Wednesday, November 26, 2008

Organs for Sale

Organ donation has always been regarded as an altruistic act. Thus all government, professional societies and ethics committees regard it as unethical to allow for sales of kidney. Altruism is implied that a person donates an organ (usually a kidney) without coercion and receiving any compensation including financial ones. Their only reward is satisfaction in their self-sacrificial action. Unfortunately there are not many altruistic persons around. Most organs for transplants come from brain dead or dead donors (cadaveric organ transplants). Very few living persons come forward as donors. The result is a scarcity of organs for transplants which results in thousands of deaths for want of organs.

By not allowing sales of organs, these organisations have unwittingly created a black market for organs sales. Unscrupulous middlemen have arisen to take advantage of the needs of organs. In countries where the laws were not so stringent, a commercial transplantation trade of transplant tourism has arisen where one may buy a kidney if one is willing to pay and not ask too many questions. There is no protection for donors. Horror stories abound of people being kidnapped and their kidneys removed, the poor exploited or prisoners forced to donate their kidneys. The middlemen reaped large amount while the donors were given pittance. In a recent court case in Singapore, the donor received $23,700 for his kidney out of the $300,000, magnate Tang Wee Sung paid the middleman. This is the unregulated free market!

In an effect to address the scarcity of organs for transplantation, the Singapore government has taken the bold step of legalising the monetary ‘compensation’ for kidney donors (The Straits Times, Nov 1, 2008). The amount which may be in five or six figures will compensate the donors for their kidneys. It is also suggested that all transplants be regulated through an independent organisation to ensure that the donors will not be taken advantage of. Singapore sidestepped the ethical issue by allowing monetary compensation rather than sales. This is the semi-regulated approach to organ donations.

A third alternative is the Iranian model which the fully regulated model. In Iran, all organs transplants are done through a state-sponsored body which regulate organ transplant in a transparent, non-commercial, and middle-man free process. Donors are paid by this government sponsored agency. It has worked well so far and in Iran there is no waiting list; all patients (rich, poor, educated, uneducated) have receive their transplants. Iran has a government sponsored healthcare system so the model may not work in other countries.

Is there a difference between a sale and compensation? A sale is a business transaction while a compensation is something given for something lost or given. However when it comes to human organ, it is a thin line between the two. It is interesting to note that while it is unethical to sell one’s kidney, however it is acceptable to sell one’s sperms or eggs or in some countries, blood. The moral ethical basis that lies behind the forbidding of sale of human organs come from the group of moral theories called virtue-based theories. The virtue-based theories are based on the premise that human beings are basically good and altruistic. Reality has however shown how far that is from the truth.

It may be time for us to review the ethics of human organ sales. What do you think?

picture credit


Gordie Hayduk said...

And in America it will be known as Donate-For-Life Organ Donor Program. It is better than the Singapore arrangement and even better than the Iran scenario. Free transplantation and several forms of incentive to boot. Within 48-months all or most of the 100,000 persons on the UNOS waiting-to-die list will have a transplant.

Alex Tang said...

Hi Gordie Hayduk,

Thank you for alerting us to the Donate-For-Life-Organ-Donor Program. I have been exploring your website but I could not find information about when was the program set up, how would it be self-sustaining and how many organs were actually donated and transplanted.

Gordie Hayduk said...

Greetings Alex Tang...

Obviously I'm not an active blogger -- I only reply when a Google Alert Search informs me that Donate-For-Life Organ Donor Program has been located by their search robots. So here I am addressing an old query. My apologies Alex Tang.

The 'program' is 5-years-old; an effort of love lost after my wife was unable to obtain a liver in a timely fashion. Since that point in time David and I have been working out all the details -- trying to work around the legal and ethical issues. Finally, just recently, all the pieces have been brought together and we have the final SOLUTION. Now we need funding.

Apparently death is a scary topic to many/most people and they avoid discussing it at all costs, so it has been an uphill effort to interest government and/or a venture capitalist in providing upfront money to effect a solid startup.

Now we're focused on California -- where an economic vitality organization, a venture capitalist and the governor's office may be willing to collaborate to achieve a success story. The economy is a huge factor because it will bring business to California (As always, the devil is in the details). Sorry, I can't reveal all the details because too many people would try to do the same thing and ruin our win-win-win effort. We have a presentation target date of May 15, 2009.

The DFL program could work in virtually every country, although it might require some modification because of cultural considerations.

I stand by my initial post to your blog.

I am VERY persistent about locating startup financing; afterward it will be self-sustaining due to taxpayer savings, and other resources.

Thank you for inquiring.