of financial incentives in organ donation. To begin with, prevailing patterns in the US healthcare system show that racial/ethnic and socioeconomic status disparities have been linked to negative health outcomes [3]. Moreover, those who are most disadvantaged and are the ones who wait the longest to receive healthcare are disproportionately African Americans [4]. Introduction of financial incentives could lead to further discrimination or oppressive practices towards minorities. Patient voluntariness may be threatened as extreme financial situations arise. The family reward futures market may be able to prevent this, as it eliminates the need for immediate compensation and potentially removes vulnerable populations such as the homeless from the seller pool.
Secondly, the commodification of organs would allow the value of the goods to increase or decrease once a price is assigned. This would assign a value to human body parts, which has been deemed ethically impermissible as this class of goods is known to be “sacred” in the world of science, technology, and religious ideals. Also, several questions are raised in terms of who would be involved in the process of organ sale, who would determine the prices, and whether or not homeless/impoverished individuals would be allowed to donate. It is uncertain whether all socioeconomic classes would have access to organs.
Additionally, there is still debate as to whether the legalization of the sale of organs would achieve the primary goal of reducing the shortage gap or whether there would be a potential backspiral due to those sellers later requiring organs. The healthcare costs of patients who have sold may also substantially increase as a long term consequence. Debates that concern families’ right to sell patients’ organs before their death would also present issues of consent and potential exploitation. A patient who has a neurological disorder is at risk of exploitation by the surrogate decision maker’s need to financially profit. Patient susceptibility to pain is also debatable due to uncertainty around complete loss of circulatory function or brain death. This creates a form of “medical charades” in which the clinician attempts to “have confidence that the heart will not restart on its own, and the patient or surrogate agrees that resuscitation will not be attempted” [5].
Thus far, several arguments in support of financial incentives have been considered. According to Dr. Arthur Matas, a surgeon at the University of Minnesota, those who are against financial incentive on the moral basis that there may be potential exploitation of the potential paid donor or the loss of society’s human dignity, are actually just subjecting many transplant candidates to death [6]. This presents “antiquated moralism rather than legitimate problem-solving” [4]. Supporters of financial incentives also claim that organ selling is beneficial to both parties involved. The donors receive an additional means of income, and the recipients enjoy longer, healthier lives. It is also important to recognize that surrogate mothers and sperm and egg donors could also be rewarded. Furthermore, the principles of autonomy are considered. Bioethicist Mark Cherry argues that one cannot deny an individual the authority over their own body or limit that person’s ability to engage in a process that would greatly improve the individual’s living standard [4].
Despite the emphasis on patient autonomy and the potential solution to the increasing organ demand, introducing a financial incentive for organ transplantation needs a great deal of more research on its efficacy. Important questions concern the ethical permissibility of pricing human body parts, how strict regulations will be put in place to protect minorities, and whether long term success rates can be predicted.
Works Cited
Hodge, S. D., & Saitta-Gill, N. M. (2015). Solving the Problem of Organ Donation Shortage.
University of Baltimore Law Review, 45(1).
Albertsen, A. (2020). If the price is right: The Ethics and efficiency of market solutions to
the organ shortage. Journal of Bioethical Inquiry, 17(3), 357–367. https://doi.org/10.1007/s11673-020-09981-y
Khanijahani, A., Gholipour, K., Azami-Aghdash, S., & Iezadi, S. (2020). Protocol for a
systematic review and meta-analysis of racial, ethnic, and socioeconomic disparities in covid-19. https://doi.org/10.21203/rs.3.rs-35394/v1
Flescher, A. M. (2018). The organ shortage crisis in America incentives, civic duty, and
closing the gap. Georgetown University Press.
Truog, R. D., Miller, F. G., & Halpern, S. D. (2013). The dead-donor rule and the future of
organ donation. New England Journal of Medicine, 369(14), 1287–1289. https://doi.org/10.1056/nejmp1307220
Matas, A. J. (2008). Should we pay donors to increase the supply of organs for
transplantation? yes. BMJ, 336(7657), 1342–1342. https://doi.org/10.1136/bmj.a157