Study Notes on the Buying and Selling of Human Organs Debate

Issue Summary

The debate centers around whether Congress should allow the buying and selling of human organs. This dialogue encapsulates arguments from both sides, providing insights on ethical, medical, and economic considerations surrounding the organ transplant system in the United States.

Pro Position: Robert J. Cihak and Michael A. Glueck

Cihak and Glueck argue in favor of a free market for kidneys, putting forth several key points:

Supply vs. Demand: The demand for kidneys far exceeds the supply. As of 2001, over 48,200 people were on waiting lists for kidney transplants, while only about 12,000 kidneys were available. The disparity has led to increasing waiting times and fatalities among those in need of transplants.
Inefficiencies of the Current System: The authors highlight the failure of the current organ procurement system, citing that thousands of dollars are paid to various parties (physicians, hospitals, and nonprofit organizations) while the organ donors typically receive no compensation beyond minimal reimbursement for expenses. The National Organ Transplant Act of 1984 makes it illegal to buy or sell organs, perpetuating the shortage.
Living Donors: Human nature exhibits that people can live healthy lives with a single kidney, hence a market for kidney sales would offer a viable solution. The authors argue that compensating donors could incentivize more people to donate, which would address the organ shortage.
Financial Implications: Based on UNOS statistics, dialysis costs approximately $40,000 annually versus $87,000 for a kidney transplant in the first year and $12,000 annually thereafter. Transplants prove more cost-effective in the long term.
Health Outcomes: Kidney transplants from living donors have significantly higher success rates compared to those from deceased donors, which raises questions about the existing procurement protocols that discourage living donor compensation.
Empowerment of Donors: A regulated market could empower individuals, particularly those in financial need, to make choices that could improve their lives while helping those who require transplants. This model argues against paternalistic views that restrict personal liberties in the name of protection.

Con Position: James F. Childress

Childress argues against the commodification of human organs and presents several foundational concerns:

Ethics of Commodification: Childress posits that allowing organ sales would degrade societal values of altruism, turning the act of donation into a transaction. It could diminish the inherent nobility of giving.
Economic Inequality: The potential market structure would likely lead to a scenario where wealthier individuals can purchase organs while poorer individuals sell theirs, exacerbating inequality.
Ineffectiveness of Markets: Childress questions whether a free market would even increase organ supply. Current statistics show that fears surrounding the acquisition of organs significantly deter people from signing donor cards. These fears would likely be amplified in a market system.
Lack of Trust: Trust in healthcare systems is eroded when commodification takes place. The anxiety that could arise from knowing that organs are being bought and sold could deter potential donors from participating in the existing donation system.
Existing Solutions: Instead of instituting a market, Childress advocates for bolstering public education, increasing trust, and changing societal attitudes towards organ donation. He believes that with the right initiatives, the current system can be made more efficient without introducing market dynamics.
Alternative Incentives: Suggestions include symbolic recognition for donors or potential coverage of funeral expenses. Such gestures could appreciate the act of donation without creating a market for organs.

Conclusion

The innate challenge is balancing the ethical implications of commodifying human life with the dire need for organs in transplant situations. The debate reveals deeply ingrained beliefs about altruism, societal values, the concept of ownership of one's body, socioeconomic disparities, and the existing inefficiencies within the healthcare system. Current discussions in literature also highlight the evolving nature of this issue and explore various solutions while weighing the moral ramifications of each proposed approach.

Key Statistics and Facts

Statistics on Kidney Transplants (2001): 48,200 individuals on waiting lists; 12,000 kidneys available.
Waiting Times (1990-1997): Median waiting time increased from 427 days (females) to 1,196 days; from 353 days (males) to 1,033 days.
National Organ Transplant Act of 1984: Prohibits the buying/selling of organs under penalties of fines ($50,000) and prison time (up to 5 years).
Costs: Average annual cost of dialysis: $40,000; initial transplant cost: $87,000, $12,000 subsequently.
Success Rates: 98% survival for one year with kidneys from living donors compared to a 10.6% failure rate for deceased donors.