A Kidney Market The Need of the Hour - Coursework Example

A Kidney Market – The Need of the Hour Table of Contents Introduction 3 2. Background 3 3. Why a Legal Market for Transplant Kidneys Should Be Established 4 4. The Legalized Kidney Market Should Take a Controlled Market Form 7 Bibliography 11 1. Introduction The question of whether or not to create a market for transplant kidneys is not relevant anymore. That is because a kidney black market is already thriving in almost all nations of the world. It is an inescapable reality that kidneys are already being bought and sold as commodities, where the poor are usually at the receiving end of exploitation. Because of the black market, exploited individuals rarely get to raise a voice or seek legal action against wrong-doers, mainly because of the illegal nature of the transaction itself. The major question now is not whether or not to create a market for transplant kidneys (because it already exists and will continue to exist at least as a black market), but rather how a free market can be created and the rights of both sellers and buyers be protected. Such a market also raises innumerable ethical questions. This paper argues in favor of the establishment of a legal market for transplant kidneys from live donors. It also goes on to discuss what form the market should take in order to protect the interests of all parties while addressing ethical issues raised by such a market. 2. Background Millions of people globally are suffering due to kidney problems. While numerous cases of kidney failures are registered everyday throughout the world, there is an acute shortage of kidney donors to help the patients suffering from kidney failures. Consequently, millions of people continue to suffer globally, as they wait for the time a matching donor will be found, so a kidney could save their lives (Castro 2003, p.142). By the end of 2001, around 1,479,000 people survived kidney failures only because they had access to renal transplant facilities and dialysis (Ghods & Savaj 2006, p.1136). By the end of 2004, this number had increased to 1,783,000. According to reports, in 2002 in the UK, 667 people donated organs and 2055 received transplants, while 5616 people still awaited transplants (Erin & Harris 2003, p.137). In the year 2013 in the US, 3,381 patients died while waiting for an organ and every month, 2,500 new patients are added to the kidney waiting list (Roth n.d., p.6). What is more disturbing is that fourteen people die every day awaiting a kidney and every 20 minutes, a person is added to the kidney transplant list (Roth n.d., p.6). All patients requiring kidney transplant await altruistic donations from living relatives/non-relatives, or from cadavers. Because of the huge demand for transplant kidneys and a disproportionately low number of organ donors, a large number of patients, especially wealthy ones, are willing to shell out huge sums of money to buy organs, resulting in a thriving black market where the poor are destitute enough to sell their organs in return for money. “Kidney selling” is however illegal in all developed countries of the world (Satz 2010, p.2). 3. Why a Legal Market for Transplant Kidneys Should Be Established There are two major ways through which kidneys for transplants required by suffering patients can be accessed. First, through social-medical altruism, where willing donors give away their kidneys to the suffering patients, as a means of social respect for human life, and the willingness to continue the social cohesiveness within the society (Fern 2004, p.112). The second is the black market, where kidneys are bought from live individuals most of whom are poor and destitute and so to wealthy individuals who can afford to buy transplant organs at high costs. 3.1. Altruistic donations are not enough to meet the current demand Death should only be allowed to take life under circumstances where humans have done everything necessary to save a life (Kluge 2000, p.279). In this respect, human beings have a moral obligation to protect and save the lives of those who are suffering or those who are on the blink of death, by offering the relevant remedies that can help in protecting that life. However, altruistic donations do not meet the current requirement for transplant kidneys. Global statistics have indicated that, among the overall kidney transplants that require to be conducted every year, only 10% are undertaken, while the rest of the 90% the patients with kidney failure are kept on the waiting list (Friedman 2006, p.747). The kidney donation system has been made effective through interventions such as those by Roth, who introduced a model for pair-wise allotment of transplant organs to patients needing them (Reuters 2012). However, this model depends on altruistic donations of kidneys and thus, does not increase the supply of kidneys. There is thus a need to devise a more effective and practical solution that can increase the accessibility of donors for kidneys. 3.2. Dialysis is expensive Dialysis, which is the only other alternative to transplant kidneys, is associated with very high costs. Kidney transplantation is more cost effective than dialysis. On an average, dialysis costs £30,800 annually, per patient, while kidney transplantation costs £17,000 per transplant per patient in addition to immunosuppressant drugs that cost £5,000 per year per patient (Jackson 2013, p.561). Therefore, the treatment of kidney failure through the dialysis intervention becomes expensive for patients and their families, more so, considering that the dialysis therapy session may require multiple sessions in a week, depending on the extent of the kidney failure suffered by the patient (Mayes 2003, n.p.). Establishing a legal market for transplant kidneys, it will be possible to reduce the costs of kidney transplants, especially because the current costs are very high considering that most transactions occur in the black market. Another benefit would be that while currently, the poor often fail to procure kidneys due to lack of funds, establishing a free market would help in regulating the price so that patients from low socio-economic categories can also be benefited. 3.3. The black market can be uprooted and equal access can be promoted The current shortage of kidneys has resulted in illegal activity through black markets. Moreover, in lower socio-economic groups, there is coercion from family members to sell kidneys as it is considered as a way of making easy money. Defenders of legalized and regulated organ markets contend that such a market would eliminate the capturing of the major proportion of the organ price by organ brokers, and will allow open competition in addition to enforcing contractual terms (Satz 2010, p.7). A look at the current black market in transplant kidneys shows that most sellers are desperately poor and most buyers are wealthy (Satz 2010, p.10). Un-regulated black markets promote inequality and discriminated access to organs. Because of the illegal nature of such transactions, sellers cannot seek legal action if they have been wronged, and neither do they have access to post-surgery healthcare of health benefits if they suffer ill-health in future because of selling their kidney. Because of the reasons highlighted here, a legal market for transplant kidneys is the need of the hour. It will not only offset the black market, but will also increase the supply of kidneys as more and more people will be willing to sell a kidney if they get monetary benefit and healthcare benefits. Moreover, it will also help in protecting the rights of both buyers and sellers as they can seek legal recourse if they have been wronged during or after the transaction. The price of kidneys can be regulated by an authoritative entity such as the government and a free market will enable competitive pricing due to which kidney transplants will become more affordable. 4. The Legalized Kidney Market Should Take a Controlled Market Form The legalized market for transplant kidneys should assume the form of a controlled market where competitive pricing is promoted and the rights of both buyers and sellers are protected. The market should have governmental control in order to promote fair practices. 4.1. Ethical and economic questions raised by such a market The major problem associated with the establishment of a legal market for transplant kidneys from live donors is the problem of ethics and morality. This option is challenged for being unethical and immoral, since it involves the creation of an avenue for selling human body organs on the free market, as if such organs were normal trade commodities (Friedman 2006, p.962). As stated by Radin, some goods, which she terms as “market-inalienable” are transferable only as gifts and cannot be traded in the market (1987, p.1850). She contends that “economic analysis and traditional liberal pluralism have failed to recognize and correctly understand its significance because of the market orientation of their premises” (p.1936). By this, she implies that by commodifying everything, we undermine the value of “personhood”. While Radin’s views are justified, who has the right to define which goods can be treated as commodities and which couldn’t? What one may consider as a commodity, another may not. For instance, while some are willing to give blood in the form of a gift or donation, others may expect money in return for their own blood. A similar question is explored by Anderson, who asks “How can we determine which goods are properly subjects of market transactions and which are not?” (1990, p.179). He acknowledges that some goods belong to two classes – gift values and shared values (p.201). Their exchange should only occur within non-market norms. Altruistic donations of organs imply that these have gift value and are not to be considered as commodities. Once the exchange of kidneys assumes a market form, kidneys will be considered as commodities. Titmuss (cited in Satz 2010, p.4) stated that altruism is better than market exchange. Giving the example of blood, he stated that those who donated blood out of altruistic motive would have reason to conceal their illnesses if they have any because of which the blood would be of good quality. If blood donation was incentivized or if blood is bought and sold, the purchased blood would be of a low quality as people will hide their illnesses to get their blood sold and earn money. He argued that this would also erode the sense of community and altruism because of which people who wished to donate blood would withdraw from donating it if it was commodified, as they would no longer feel it to be an act of virtue. Frey and Oberholzer-Gee investigated this aspect showed that monetary incentives led to the phenomenon of ‘crowding-out’ where people desisted from an act when price incentives were presented, which they would have otherwise done altruistically (1997, p.753). Coinciding with this, even Bowles states that “market-like incentives are sometimes counterproductive, apparently because they displace preexisting ethical commitments in favor of a self-interested strategic mode of reasoning” (2011, p.46). It is thus feared that people who would have donated a kidney altruistically would not do so if monetary incentive is given. Rather than increasing supply, it would only spoil the quality of organs. However, Arrow (1972) criticizes Titmuss’ conclusions by indicating that these are limited in scope. It is difficult however to conclude which viewpoints are acceptable especially because of the strong defense for Titmuss put forth by Singer (1973) against Arrow’s criticisms. It should be noted nevertheless that if market transaction is allowed, then a ‘pareto-optimal state’ can be achieved because allowing a transaction will enable both parties to exercise their preferences, although, as Sen points out, some pareto-optimal states may be “morally revolting” (1985, p.10). A kidney market would definitely have some moral drawbacks. A kidney market also raises questions of vulnerability and equal status (Satz 2010). Out of paternalistic concern, many argue against kidney selling fearing that people in need of money will sell their kidneys despite the effect it will have on their health. Such a market would also promote more organ selling by the poor and buying by the rich, making the poor as “spare parts” for the rich (Satz 2010, p.10). 4.2. Characteristics of the proposed market A market can be created where the kidneys are offered not based on the economic principles of trade where the seller is in search of the highest profit possible from the transaction, but on the basis of offering minimal monetary incentive. The monetary gain can instead be replaced with a high medical incentive scheme (Bramstedt 2007, p.101). Therefore, the legal market for kidneys from live donors can take the form of offering minimized financial benefits to the donors, which will be limited to covering the transport, healthy diet and other associated expenditures incurred by the patient in monetary terms, while the rest of the benefit is offered to the patient in the form of a medical insurance. Similar systems are already in place for blood. For example, Canadian Plasma Resources offers a donor value card where blood donors receive monetary benefit credited to their donor value card but the card is not redeemable by cash (giveplasma.ca 2013). Paid kidney donation in Iran has helped in the elimination of the black market and there is no person on the waiting list (Ghods & Savaj 2006, p.1136). The model is closely regulated by the government and there is no agency or broker involved. Some of the characteristics of the Iranian model can be employed in such a market. Erin and Harris (2003, p. 137) proposed a highly ethical and strictly regulated market that would be confined to a specific geopolitical area that is self-governing. To avoid exploitation of people from low socio-economic groups, direct purchases could be avoided and only the government could be the agency for transactions. Bibliography Anderson, E. (1990) ‘The Ethical Limitations of the Market’, Economics and Philosophy 6(2), 179 – 205. Arrow, J. K. (1972) ‘Gifts and Exchanges’, Philosophy & Public Affairs 1(4), 343-362. Bowles, S. (2011) ‘Is Liberal Society a Parasite on Tradition?’ Philosophy & Public Affairs 39(1), 46-81. Bramstedt, K. (2007) ‘Checklist: Passport, plane ticket, organ transplant’, American Journal of Transplantation 7(7), 98-101. Castro, L.D. (2003) ‘Commodification and exploitation: Arguments in favor of compensated organ donation’, Journal of Medical Ethics 29, 142-146. Erin, C. A. & Harris, J. (2003) ‘An ethical market in human organs’, Journal of Medical Ethics 29, 137–138. Fern, S. C. (2004) ‘The Life and Death Questions of an Organ Market’, Fortune, 108-118. Frey, S. & Oberholzer-Gee, F. (1997) ‘The cost of price incentives: An empirical analysis of motivation crowding-out’, The American Economic Review 87(4), 746-755. Ghods, J. & Savaj, S. (2006) ‘Iranian Model of Paid and Regulated Living-Unrelated: Kidney Donation’, Clinical Journal Nephrol 1, 1136–1145. Giveplasma.ca. (2013). Compensation. Accessible at http://www.giveplasma.ca/compensation. Jackson, E. (2013): Medical Law. Oxford University Press: Oxford. Mayes, G. (2003) ‘Buying and selling organs for transplantation in the United States’, Medscape Transplantation 4(2), Retrieved April 6, 2014, from http://www.medscape.com/viewarticle/465200 Radin, M. J. (1987) ‘Market Inalienability’, Harvard Law Review 100(8), 1849-1937. Reuters. (2012) ‘Alvin Roth Transformed Kidney Donation System: 2,000 Have Received Transplants Thanks to Nobel Economist’, The Forward Association, Inc., 1-2. Roth, A. (n.d.) Victory after victory in a battle we are losing, Presentation. Satz, D. (2010) ‘Why Some Things Should Not Be for Sale: The Moral Limits of Markets’, Ethical Issues in the Supply and Demand of Human Kidneys, 1-22. Sen, A. (1985) ‘The moral standing of the market’, Social Philosophy & Policy 2(2), 1-19. Singer, P. (1973) ‘Altruism and Commerce: A Defense of Titmuss against Arrow’, Philosophy & Public Affairs 2(3), 312-320. Read More