TEXAS DOUBLES NEG V.

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EXPLOITATION
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Global norms against sales solidifying but its reversible if the US legalizes organ
sales
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and
Ethics, University of Southern California (Alexander, SIX DECADES OF ORGAN DONATION
AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM
WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY PROBLEMS Vol.
77:25)

India was one of about fifty countries that undertook to reform their practices following the approval of
WHOs original Guiding Principles. These countries adopted laws in the early 1990s to institute the
anticommercial system recommended by WHO. Similarly, a number of countriesincluding
several that were centers for organ sales, such as Pakistan and the Philippines, and other countries, such as Israel,
that had sent large numbers of transplant tourists abroad to receive vended kidneys40have adopted laws and regulations
in the past few years that aim to put the 2010 WHO Guiding Principles into effect.41 These changes
have been strongly supported by other intergovernmental bodies such as the United Nations,42 the Council of Europe,43 and the
UN Office on Drugs and Crime,44 all of which have addressed the phenomena of organ trafficking45 and of people being trafficked
for the removal of the organs.46
Equally significant in driving ethical and legal reforms have been the advocacy efforts of leaders in transplantation medicine. For
example, the Transplantation Society (TTS) and the International Society of Nephrology organized a global summit on organ
trafficking and transplant tourism in Istanbul in late April 2008, where a statement of professional opposition to organ markets, the
Declaration of Istanbul, was adopted.47 The Declaration of Istanbul has since been endorsed by
more than 120 medical organizations and governmental agencies.48 Realizing that the declaration
would not be selfimplementing, its creators formed the Declaration of Istanbul Custodian Group (DICG) in 2010 to encourage
adherence to its principles and proposals.49 The DICG and TTS have produced some notable results by calling on government
officials to adopt and enforce prohibitions, and by making clear to them the harm done to the standing of medical professionals who
work in locales where organ sales are widespread.50 Furthermore, the DICGs direct interventions to change professional practices
have been even more successful.51 For instance, academic recognition has been withheld from physicians who have carried out
transplants with organs from executed prisoners by barring the physicians abstracts from inclusion in international medical
congresses.52 Many medical journals have announced that they expect adherence to the Declaration of Istanbul by their authors,
just as they have long insisted that research conducted with human beings must adhere to the Declaration of Helsinki, first
promulgated by the World Medical Association in 1964.53 In at least one instance, several articles were retracted from an academic
journal when it was discovered that the work discussed involved living donors who had been paid to supply a kidney.54
C. Recent National Changes in Response to Global Norms
Bringing about thoroughgoing changes in transplant practices requires more than academic and professional sanctions;
governments must also adopt and enforce bans on organ purchases and transplant tourism. The
latter has proven particularly difficult, not the least because of the built-in opposition of the people who have profited from catering
to transplant tourists. Accordingly, the hard-won gains in this regard that have been achieved in the past five
years are all the more remarkable.
Some local proponents of organ-trade prohibitions have successfully used global standards in
their transformative efforts. This is illustrated by the experiences of Pakistan where the Transplantation of Human Organs
and Tissues Ordinance was adopted by presidential decree in 2007 before becoming a parliamentary act in 2010.55 Before the
ordinance, an estimated 1500 patients from other countriesprincipally in the Middle Eastas well as about 500 wealthy Pakistanis
received vended kidneys each year, mainly in private hospitals and clinics in Lahore and other Punjab cities.56 The efforts to bring
that practice to an end were lead by the professionals associated with the Sindh Institute of Urology and Transplantation (SIUT), a
medical center in Karachi that provides donation-driven kidney dialysis and transplantation to all patients without charge. SIUT
supplied the moral entrepreneurs: groups and individuals in civil society who are committed to the elimination of trade they
consider harmful and repugnant,57 who mobilized public opposition to commercial organ donation. They urged the government to
adopt the new law. Descriptions written by SIUT physicians of the socioeconomic realities of the organ trade58 and of the resulting
hazards to both donors and recipients59 led to critical reporting of the practice in newspapers and on television.60
The media coverage took specific aim at the role of the government, whose failed poverty-alleviation programs left individuals no
choice but to sell their kidneys, and whose failure to enact a transplant law and later to enforce it allowed the organ trade to thrive. It
was also noted that reports of Pakistans flourishing kidney market had appeared in the
international press, tarnishing the countrys reputation.61
The owners of the private hospitals who profited greatly from transplant commercialism and who had strong connections to high-
level officials mounted fierce opposition to the transplant bill and sought to water down its prohibitions on unrelated living
donation.62 On the other side, SIUTs founder and director, Professor Adib Rizvi, used his strong connections with international
medical groups, particularly his membership in the DICG, to counteract these powerful opponents.63 Prominent transplant
surgeons among the DICG leadership came to Pakistan to convince government officials that organ
sales were a matter of international concern and needed to be curbed to rehabilitate the
reputation of Pakistani physicians.64 As Professor Asif Esrat concludes, For government officials, the
desire to conform to widely held international norms and redeem the national reputation served
as a motivation for action.65 When the law was contested in a federal Shariat court as an interference with the Islamic
duty to save life, the existence of the international standards, as embodied in the WHO Guiding Principles (which Pakistan had
joined in endorsing at the World Health Assembly), weighed heavily enough that the court rejected the challenge.66 When several
transplant programs continued to carry out commercial transplants, including on patients from abroad, Dr. Rizvi and his colleagues
reported these violations to the authorities and prosecutions were brought against the surgeons and hospitals that had attempted to
profit by breaking the law.67
The current situation in the Philippines resembles that in Pakistan in some ways but differs in significant respects. The country has
been a well-known locale for organ purchases for the past several decades; indeed, it was one of the first places where the
anthropologists of Organs Watch, an independent research and medical-human-rights project at the University of California,
Berkeley, began their examination of the new body trade in which the circulation of kidneys follows established routes of capital
from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones, and from
female to male or from poor, low status men to more affluent men.68
Although Internet sites have made the Philippines another important locus for the global organ trade, the initial pattern of using
vended kidneys there differed from what had occurred in Pakistan because the recipients were mainly wealthy Filipinos, not
foreigners. 358 of the 468 kidney transplants recorded in 2003 by the Renal Disease Control Program of the Department of Health
in the Philippines involved domestic patients (though the possibility of incomplete reporting by private hospitals cannot be totally
discounted).69 It was thus not surprising that elite groups at that time supported a proposal under consideration by the government
to institutionalize paid kidney donation as well as to formally accept transplantation for foreign patients.70 As appealing as this idea
may have seemed to someone viewing it from a private hospital room in Quezon City, it was much less so for human-rights
advocates trying to protect potential organ sellers in a sewage-infested banguay (slum) in Manila.71 These advocates used the
attention that the World Health Organization was bringing to the issue at that time to halt the movement toward legalizing
compensation.
Over the following five years, international pressure on the government intensified, not only from intergovernmental and medical
bodies72 but from the Catholic hierarchy, particularly in light of press coverage about unscrupulous organ brokers trolling in the
slums for donors to meet the ever-increasing demand for kidneys coming from Manilas transplant tourists.73 On April 30, 2008, a
ministerial directive barred foreign recipients from getting kidneys from Filipino living donors.74 The next year, the Inter-Agency
Council Against Trafficking followed the international trend and used the organ trafficking provisions of the Philippines Anti-
Human Trafficking Law as the basis for supplemental regulations outlawing all organ purchases, as well as other means of
trafficking persons for organ removal, including the use of force, fraud, and taking advantage of vulnerability.75
The fragility of these legal changes in the face of the determined opposition is indicated by the next swing of the Filipino organ-
policy pendulum. When Benigno Aquino III assumed office as President in June 2010, he nominated as secretary of health Dr.
Enrique T. Ona, a transplant surgeon who had previously expressed his opposition to the ban on organ sales.76 The nomination was
held up, however, when Ona announced his intention to allow organ donors to be compensated by a $3200 gratuity package77 and
joined several American regulated-market advocates in sponsoring an international forum on Incentives for Donation in Manila
that November.78 He was confirmed as health minister, however, after providing assurances that he would not institute financial
gratuities, but he did sign the proposal for incentives that emerged from the international forum.79 In effect, the pendulum has
swung back, as the number of foreign transplant recipients, which had risen to 531 by 2007 before the ban, fell to two by 2011, even
as a threefold increase occurred in deceased-donor transplants for Filipinos.80 Movement in the opposite direction remains
possible, however, as organ purchases by wealthy Filipinos have not completely disappeared, with brokers helping potential kidney
recipients persuade review committees to allow as emotionally related donations what are in fact commercial transactions.81
Another variation on the theme of transplant tourism has taken place in Colombia, which was a major provider of deceased-donor
organs for wealthy foreigners during the first decade of this century,82 mainly for liver transplantation.83 With strong
international and regional backing, local medical leaders succeeded in redirecting organs to recipients from Colombia and
neighboring countries. The annual rate of transplantation to foreigners, which stood at 200 in 2005 (16.5% of the national total),
was reduced to 10 by 2011 (0.9% of the total, down from 1.45% the prior year).84
The situation in Colombia is indicative of the progress that has been made across Latin
America with the adoption by the Ibero-American Council of a set of principles and objectives in a regional parallel to the
Declaration of Istanbul, the Document of Aguascalientes,85 which was encouraged through a strong alliance with the Spanish
transplant program. The Document of Aguascalientes has provided legal and ethical as well as technical guidance for countries
across that region as they have created or strengthened their own systems for organ donation, allocation, and transplantation that
seek the support of the public and medical professionals and that aim to meet the transplant needs of the domestic population and
achieve self-sufficiency nationally or through regional cooperation.86
Over the past five years, the most impressive examples of countries that have responded to
stronger global norms regarding the opposite side of self-sufficiency namely, not sending transplant
tourists abroad as the means to meet domestic demand for organsare in the Middle East. Israels
enactment in 2008 of legislation halting insurance coverage for commercial transplants that violate local laws ended its reliance on
Turkey, South Africa, China, and the Philippines, among other countries, as sites where Israeli patients could go to obtain vended
kidneys.87 The law also stimulated the development of a robust system of deceased and living-related donation, which has been
widely praised.88
A number of Arab countries have taken stepsthus far less sweeping in scope or impact than the Israeli program
but still effectiveto treat patients at home rather than sending them abroad. The evolution of policy in Qatar
provides a vivid example of the competing forces at work: expediency, selfinterest, generosity, and concern about adhering to
international norms. The local provider of transplant services, the Hamad Medical Corporation (HMC), has concluded that it needs
to go beyond the existing Qatari program for honoring donors if it is to achieve self-sufficiency in organ transplantation.89
Consequently, the HMC increased outreach within the expatriate community in Qatar (more than 85% of residents) to ensure that
they too have access to transplantation services.90 Additionally, the HMC has substantially increased deceased donation by
publicizing that brain death is acceptable under Islam91 and by having prominent persons, such as members of the royal family,
not only recognize the generosity of living donors and the families of deceased donors but also enroll in the organ-donor registry.92
A central component of the new Qatari program is the Doha Donation Accord,93 which was formulated in November 2009 with
assistance from the leaders of the DICG and the International Society for Organ Transplantation, and which came into effect in 2010
following approval by the countrys Supreme Council of Health. The accord aimed to combat organ commercialism, to create a
deceased-donor program in which everyonewhether citizen or foreign workerwould participate as both a potential donor and
potential recipient, and to provide a path to self-sufficiency in organ transplantation.94 The original accord departed from practices
elsewhere in the region by not offering any financial payment to the families of donors,95 but several of its promisesin particular,
that a their family member would be offered a free airplane ticket to accompany the deceaseds body from Qatar at the time of
donationdo not align with Guiding Principle 5 of the WHO Guiding Principles, which states that [c]ells, tissues and organs
should only be donated freely, without any monetary payment or other reward of monetary value.96 To the accords framers, it
would have been inconsistent with cultural norms of reciprocal gift-giving not to provide something of value to those who agree to
donate organs for transplantation. To outsiders, however, such a provision seemed to exploit the vulnerable situation of the families
of Qatars manual laborers and domestic workers from India, Nepal, the Philippines, and other developing countries, who would
otherwise find it difficult to repatriate their loved ones remains.97
At a meeting in Doha in April 2013, held to mark the fifth anniversary of the Declaration of Istanbul, the leaders of the HMC
transplant program acknowledged the remaining shortcomings in the Doha Donation Accord and pledged to make revisions
satisfactory to the DICG.98 In particular, they pledged to ensure that any benefits provided to donors families would be offered to
the families of all potential donors, irrespective of whether they agree to donate their deceased relatives organs for transplantation;
further,
[A] social welfare program at HMC, in association with Qatar charities, provides assistance where required to patients and their
families. This assists in securing longterm medical care, supply of medications, and financial support during residency in Qatar and
sometimes following the return home of expatriates. For example, following a formal socioeconomic evaluation, social services
provide support to eligible families of all patients who die within HMC hospitals, including families resident abroad. [W]hile the
team at the Organ Donation Centre may directly refer families of critically ill patients to welfare services for assistance as part of
their routine care, such referrals and provision of welfare benefits are unrelated to donation decisionsa point that is made clear to
families.99
The forces at play in the movement of Qatar toward a more self-sufficient program of organ transplantation are the same as those
that have operated in the other countries described. In the countries that have provided transplants to large numbers of transplant
tourists, the forces favoring payments to living donors have largely been controlled by those who directly profit from this business.
But in Qatar, as in other countries that have sent most of their potential kidney and liver recipients abroad for transplantation, those
who had supported transplant tourism shifted toward favoring payments to donors in Qatar, because they do not believe a domestic
transplant program can be built without such financial rewards.100 In a setting like Qatar where the population is sharply divided in
both socioeconomic and ethnic terms, as well as by residents degree of integration in, and identification with, the country and its
institutions, it is particularly easy to understand the view that those who are disadvantaged and disenfranchised will only respond to
a request for assistancein the form of a life-saving organwhen it is accompanied by an offer to improve their condition
materially. Nevertheless, the forces on the other side have been successfulas they have been in Pakistan and
the Philippinesin finding ways of overcoming the barriers to voluntary donation that do not
link benefits to an agreement to donate.101
In all these settings, the local medical and human rights advocates opposed to giving material rewards
for organ donation have been inspired by professional and intergovernmental statements of
principle and have derived strength from the medical leaders and WHO officials who have
assisted them in persuading their governments to align national laws and practices with
international norms.
IV BENEFITS, COSTS, AND INTERCONNECTIONS
National patterns of organ donation can be expected to be less diverse in the future, thanks to changes of
the sort detailed above, as countries move away from their former roles as buyers or sellers in what has
been called the global traffic in human organs.102 But progress toward a world in which all countries where organ
transplants are performed103 rely on deceased and living-related donors, rather than paying living donors and the families of
cadaver donors, has been halting, and the outcome is far from assured. To a large extent, the changes that
have occurred have been heavily influenced by the WHO Guiding Principles and the Declaration of Istanbul, which, in turn, rest
on the consistent practice of noncommercial organ donation in the United States,
Canada, and Western Europe for more than four decades. The hands-on advocacy of WHO and DICG leaders has conveyed this
vision to the responsible authorities in countries that have previously relied on paid organ vendors, and it has reinforced the efforts
of local medical leaders to reform national laws and practices.
But if systems that have so long embodied the ideal of voluntary, altruistic solidarity as their basis for
organ donation and that have thereby attained the highest rates of donation were to move to a regulated
market with financial inducements for donation, the progress achieved in countries that have only
recently come into line with, or that have been moving in the direction of, the WHO Guiding
Principles and the Declaration of Istanbul would reverse course in short order. The proponents of
paying for organs in those countries whether they be surgeons and brokers who stand to profit from transplant
tourists or those who believe it is necessary to offer material expressions of gratitude in order to build a functioning organ-transplant
system104would seize upon the change of policy in the West and say, Clearly, no principle is
offended by the sale and purchase of organs, for these enlightened countries allow it; and if these countries,
which are rich and medically well equipped, find payment necessary to generate an adequate supply of organs, how can we succeed
in any way other than by following their example?

Legal sales cause widespread suffering, economic ruin and structural violence
Moniruzzaman, 14 - Department of Anthropology and Center for Ethics and Humanities in
Life Sciences, Michigan State University (Monir, Regulated Organ Market: Reality Versus
Rhetoric October, Volume 14, Number 10, 2014)

To make matters worse, selling an organ does not alleviate the sellers poverty. In my study, 81% of
organ sellers did not receive the payment they were promised. For example, Koliza, a liver seller, received
150,000 Taka (US$1,875), only half the amount the broker had promised him. Proponents of the organ market
therefore argue that a regulated system could offer full payment for the sellers (though the Iranian
regulated market proves otherwise; Zargooshi 2001), yet these proponents fail to explain how the
payment (if it is paid in full) ensures income-generating opportunities for impoverished populations.
Here, Koplin aptly argues that an organ market could not compensate for the extensive harms and
ensure long-term benefits for vendors overall well-being. My research cultivates Koplins claim by capturing
that Bangladeshi sellers mostly used their money to pay off their microloans; buy material goods, such as a cell phone, a television,
or gold jewelry; or arrange a dowry or medical treatment for their family. Once the money had nearly run out, most
sellers had already lost their jobs. Some managed to get new jobs, but their damaged
bodies impeded their abilities to continue to do physically demanding jobs, such as rickshaw pulling,
manual farm work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages not only himself, but also his
family, noting that three of my family members were depending on my income, and now I am done, and so are they. As a result,
some sellers have turned to organ brokering; they prey on their families, neighbors, and
villagers just to get by. My research also finds that many sellers entered the organ market to pay
off their debts, but soon were back in debt (see Cohen 2003). For example, Koliza took out new microcredit loans to
start a poultry farm a year after selling his liver lobe. With a chicken mortality rate as high as 50%, at the return of his microcredit
debt Koliza remarked, I no longer have other parts to spare. A regulated organ market could not ensure the
long-term economic benefits of organ sellers, but rather might corrupt the overall situation.
My recent fieldwork reveals that moneylenders have pressured the poor to sell their spare
organs to repay loans. Husbands have tricked or forced their wives to sell their organs for economic gain (in one case, a man
married twice to profit from the sale of his wives kidneys, and in another case, a man sold his wifes kidney after claiming to take her
to the hospital for an appendectomy). A 6-year-old boy was murdered by an organ trafficking racket and his body tossed in a pond
after both kidneys were removed (The Daily Star 2014). I also document that four members of one family (a father, two brothers,
and a daughter-in-law) each sold a kidney. Buyers regularly publish organ classifieds in major newspapers for soliciting organs, and
brokers have expanded their networks from local to national to international levels. Such profound violence,
exploitation, and suffering would be rife in the regulated or rampant commerce of organs.
In sum, after selling their vital organs, the health of sellers is compromised, their economic
situation has worsened, and their social status has declined (Moniruzzaman 2012). The outcomes of
organ selling are invasive, harmful, and devastating. As seller Koliza said with regret, I donated my liver lobe to:
i) live better, ii) save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of
poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.
It can therefore be argued that a regulated organ market is not the solution, but rather, the strict
criminalization of the organ trade is ethically and pragmatically essential. As Koplin notes, a
regulated organ market would improve vendors well-being or minimize their harms lack evidential warrant. Such a system
does not speak to the lives of the economic underclass, but rather seriously discriminates against
them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and justice to organ sellers. We
ought to oppose the organ market in order to curb this illicit practice.

The impact is widespread global exploitation and structural violence

Moniruzzaman, 12 - Department of Anthropology and Center for Ethics and Humanities in
the Life Sciences Michigan State University (Monir, Living Cadavers in Bangladesh:
Bioviolence in the Human Organ Bazaar MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 26,
Issue 1, pp. 6991, DOI: 10.1111/j.1548-1387.2011.01197.x)

The bioviolence, particularly for the extraction of organs, stems from the growth of the
transplant industry and is closely linked to the suppression of the poor. It is not only widespread
in the current practice of organ commodification but also in every aspect of transplant
technology. I will argue that the bioviolence is seriously exploitative and highly unethical;
however, it is deliberately concealed for personal gains of vested interest groups. So far I have
documented how poor Bangladeshis are victims of bioviolence that turns them into kidney
sellers and causes extreme suffering. In the remainder of the article, I will discuss the
varieties of bioviolence, including physical, structural, and symbolic violence that dominate the
lives of kidney sellers.
In Bangladesh, about 35 million of its inhabitants (nearly one-quarter of the population) face
the violence of needless hungerwhat Amartya Sen calls a humanmade disaster (Hartman and
Boyce 1998; Sen 1982). Inevitably, 77 percent of poor Bangladeshis lack the minimal
requirements for a healthy human existence; about 50 percent of women have anemia, and two
million children are suffering from acute malnutrition (United Nations 2009). To make matters
worse, socioenvironmental factors, such as arsenic poisoning, air pollution, pesticide use, and
smoking tobacco contribute to a high number of organ maladies. Although the majority the
economic underclassis at the greatest risk of organ failure because of high exposure to these
factors, they die prematurely without receiving a transplant, let alone dialysis.
Kidney transplant is one of the most expensive medical procedures, starting at about 225,000
Taka ($3,200) for the surgery and two weeks of postoperative care in a public hospital in
Bangladesh. It is virtually impossible for most of the poor, as well as many middle-class
Bangladeshis, to save this amount of money in their lifetime. Nevertheless, many of them strive
for an organ transplant by literally begging for money in local newspapers, but in the end, they
experience serious drawbacks.9 For example, a brother of a recipient who died from kidney
rejection just one month after the transplantation told me, All of our family members tried our
best to save my brothers life. We sold our land and jewelry, and borrowed money from the bank
to arrange the transplant. But we could not save my brother and we are still paying off our debt.
Moreover, the health care for organs in Bangladesh is concentrated in two major cities; most
poor people do not have access to organ care at all.
Evidently, transplantation does not proceed according to the principle of equity: The poor suffer
from organ maladies, but the wealthy receive care. The service of transplantation fulfills the
needs of fewer than 1 percent of the population the wealthy minority, while the majority of
Bangladeshis die in silence, knowing they could have saved their lives through this modern
technology. Consequently, the current practice of organ transplant constitutes a form of
structural violence against the poor (see the detailed discussion on structural violence
in Galtung 1969; Farmer 2005), which is palpable in every aspect of the transplant industry.
Not only are the poor deprived but also they are subject to physical violence as their vital organs
are viciously removed from their living bodies. As my ethnography explores, the wealthy buyers
(both recipients and brokers) create a desire for the poor sellers, most of whom do not
understand the function of the kidney, but are tempted to donate because of the buyers
fraudulent claim that kidney donation is a safe, lucrative, and noble act. Once the sellers are
induced, buyers extract their organs through deception, manipulation, and without consent, and
then deprive them once the scar is permanent. The deception is so extensive here that not only
brokers but also most recipients do not pay the total amount they had promised to the sellers.
For example, seller Monu received from his recipient as little as 40,000 Taka ($600)one-third
of the promised amount. Some buyers even use coercive force to extract organs from the sellers.
For example, seller Mofiz was unable to attend the funeral of his sister, who died of a heart
attack after learning that her brother had left home to sell his kidney to arrange her dowry.
Mofiz was then held captive by three bodyguards at his recipients house and was tricked into
traveling to India a few days later. In the post-transplant period, bothMofiz and his wife were
physically abused and threatened with jail while he disputed the payment with his recipient (see
also the above-mentioned case of seller Sodrul). Furthermore, informed consent was completely
flawed here, as buyers intentionally provide misleading and inadequate information (e.g., the
story of the sleeping kidney); because kidney sellers cannot act competently and voluntarily
(because of extensive manipulation, not to mention the coercion of poverty); and because sellers
gave misinformed consent. These are means of the physical violence organ buyers use to exploit
their counterparts.
The bioviolence is both exploitative and unethical, as organs are deliberately removed from the
economic underclass to prolong the lives of the affluent few. In this visceral violence, the
wealthy recipients are beneficiaries, while the poor sellers are mere suppliers of body parts, but
at the severe cost of their suffering. This bioviolence constitutes an abuse of human rights
(the 1948 Universal Declaration of Human Rights adopted that health is a human right), as the
poor deserve proper transplant care, rather than losing organs from their underfed bodies. This
bioviolence also violates the principle of social justice, as the poor have an equal right to keep
their organs inside their bodies. They need their organs for their physical survival; the
bioviolence against them is a serious crime.

Exploitation from organ sales justifies slavery and genocide by viewing some
people as less valuable than others
George, 1 - Southern Railway Hospital, Perambur, Chennai, 600 023, India (Thomas, Issues in
Medical Ethics, January-March, The case against kidney sales PubMed)

I am one of those who, according to Radcliffe-Richards et al, oppose the practice of buying
kidneys from live vendors from a feeling of outrage and disgust. (1) These feelings are by no
means irrational. They are based on a bedrock of moral principle: that no human being should
exploit another. The opponents and proponents of the trade in human organs are divided by this
(perhaps unbridgeable) chasm the one side is wedded to the belief that not only are all human
beings born free, but that they should stay free; the other is not so sure. The evolution of human
civilisation has witnessed several periods of gross exploitation of human beings. Slavery, the
extermination of six million Jews, and today the transfer of body parts from one living human
being to another, for a financial consideration, are part of a continuum of values which sees
some human beings as less valuable than others. It is this value system that those of us who
oppose the sale of kidneys, seek to change. All arguments in favour of the trade are attempts to
clothe, in the garb of reason, the concept that it is all right to remove a body part from a poor
person and put it into a rich one. But even these arguments will not bear scrutiny and I will deal
with them below.
First, the argument that the prohibition of organ sales worsens the position of the poor because
it removes an option in their already deprived lives: Here the authors (1) of the paper have
cleverly stated the most potent contrary argument themselves: the solution is the removal of
poverty. They, however, appear to consider this a distant possibility, and in the meantime
advocate the selling of kidneys as one option available to the poor to better their circumstances.
It would have been useful if the authors had adduced material to show how and how long this
so-called option works. In the absence of any sustained means of livelihood, it is quite probable
that the money obtained by the sale of one organ will soon be gone. What shall the seller do
next? Sell another organ? An eye? A lung? And when all the paired organs are gone?
Let us accept that the risk involved in nephrectomy is not high. But is it not a fundamental tenet
of medicine that the risk must be in the medical interest of the patient? What medical advantage
does the donor obtain? Undoubtedly the risk is the same for those who sell and those living
donors who do not sell but donate out of regard for the recipient. Radcliffe -Richards et al move
from this fact to the inference that therefore there should be no difference between the two
groups with surprising facility. What matters here is motive: the implicit coercion in the case of
the poor who sell out of financial compulsion. Radcliffe - Richards equating of the motives of the
better off, and comparing the risks of nephrectomy with the risks of dangerous sports can only
be described as callous. No one prevents them from campaigning against these sports if they are
so moved, but for us activists in the Third World there are more pressing matters than looking
after the well - being of the jet- set. A profile of the sellers would be revealing. It will come as no
surprise that they all belong to the Third World. And it will also come as no surprise that besides
the wealthy in the Third World, the potential buyers will be from the rich, white, First World
and from the petroleum driven nouveau - riche! No wonder a veritable industry of philosophers
has risen in these countries to justify this horrible practice. And in the honourable tradition of
colonialism there will always be locals ready to aid and abet the conquerors. He who pays the
piper calls the tune!
Radcliffe-Richards et al (1) seem fixated on the belief that legalising and controlling the trade in
human organs will protect the exploited. The situation in other fields shows that this is nave
indeed. In Hamburg, legal commercial sex workers throng the glittering Reeperbahn, while in
the sad, sordid, shadowy bylanes the illegal commercial sex workers have no shortage of clients.
This in a country where social conditions ensure much closer adherence to the rule of law than is
the case in most developing countries, which are the main source of people willing to sell their
organs. In India, child labour is a reality. Poverty is the main reason for its existence. The efforts
of numerous groups have succeeded in making it illegal. Have they removed an option for the
poor? After all, the poor consciously send these children to work. Would it be a good idea to
legalise the practice and control it on the theoretical basis that it would improve the lot of these
unfortunate children? There are many reasons why such trades will always be open to
exploitation. The most potent one is that the victims are poor and voiceless while the
beneficiaries are generally rich and powerful.
The argument that organ selling is acceptable because some services are available to the rich,
which are not available to the poor, is extremely strange. Do the authors believe that the
presence of undesirable practices justifies adding a few more? What will the limit be? Who will
decide how many more are to be allowed? No prizes for getting it right. The answer is: the rich
and powerful. Permit whatever is in their interest. They can always hire a motley crew of
philosophers and technicians to justify it and make it possible.
Why is altruism necessary in organ donation? It is because it will ensure the absence of
exploitation. It is nobodys case that unless some useful action is altruistic it is better to forbid it
altogether. Altruism removes the profit - making element. It will help ensure that organ
transplantation is done in the best possible way and thereby achieve the best possible medical
result. It will also ensure that no vital organ is removed from a living person. On the other hand,
trade in kidneys definitely puts one on the slippery slope to selling vital organs as documented
elsewhere. (2) Here, the authors utilise the familiar stratagem of positing and demolishing
imaginary weak arguments against their stated position, while ignoring the real and powerful
argument.
 IMPACT CALC
Dont be held hostage to the rhetoric of saving lives they only count the lives of
the affluent few while authorizing the systematic extermination of the poor. A
regulated market isnt an Aladdins lamp of hope for the poor the practical
reality is it serves to conceal the violence
Moniruzzaman, 12 - Department of Anthropology and Center for Ethics and Humanities in
the Life Sciences Michigan State University (Monir, Living Cadavers in Bangladesh:
Bioviolence in the Human Organ Bazaar MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 26,
Issue 1, pp. 6991, DOI: 10.1111/j.1548-1387.2011.01197.x)

Although vested interest groups silence the organ trade, some liberal bioethicists have proposed
that a regulated organ market would be an efficient way to save the lives of dying patients
(Cherry 2005; Friedman and Friedman 2006; Hippen 2005; Matas 2008; Radcliffe-Richards
1996; Taylor 2005; Veatch 2000). In my opinion, these bioethicists generate a symbolic
violence (if unconsciously) by emphasizing saving lives of the affluent few, while
allowing bioviolence against impoverished kidney sellers. A regulated organ market
is not an Aladdins lamp that by itself would eliminate widespread deception, manipulation,
and misinformed consent, or ensure justice, equity, and rights to kidney sellers; rather, it would
escalate the bioviolence for stripping organs from the poor majority at the high cost of
their bodily and social suffering. It would rationalize, institutionalize, and normalize the
bioviolence, which is extremely discriminatory against the economic underclass. Not
surprisingly, 85 percent of the Bangladeshi kidney sellers I interviewed spoke against an organ
market; many of them proclaimed that selling a kidney is an irrevocable loss; if they had a
second chance in life, they would not sell their kidneys.
In summary, the bioviolence against kidney sellers is seriously problematic, even though organ
transplant saves many lives. As the transplant industry flourishes, the structural violence
against the poor becomes widely institutionalized. The physical violence for extracting
organs from their bodies is increasingly routinized. However, it is justified by a symbolic
violence that masks organ trade by the rhetoric of saving lives. Meanwhile, bioviolence
against the poor remains concealed to promote the personal interests of vested beneficiaries.
The bioviolence that is entrenched in the transplant enterprise, as well as other emerging
biotechnologies, needs to be fully exposed to strike against the exploitation of the poor. This is
the time to write a transplant manifesto that is grounded in social justice, and that promotes
humanitarian ethics.

That causes massive structural violence and worse health outcomes for vendors
and buyers
Emily Kelly 13, Executive Comment Editor for the Boston College International & Comparative
Law Review, International Organ Trafficking Crisis: Solutions Addressing the Heart of the
Matter,
http://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=3324&context=bclr&sei-redir=1
Transplant tourism and organ trafficking have pervasive negative effects.57 Organ trafficking
exploits poor individuals who are desperate to make money for survival.58 Because profit-motivated facilitators negotiate most
transactions, donor compensation is often extremely low.59 For example, kidney donors frequently receive less than one-third of the price that recipients pay for the organ, despite initial promises of higher

donors rarely receive adequate health care after the transplant, generating
payment.60 Furthermore,

negative health outcomes that impede their ability to work and worsening their long-run financial and
physical condition.61 As a result, donors rarely succeed in paying off the very debts that often lead them to
sell an organ in the first place.62 In addition, studies have exposed the negative sociological and
psychological effects of organ sales.63 Kidney vendors frequently express regret and disgrace associated with the decision to sell a body part.64
Communities with high rates of organ sales also shame donors, leading many to conceal their decision out of embarrassment.65 With regard to recipients, the
dangers of receiving medical care in developing countries can outweigh the benefits of life-saving
transplant tourism.66 Because governmental disease control agencies do not monitor underground organ trafficking, recipients risk contracting
infectious diseases like West Nile Virus and HIV.67 Tragically, transplant tourists also have a higher
cumulative incidence of acute [organ] rejection in the first year after transplantation.68 Transplant tourism also harms global public health
policies.69 Most notably, the underground market impedes the success of legal organ donation frameworks.70 For example, Thai patients have difficulty accessing health care because local doctors are preoccupied
with the lucrative practice of treating transplant tourists.71 In 2007, China banned transplant tourism because wealthy foreignersrather than the 1.5 million Chinese on the waiting listreceived an
overwhelming amount of organ transplants.72 Grisly tales of transplant tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to altruistic donation upon death

transplant
out of fear that their bodies may be exploited. 73 This further contributes to the global organ shortage and exacerbates the underlying causes of OTC trafficking.74 Additionally,

tourism and broader medical tourism facilitate the spread of antibiotic-resistant bacteria.75 Because such
bacteria are frequently found in hospitals, tourists are easily exposed and transmit these unique
strains across borders upon returning to their home countries.76 As a result of these effects, transplant tourism has drawn increasing
attention to the root of the problem: organ shortages.77
 2NC LINK WALL
And err neg on the link -

a. Our ev reflects the consensus of international studies based on legal and

unregulated organ markets their ev is conjecture based on economic theory
Koplin, 14 PhD candidate in bioethics at Monash University, member of the Declaration of
Istanbul Custodian Group, managing editor of ERAS Journal, (Julian, Assessing the Likely
Harms to Kidney Vendors in Regulated Organ Markets The American Journal of Bioethics,
14(10): 718, 2014)

Almost every study that has asked the question has found that the majority of vendors regret
selling a kidney and/or would not recommend doing so to others (Awaya et al. 2009; Goyal et al.
2002; Mendoza 2010a, 380; Moazam et al. 2009, 2223; Moniruzzaman 2010, 320; Naqvi et al.
2007, 936937; Tanchanco et al., cited in Padilla 2009, 122; Zargooshi 2001b). Moreover, a
study of 100 Iranian donors (97 of whom were vendors) found that 76% were in favor of
banning kidney sales (Zargooshi 2001a). According to vendors own accounts, selling a
kidney left them worse off physically, psychologically, socially, and financially. In the face of this
body of research, and in the absence of compelling reasons to believe that such outcomes are
entirely attributable to black-market abuses, the ubiquitous claim that regulated systems of
kidney selling would improve vendors well-being lacks evidential warrant. The available
research, despite its limitations, suggests the opposite: that vendors will usually experience a
range of significant harms that ultimately leave them worse off than before the sale.
Given the limitations of existing research on vendor outcomes, and particularly the scarcity of
controlled studies in regulated contexts, it could be argued that this articles conclusion is
prematurethat instead of relying on evidence from existing markets, we should conduct pilot
programs and clinical trials (Hippen and Matas 2009). My argument here, however, is limited to
what conclusions we should draw from the available literature; it therefore neither rules out nor
entails support for conducting clinical trials. Like all empirical arguments, it is open to revision
in the light of new research. However, unless new evidence is produced, market proponents
confidence that a regulated market in kidneys would benefit vendors is unwarranted.

b. a purely economic approach to organ sales overlooks the cultural and social
factors that increase exploitation. Even if the plan is effective in the US the
global effects of their model spur massive exploitation
Hentrich, 12 independent researcher (Michael, Health Matters: Human Organ Donations,
Sales, and the Black Market http://arxiv-web3.library.cornell.edu/abs/1203.4289

The implications of permitting the sale of organs also differs by country based on levels of
wealth and cultural norms. The same policy decisions made in the United States and Kenya
would have vastly different results. Global policy decisions about organ transplant made
purely on a homogenous economic analysis could well be misguided by failing to account for
cultural norms and differing social conditions (Kaserman 2002). In developing countries the
formal institutions involved with organ transplant are also less advanced. There are fewer
doctors in the related areas and fewer transplant organizations through which to organize a legal
market. These conditions combine to leave developing countries open to poorly regulated
markets, abuse of donors and sellers, and the existence of a black market for organs obtained in
ways that may not be fair and legal (Goodwin 2006).
 AT: DOI FAILS
The new Convention against Trafficking passed by the Council of Europe solves
legal gaps in the current anti-trafficking framework
Lopez-Fraga et al, 14 - European Committee on Organ Transplantation, European
Directorate for the Quality of Medicines & HealthCare, Council of Europe (Marta, A needed
Convention against trafficking in human organs The Lancet, 7/4, doi:10.1016/S0140-
6736(14)60835-7)
The Convention against Trafficking in Human Organs,7 and 8 soon to be adopted by the Council
of Europe, provides a solution to these problems by identifying distinct activities that constitute trafficking in human
organs, which ratifying states are obligated to criminalise. The central concept is the illicit removal of organs, which consists of
removal without the free, informed, and specific consent of a living donor; removal from a deceased donor other than as authorised
under domestic law; removal when a living donor (or a third party) has been offered or received a financial gain or comparable
advantage; or removal from a deceased donor when a third party has been offered or received a financial gain or comparable
advantage.
Additionally, the Convention criminalises the use, preparation, preservation, storage, transportation, transfer, receipt, import, and
export of illicitly removed organs and the solicitation or recruitment of organ donors or recipients, where carried out for financial
gain or comparable advantage. The promising, offering or giving of any undue advantage to or the request or receipt of any undue
advantage by health-care professionals, public officials, or people who direct or work for private institutions for the illicit removal of
organs or for the use of organs that have been illicitly removed are also criminalised. The Convention calls for states to employ
preventive measures, cooperate internationally in investigation and prosecution (including extraditing accused people), and protect
witnesses and especially victims (including through civil damages). Implementation will be monitored and facilitated by a
Committee of the Parties. Importantly, the Convention has international scope, because it is open to any nation
and not restricted to the 47 Council of Europe member states.
The Convention is intended to complement the provisions included in other international instruments criminalising human
trafficking for organ removal. The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons9 defines human trafficking
as an action (the recruitment, transportation, transfer, harboring or receipt of persons) that occurs by means of threat or use of
force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the
giving or receiving of payments or benefits to achieve the consent of a person having control over another person. Among the
purposes identified by the Protocol is removal of organs. In Europe, human trafficking for organ removal is also included in the
Council of Europe Convention on Action against Trafficking in Human Beings10 and the European Union Directive 2011/36/EU on
Preventing and Combating Trafficking in Human Beings and Protecting its Victims.11 These instruments are important in
countering the use of the human body to give rise to financial gain, as prohibited under the Convention on Human Rights and
Biomedicine.12
Yet the legal instruments intended to combat human trafficking for organ removal leave gaps
because sometimes the three components of this problem (action, means, and purpose) are difficult to prove.13
Establishing an illegal means can be problematic, since force or fraud are not always used and the abuse of a position of
vulnerability is somewhat ill defined. Likewise, when sellers take the initiative, by contacting potential recipients or intermediaries,
prosecutors can struggle to show that the person has been trafficked, even if the seller was driven to act by poverty or other
desperate needs. Moreover, human trafficking for organ removal does not encompass commercial transactions involving organs
from deceased persons, nor the diversion of properly obtained organs for illicit use by physicians providing transplant services to
patients who do not qualify to receive them within national programmes or at facilities that serve so-called transplant tourists.
The new Convention fills these gaps. It provides an explicit basis for prosecution of
brokers, even if the means they use do not amount to human trafficking. It criminalises both corrupt officials who
abuse their position within the organ donation system, and health-care professionals and others
who remove, transfer, or use an organ if they know that the donor has not given valid consent or was offered payment.
Physicians are likewise liable under the Convention for removing organs from deceased donors knowing that no valid authorisation
was obtained or that payment was offered to obtain permission from the family. Under the new Convention, states can choose not to
prosecute recipients who have purchased an organ, although recipients would be liable under instruments regarding human
trafficking for organ removal if they knew that the organ came from a victim of human trafficking. People who sell an organ under
circumstances of human trafficking for organ removal are entitled to protection as victims. If human trafficking is not involved,
states can choose to prosecute sellers under the Convention.
In conclusion, the Convention will be a seminal international legal instrument that for the
first time reaches illicit transplant practices that currently escape prosecution. By
complementing each other, this Convention on trafficking of human organs and the instruments on human
trafficking for organ removal provide a comprehensive legal framework to prevent and combat
transplant activities that violate basic human rights. The worldwide problem of organ trafficking can only be addressed
through concerted action at global level. Therefore, we urge all countries to quickly become Parties to the Convention.
Physician norms are developing against trafficking theyll strengthen the
international framework and spur wider adoption
Efrat, 15 - Lauder School of Government, Diplomacy and Strategy, Interdisciplinary Center
(IDC) Herzliya (Asif, Professional Socialization and International Norms: Physicians against
Organ Trafficking Forthcoming, European Journal of International Relations (2015),
academia.edu)

Why establish a shared professional position? Why wasn't the government track sufficient? First, intraprofessional
activity
was needed to create change on the ground, that is, induce healthcare professionals to cease their direct or
indirect participation in the organ trade. Organ trafficking, after all, is not perpetrated by state agents, but
by private actors: organ brokers and, crucially, transplant professionals. Yet governments are often reluctant to
police professional communities and interfere with their internal workings. Instead, they allow professionals autonomy in
establishing and enforcing their ethical requirements and use the state's enforcement power only in the most serious, publicly visible
cases (Friedson, 1975). Given the low visibility of the organ trade and its negative effects, governments were unlikely to make the
efforts necessary for eliminating this practice. A fundamental change on the ground required the medical profession to establish its
own standards and provide a clear framework for distinguishing between ethical and unethical conduct. Such a framework would
identify physicians' involvement in commercial transplantations as a transgression; it would also empower ethically compliant
physicians to put pressure on their transgressing colleagues and on hospital administrators: exhortations against commercial
transplantations would be more potent if backed by global professional standards.4
A predominant anti-commercialism view within the profession was also necessary for changing governments' attitude to
transplantation and ending their tolerance of the organ trade. To eliminate the trade, governments had to address the persistent
shortage of organs that was the trade's cause. The WHO thus encouraged governments to increase deceased organ donations
through educational initiatives, and by providing the medical and administrative infrastructure for maximizing donations
(Delmonico et al., 2011). The intraprofessional endeavors were a necessary reinforcement of the WHO's government-focused efforts,
since physicians are key actors in healthcare policymaking (Immergut, 1990). In reforming transplantation policies, governments
were likely to consult local physicians and make sure that they approved of the proposed changes. Local physicians' endorsement of
the efforts against organ trafficking would have facilitated government support for these efforts; by contrast, resistance on the part
of local physicians would likely have hindered the change of government policy.5 Furthermore, since organ trafficking is a
crime involving healthcare professionals, the medical community had to put its own house in
order before urging governments to act. The medical community's denunciation of organ trafficking and commitment to its
eradication would in turn legitimize the community's demands from governments. Armed with global professional standards, the
community's call for government action would be more forceful and credible.
In short, combating the organ trade requires standards that are developed, owned, and endorsed
by the medical profession. Such standards are meant to express the prevailing ethical view of the
transplant community, identify those defying this view, and provide leverage for
pressuring them. These standards are also a tool to mobilize the community for political
action and convince governments that eliminating the organ trade is necessary and feasible.
Socialization aimed at establishing and spreading professional norms thus had to take place in tandem with the efforts to socialize
states. How did the anti-trafficking norm manage to gain wide adherence among transplant professionals?

Transplant professionals are the vital internal link to stopping trafficking since
they do the black market transplants
Scheper-Hughes, 14 - is Professor of Medical Anthropology at the University of California,
Berkeley (Nancy, Human traffic: exposing the brutal organ trade New Internationalist, May, -
See more at: http://newint.org/features/2014/05/01/organ-trafficking-
keynote/#sthash.MMhZ7cHk.dpuf

Convicted brokers and their kidney hunters are easily replaced by other criminals the rewards
of their crimes ensure that. Prosecuting transplant professionals, on the other hand, would
definitely interrupt the networks. Professional sanctions such as loss of licence to
practice could be very effective. Outlaw surgeons and their colleagues co-operate within a code
of silence equal to that of the Vatican. International bodies like the UN and the EU need to take
concerted action on the legal framework in order to prosecute these international crimes.
And theres been major progress in hotspots globally only the aff threatens to
reverse it
Efrat, 15 - Lauder School of Government, Diplomacy and Strategy, Interdisciplinary Center
(IDC) Herzliya (Asif, Professional Socialization and International Norms: Physicians against
Organ Trafficking Forthcoming, European Journal of International Relations (2015),
academia.edu)

The transplant community managed to place organ trafficking on the political agenda and bring
governments to take measures against it including in countries that had been the centers of
organ trafficking and transplant tourism. Legislative changes in the Philippines in 2008-9
nearly eliminated incoming transplant tourism, and Pakistan's transplant legislation has
considerably reduced the number of commercial transplants performed there (Rizvi et al., 2011;
Padilla, Danovitch, and Lavee, 2013). Israel has stopped the official funding of transplant
tourism, instead taking action to increase local organ donations (Lavee et al., 2013). Similar
changes in policies and practices have occurred in various other countries (Abraham et al.,
2012; Danovitch et al., 2013). The transplant community brought about these reforms by
building support for a set of professional ethical standards and using them as a foundation for a
political advocacy campaign. The pressure from local and international physicians, reinforced by
media coverage of the organ trade, resulted in major policy changes and a reduction of the organ
trade.
The picture, however, is not entirely rosy, since socialization and coercion may influence some
professionals but not others. While the principles of the Declaration of Istanbul have received
broad support, there are still voices within the transplant community who call for a regulated
organ market, defying the norm that requires altruistic donations. Some profit-seeking
physicians continue to perform commercial transplantations, notwithstanding the social
pressure and persuasive influence of the transplant community. In Egypt, the 2010 prohibition
on organ trafficking has seen little enforcement in the unstable political environment that
followed the 2011 revolution. In China, the transplant community's efforts have had a limited
effect. High-ranking Chinese officials have indeed brought attention to the community's
repudiation of the practice of using organs from executed prisoners, and the Chinese authorities
have stated their intention to cease this practice and develop an ethical organ-donation system.
But while steps in this direction have been made (Wang, 2012), the use of organs from executed
prisoners persists.
While the organ trade has not yet been eliminated, the international community has certainly
made important progress toward achieving this goal. Previously indifferent to organ
trafficking and transplant tourism, governments have come to recognize these practices as
problems and have taken measures to curb them. Underlying this change of political norms is
the move toward shared professional norms within the international medical community. The
socialization of transplant professionals has laid the foundation for the socialization of
states.
 AT: REGULATIONS SOLVE
Regulations are circumvented
Capron et al, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and
Ethics, University of Southern California (Alexander, Organ Markets: Problems Beyond Harms
to Vendors, American Journal of Bioethics, October, Volume 14, Number 10, 2014)
Further, in all settings where kidneys have been market commodities, the act of selling a kidney
is seen as debasing, something that a person would do only if he or she had no other means of
survival. A regulated market wont change that. Indeed, it is likely that means would arise to
circumvent the intended limitations on the incentives, such as financial entrepreneurs
arranging for poor kidney sellers to obtain a lesser sum in cash in exchange for the money
deposited into a retirement account for them. From the viewpoint of transplant programs, this
would have the advantage of producing more kidneys (since in all societies the poor are the
readiest source of organs), but very unjustly and by making a mockery of the notion of a
regulated market.

A regulated system is no different from the black market in practice

Koplin, 14 PhD candidate in bioethics at Monash University, member of the Declaration of
Istanbul Custodian Group, managing editor of ERAS Journal, (Julian, Assessing the Likely
Harms to Kidney Vendors in Regulated Organ Markets The American Journal of Bioethics,
14(10): 718, 2014)
Taylor interprets this argument as follows: We should oppose regulated markets in organs because vendors who sell their kidneys on
the black market are subjected to fraud and coercion and therefore suffer adverse effects to their physical, psychological, social, and
financial wellbeing. According to Taylor, this argument falsely assumes that legalized organ markets would replicate these practices.
Taylor offers a simple but powerful response: Since vendors in a regulated system would enjoy
legal protection against these abuses, the proportion of vendors coerced or defrauded will
presumably decrease (Taylor 2006). In much the same way, Richards (2012, 55) has responded to the concern that vendors
would experience significant harms by pointing out that fraud, poor screening, and poor medical care and aftercare seem
characteristic of unregulated black markets, not of regulated ones. As the Working Group on Incentives for Living Donation (2011,
307) has stated,
We are fully cognizant of the harms that have occurred with unregulated markets. . . . However, there are no data to suggest that
similar harms would occur in a carefully controlled, transparent and regulated system of incentives.
The claim that regulated systems of organ sales can reduce black market abuses is certainly plausible,2 but focusing narrowly on
these practices is misleading. Taylors construal of Scheper-Hughess argument, Richardss point regarding the
dangers of unregulated markets, and promarket arguments regarding harm to vendors in general
conflate two related yet distinct concerns: first, that vendors endure a range of harms they attribute to
the sale of their kidney, and second, that vendors are deceived, coerced, or treated poorly by
organ brokers. I argue that eliminating abusive black-market practices may not eliminate vendors
poor outcomes by demonstrating that some of the harms vendors experience may persist even
under a well-regulated system. Empirical research on kidney sellers outcomes not only
documents a range of harms to physical, psychological, social, and financial well-being, but
also provides reason to worry that a regulated system would reproduce many of these
harms. I draw attention to a range of concerns proponents of kidney selling have often overlooked: that the risks of
nephrectomy may be greater for the desperately poor than the relatively affluent; that providing
follow-up care does not guarantee vendors will receive it; that many sellers face depression,
anxiety, stigma, and social isolation as a consequence of the sale; and that receiving the
promised payment in full does little to protect against long-term difficulties of finding and
maintaining employment.

Its far more likely no regulation would emerge because it would be seen as a
barrier to effective sales
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and
Ethics, University of Southern California (Alexander, SIX DECADES OF ORGAN DONATION
AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM
WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY PROBLEMS Vol.
77:25)
The alternativewhich true believers in inducements should embrace would be a genuine market with prices set by the
forces of supply and demand that reflect the point at which individual sellers would part with an organ and individual buyers would
part with their money to obtain one. The market would qualify as regulated because of other non-price-based
rules aimed at protecting donors against abuses, such as requirements regarding postoperative care of organ donors. On
the demand side, reliance on a true market would effectively upend the present allocation
system, because successful buyers would be those who not only place a higher value on receiving
an organ transplant but also have a greater ability to pay (whether from their own wealth or generous medical-
insurance coverage). The result would be differentiation not only among the purchasers, with
willingness to pay determining ones place in line, but also among the sellers, with the most
desirable organs commanding a higher price. Although some market proponents might not be bothered by this outcome,
others have suggested that it should be avoided by keeping organ donors and recipients anonymous to each other and by having the latter pay into the
fund that supports the organ-procurement system rather than directly to their donor.118 Yet such a system would produce both market inefficiencies
and strategies to get around them, of the sort previously described.119
On the supply side of a true market in organs, one
must begin with the question of whether, in this era of trade
liberalization, there would be any ground for restricting donation to domestic sellers. The aversion in
certain circles to letting people from other countries come to the United States to work really has no relevance to organ sales, because the persons
involved would be coming into the country solely as the delivery vehicles for their kidneys (or liver lobes), and would return to their country of origin
once their cargo had been unloaded. This was indeed the vision of Dr. Jacobs, whose projected International Kidney Exchange, Ltd. was intended to be
a setting where U.S. patients could exchange their funds for the kidneys of willing donors from Latin America.120 But why should such an institution
not have a more global reach than that, when it is already apparent that thousands of Pakistanis, Indians, Filipinos, and other impoverished would be
vendors of the world, when allowed to decide for themselves about their own best interests,121 are willing to exchange a kidney for a relatively
modest sum of money?
The argument for allowing payments for organs rests on the principle of utility (that the greatest good consists in saving or, in the case of kidney
transplants, extending and improving, human life) and the principle of liberty (that freedom of contract must be protected). Yet these principles
provide no grounds for erecting impediments to patients, physicians, or indeed health systems seeking potential organ sellers anywhere in the world.
As philosopher Janet Radcliffe Richards argues, If
it is presumptively bad to prevent sales altogether, because
lives will be lost and adults deprived of an option some would choose if they could, it is for the
same reason presumptively bad to restrict the selling of organs.122 Thus, if restrictions are to be placed on
markets, principles other than utility and liberty must justify them. Such justification can be found in the three basic principles of medical ethics:
justice, beneficence, and autonomy.123
 AT: NO MODELING
US organ policy is empirically modeled internationally
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and
Ethics, University of Southern California (Alexander, SIX DECADES OF ORGAN DONATION
AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM
WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY PROBLEMS Vol.
77:25)

The principle that organs for transplantation are gifts to the community rather than market
commodities influenced other countries as they established their own programs and laws.17 The U.S.
approach was fully accepted in Western Europe, where it had been practiced from the beginning of kidney transplantation;
policies in Europe were grounded in the human-rights principles that underlie bioethics legislation and in the need for cooperation across national
borders.18 Elsewhere, however, in countries where the rule of law was less strong, where human
rights were not enforced, where economic inequality was more pronounced, and where health-care systems
were not set up to support deceased donation, transplantation depended on living donors, particularly poor and
marginalized persons, whose agreement to donate could be bought or coerced.19 By the mid-1980s,
reports began emerging, principally from Asia and Latin America, of surgeons providng wealthy patients (both
indigenous and foreign) with transplanted kidneys that had been purchased from impoverished people.20
In 1987, at the urging of several member states, the Fortieth World Health Assembly took note of the problem and requested the Director-General of
the World Health Organization (WHO) to study, in collaboration with other organizations concerned, the possibility of developing appropriate guiding
principles for human organ transplants.21 The Guiding Principles on Human Organ Transplantation (Guiding Principles), which were approved by
the Forty-Fourth World Health Assembly in May 1991, established a preference for deceased over living donors and, among
living donors, a preference for related over unrelated donors, and proclaimed globally the model of voluntary, unpaid
donation of organs from living and deceased donors that had provided the ethical foundation for
transplantation in the United States for the previous four decades.22
CONSCRIPTION
 1NC CP
Text: The fifty states should, through the National Conference of Commissioners
on Uniform Law, amend the Uniform Anatomical Gift Act to require routine
recovery of cadaveric organs in the event of brain death. The United States should
promote organized, population-wide medical screening programs.

Solves supply better and avoids exploitation DA

Spital, 7 - Department of Medicine, Mount Sinai School of Medicine, New York, New York
(Aaron, Routine Recovery of Cadaveric Organs for Transplantation: Consistent, Fair, and Life-
Saving CJASN March 2007 vol. 2 no. 2 300-303, doi: 10.2215/CJN.03260906)
Transplant candidates and the people who care for them know only too well that there is a severe shortage of acceptable organs. As a
result, in the United States alone, approximately 19 people on the transplant waiting list die every day (1). Compounding this tragedy
is the fact that many potentially life-saving cadaverica organs are not procured (2). Clearly, our organ procurement
system fails to meet our needs. Recognition of this failure has led to several radical proposals designed
to increase the number of organs that are recovered for transplantation, including legalization of organ sales (3)
and offering priority status to people who agree to posthumous organ recovery (4). But before reaching for a new
approach, we need to ask first, What is wrong with our current cadaveric organ procurement
system?
The Need for Consent: Widely Accepted but Sometimes Deadly
We believe that the major problem with our present cadaveric organ procurement system is its absolute
requirement for consent. As such, the systems success depends on altruism and voluntarism. Unfortunately, this approach
has proved to be inefficient. Despite tremendous efforts to increase public commitment to posthumous organ donation, exemplified
most recently by the US Department of Health and Human Services sponsored Organ Donation Breakthrough Collaborative (5),
many families who are asked for permission to recover organs from a recently deceased relative still say no (2). The result is a tragic
syllogism: nonconsent leads to nonprocurement of potentially life-saving organs, and nonprocurement limits the number of people
who could have been saved through transplantation; therefore, nonconsent results in loss of life.
In an attempt to overcome this consent barrier while retaining personal control over the disposition of ones body after death,
several countries have enacted opting-out policies, sometimes referred to (erroneously, we believe) as presumed consent (6).
Under these plans, cadaveric organs can be procured for transplantation unless the decedentor her family after her deathhad
expressed an objection to organ recovery. Although there is evidence that this approach increases recovery rates, perhaps by
changing the default from nondonation to donation (7,8), the recent Institute of Medicine (IOM) report on organ donation
concluded that a presumed consent policy should not be adopted in the United States at this time (8). One of the most important
concerns noted by the IOM committee is the results of a 2005 survey in which 30% of the respondents said that they would opt out
under a presumed consent law. The IOM report also pointed out that in the United States there seems to be a lack of public support
for this approach, that the organ donation rate in the United States currently exceeds that of many countries with presumed consent
policies, and that in most of these countries the family of the decedent is still consulted (8). It should also be noted that even opting-
out countries do not have enough organs to meet their needs, and for people who remain unaware of the plan, presumed consent
becomes routine recovery in disguise.
Given that some people do not want to donate, it is clear that whether we follow an opting-in or an opting-out approach, life-saving
organs are and will continue to be lost because of refusals. In other words, the requirement for consent, whether explicit or
presumed, is responsible for some deaths. But isnt this the price that we must pay to show respect for people after they die? We
believe that the answer is no.
The view that consent is an absolute requirement for cadaveric organ recovery has long been accepted as self-evident, and few
experts in the field have seen the need to justify it. We agree that the premortem wishes of the deceased regarding the postmortem
disposition of his or her property should generally be respected. However, we believe that the obligation to honor these (or the
familys) wishes is prima facie, not absolute, and that it ceases to exist when the cost is unnecessary loss of human life, which is often
precisely what happens when permission for organ recovery is denied. Therefore, given the current severe organ shortage and its
implications for patients who are on the waiting list, we propose that the requirement for consent for cadaveric
organ recovery be eliminated and that whenever a person dies with transplantable organs, these
be recovered routinely (911). Consent for such recovery should be neither required nor sought. In our opinion, the practical
and ethical arguments for this proposal are compelling.
Routine Removal: Consistency with Other Socially Desirable but Intrusive Programs
One of the major reasons for insisting on consent is to show respect for autonomy, a major principle of biomedical ethics. However,
Beauchamp and Childress (12) pointed out that as important as this principle is, it has only prima facie standing and can be
overridden by competing moral considerations. One such consideration occurs when society is so invested in attaining a certain
goal that is designed to promote the public good that it mandates its citizens to behave in a manner that increases the probability of
achieving that goal, even though many of them would prefer not to act in this way. Silver (13) pointed out the legitimacy of this
approach in his discussion of an organ draft: The sense behind the coercive power of democratic governments is to move society
forward by public decree where individuals will not, by private volition, act in their own best interests. Examples of such situations
include a military draft during wartime, taxation, mandatory vaccination of children who attend public school, jury duty, and,
perhaps most relevant to routine removal of cadaveric organs, mandatory autopsy when foul play is suspected. Although some
people may not like the fact that they have no choice about these programs, the vast majority of us accept their existence as
necessary to promote the common good. Routine removal of cadaveric organs would be consistent with this established approach,
and it would save many lives at no more (and we believe much less) cost than these other mandated programs. Furthermore, had we
been born into a world where cadaveric organ removal for transplantation were routine, it is likely that few if any people would
question the policy, just as few of us question mandatory autopsy today. And while most of us will never need a transplant,
nonrecipients would also benefit from the plan in the same way that people who never file a claim benefit from the security of having
insurance. It should also be noted here that, as discussed below, a persons autonomy is lost after death.
Recovering Cadaveric Organs without Consent: Life-Saving and Fair
Few would argue against the view that routine removal of usable cadaveric organs would save many lives. Under such a
program, recovery of transplantable organs should approach 100%. It is unlikely that any program
designed to increase consent rates could even come close. Although the expected high efficiency of routine recovery is its major
raison dtre, it also has several other advantages. Routine recovery would be much simpler and cheaper to
implement than proposals designed to stimulate consent because there would be no need for
donor registries, no need to train requestors, no need for stringent governmental regulation, no
need to consider paying for organs, and no need for permanent public education
campaigns. The plan would eliminate the added stress that is experienced by some families and staff who are forced to confront
the often emotionally wrenching question of consent for recovery. Delays in the removal of transplantable organs, which sometimes
occur while awaiting the familys decision and which can jeopardize organ quality, would also be eliminated.
A final advantage of routine posthumous organ recovery is that it is more equitable than are systems
that require consent. All people would be potential contributors, and all would be potential
beneficiaries. No longer could one say, Thank you, when offered an organ but say, No, when asked to give one; such free
riders would be eliminated. And concern about exploitation of the poor, as sometimes arises
during discussions of organ sales, is not an issue here.
 2NR EPOCH TIMES
1. Prohibition on sales is the key norm conceded no impact to other norms even
if part of WHO

2. We allow consent religious opt out but people dont bother

3. Chinas bad because they conscript FOR SALES DA to perm

Hunt, 14 (Katie, Why China will struggle to end organ harvesting from executed prisoners
CNN, http://www.cnn.com/2014/12/05/world/asia/china-prisoners-organs/)

China said on Thursday it would end the harvesting of organs from executed prisoners on January 1 and
while the move has been welcomed by human rights groups, it's hard to see how China can wean itself from the
controversial practice if the views of people like Zhou are anything to go by.
Traditional beliefs regard the body as sacred and it should remain intact after death.
What's more, even if people are prepared to donate, there are fears that their body parts may be
traded for profit and end up on the black market.
Thus making a quick switch from organs supplied by death row inmates to a system based on altruism will be tough without a major
shift in attitudes -- something the head of China's transplant system acknowledges.
"People have concerns about whether the organs will be allocated in a fair, open and just way," Huang Jiefu, director of the China
Organ Donation and Transplant Committee said, according to state media.
Low donation rate
China has one of the world's lowest rates of organ transplants, with 10,000 procedures each year.
The country launched a voluntary donation scheme in 2010 but between that year and 2013 only 1,448 people donated
organs -- a drop in the ocean compared with around 300,000 people in need of organ transplants each year.
And just 0.6 people out of every million citizens have signed up to donate their organs when they die.
To plug the shortfall, China has relied overwhelmingly on organs from death row prisoners.
Technically, their organs can only be used under certain conditions, such as if no one collects the body, the inmate gives consent or
their family agrees to the medical use of the body.
However, observers both in and outside China have questioned whether prisoners have the free will to give their consent and say it's
become an unwritten policy that prisoners' organs can be used to ease the shortage.
Even with the new rules, it's likely that death-row inmates will still supply organs for
transplants.
Huang said that prisoners will still be qualified to donate, but their organs will be registered in a computerized donation system
instead of being traded privately, according to official English-language newspaper China Daily.
Skepticism
Phelim Kine, deputy director, Asia Division, Human Rights Watch in New York, says he's "extremely skeptical" about
whether China can really end its reliance on prisoners' organs in the foreseeable future.
The opacity of China's prison and death penalty system, the massive profits in organ
peddling and corruption make it "near impossible," he says.
 2NR SUPPLY
Difference is negligible
Steve P. Calandrillo 4, Associate Professor, Univ. of Washington School of Law. J.D., Harvard
Law School, CASH FOR KIDNEYS? UTILIZING INCENTIVES TO END AMERICAS ORGAN
SHORTAGE, George Mason Law Review Vol 13:1, p 69-133,
https://www.lifesharers.org/articles/calandrillo.pdf
One wrinkle in the futures market plan is whether or not organ transplant success is influenced by using a
living versus deceased donor. If outcomes are similar regardless of whether a kidney comes from a living or dead individual, then futures
markets should be just as successful as living donor sales, but without the accompanying risks. However, to the extent that success rates are reduced when a transplanted organ
is harvested from a deceased donor,201 there may still remain a small black market in living donor sales due to the greater chance of a positive outcome. In fact, some organ
To the
brokers convince dialysis patients today to buy organs abroad rather than wait for an American cadaveric donor by touting the benefits of live donation.202

contrary, most studies have concluded that the difference in outcomes based on whether
the organ was harvested from a living or non-living individual is relatively small.203 If these studies are
correct, futures markets could solve our nations organ supply crisis without reduction in health outcomes. Even if the opposite is the case, futures markets are a solid step in the
right direction, and certainly a substantial improvement over current organ supply incentives. TO FOOTNOTES 203 See, e.g., R. Knight
et al., The
Influence of Acute Rejection on Long-Term Renal Allograft Survival: A Comparison of Living and Cadaveric Donor Transplantation, 72 TRANSPLANTATION 69(2001). The
authors found that five-year survival was 90% for those receiving transplants from living relatives and 88% for those receiving
cadaveric transplants. Id. Furthermore, a cadaveric graft that was free from acute rejection three months after
transplantation had an equal likelihood of functioning at five years as that of a graft from a living
related donor. Id; see also Splendiani et al., supra note 131(finding an organ survival rate of 97% for living donor transplants versus 93% for cadaveric trans-plants);
K. Nishikawa and P. Terasaki, Annual Trends and Triple Therapy1991-2000, CLIN. TRANSPL.247 (2001) (reporting that cadaver donor graft survival

at one year improved from 84% in 1991 to 90% in 2000, while one-year graft survival of living donor transplants only improved
from 93% in 1991 to 95% in 2000. Further, triple therapy virtually eliminated the effect of sensitization for cadaveric donor grafts.)
 2NC PERM
The CP alone creates a legal bright line. The perm is the worst of all worlds
mixing sales with conscription blurs the line, wrecks public trust or the ability to
create social change in the medical system, subjects the government to costly
litigation that inhibits organ use and institutionalizes exploitation and human
rights abuses
Neri, 2 - Rebecca M. Neri, Esq., J.D. 2002, Syracuse University 2002; B.A. 1999, Hobart and
William Smith College. Ms. Neri is the Digest Form and Accuracy Editor and is an Associate of
Devorsetz, Stinziano, Gilberti, Smith & Heintz in Syracuse, New York (New Organ Donations
10 Digest 67, lexis)

3. Entering Into a Discussion about the Body as a Commodity - As mentioned briefly above, subjecting
corpses to
traditional property reasoning, and consequently, to judicial resolution creates a blanket
disincentive to individuals, [*77] families, and members of the transplant community, including doctors, donors, and
transplant centers, to participate in organ donation. Essentially, the total costs, in terms of money, time and emotional
expenditures, simply do not outweigh the benefits (i.e., a family knowing their gift let some stranger live). Additionally, requiring the
government to set prices for organs offends public policy because it permits the government to participate in organ selling
and requiresthe government to set a value scale for each organ procured. Economically, the
government and the people cannot afford to purchase the organs needed to satisfy the deficit, nor can either afford to be
tied up in litigation while the organ's value dies with its body. In this sense, discussing the body
as property inhibits the goal of increasing organs by increasing the amount of red tape one
must go through to donate. Nationalization (or the creation of a public right) of human cadaveric organs could also
result in serious human rights violations. n46 A simple, more efficient way of thinking that embraces societal problems surrounding
organ donation, while shaping public sentiment must take the place of considering the body as property.
Initiating market responses to this problem is not the simple, more efficient way of thinking. Despite this, many argue that a market
approach to organ donation could indeed remedy transactional costs as well as eliminate the need for litigation over governmental
takings. Additionally, these market advocates feel financial incentives are the most efficient means of remedying the organ shortage.
For example, in a recent work David Jefferies proposes that "the most effective way to increase the supply of organs will involve
limited commercialization of bodily components." n47 In his view, the law should provide for the use of a "middleman" who has the
authority to contract for organs and could halt potential abuses. n48 Upon the death of a willing and contracted donor, doctors
would remove the organ(s), and then the appropriate consideration for the organ would change hands. n49 Jefferies then proposes
that an organ procurement network set up an altruistic-based distribution system, rather than one conditioned on wealth. n50
This proposal is not an answer to the inefficient means of organ procurement. As will be shown in Section Three, infra, market
theories are inefficient and costly. First, contracting for body parts will require more litigation to establish
rules, interpret the rules, and to enforce the rules, requiring efforts of all [*78] branches of government and the
private sector. n51 Second, a contracting scheme exacerbates public fears, rather than reshaping
them towards a better awareness of death, in that a contract for your organs might breed
paranoia that someone is trying to "snatch" the "goods" prematurely.
III. Critique of the Market Alternatives
As stated above, applying a market strategy to remedy the current organ deficit is neither a more efficient, nor a more practical
remedy to the organ deficit problem. A market in organs creates paranoia rather than destroys societal fear,
and as such, does not incorporate the goal of shaping a new public sentiment. Though it
might eventually alleviate the organ deficit, the selling or contracting of organs would invite human rights
abuses, such as body snatching, despite retaining the specter of individual autonomy and public
control. This section makes the case that a market remedy for the organ shortage would present more obstacles to meeting the
demands for organs. Specifically, this part argues that a market strategy denies the power of substantial
societal value systems (such as common notions of ethics and human rights), and favors a select
part of the population. After discussing current market proposals and the particular faults of the trendy market cure, the
discussion will turn to why market theories are incapable of reshaping the societal preference towards organ donation.
A. The Trend of Market Solutions
Many scholars have proposed market systems as a cure for the organ deficit. n52 Specifically, those in favor of creating an organ
market have argued that since altruistic systems have failed to produce the necessary organs, self-interest in consideration might
provide the adequate incentive to donate. n53 Their basic argument is that
in the market, the supply would be self-regulating because rising demand would raise the price of tissues in short supply and
produce incentives for individuals to sell their organs; these prices would ensure that enough organs would be available to meet
demand. n54
With the demand for organs being met through a market system, these scholars argue that the market is the most efficient system of
resource allocation, and that the market would alleviate the imbalance of how benefits and burdens between the donor and recipient
are distributed. n55 Thus, economically speaking, [*79] Pareto efficiency is attained - the exchanges are consensual, voluntary, and
utility is maximized. n56
Variations to the basic supply and demand model have also been proposed. For example, Lloyd Cohen argues for a "futures market"
to cure the organ deficit. n57 Specifically, Cohen proposes that "healthy individuals be given the opportunity to contract for the sale
of their body tissue for delivery after death." n58 Some would offer alternative methods of exchange, namely, promises to donate
organs in exchange for health insurance, tax breaks, death benefits, public recognition of the donation, or a bartering system to
secure other necessities. n59
Regardless of the economic model proposed or the mode or currency of exchange, each purports to disburse ethical and human
rights concerns that arise from the notion of selling one's organs. The most cited fear about creating a market in organs is the
exploitation of the weak, elderly, poor, and the power the market gives to the wealthy. n60 Another important ethical problem a
market must deal with is whether thinking of the body as a commodity is even appropriate. n61 All proponents of a market system
insist that heavy regulation and the creation of strict criteria for both the procurement and allocation of organs would remedy ethical
concerns. n62
Any market system proposed will surely exploit the poor. First, any market theory that relies on the availability of
something to exchange, and the willingness of participants to exchange necessarily inhibits the participation of the poor. The
poor, by virtue of their economic state are not in a position of bargaining power. The poor do not
have anything to give to enable the receipt of an organ, and they are easy targets for unscrupulous organ
harvesters who would offer them a "meal for their left eye." The tension of economic hardship hardly
provides an optimal market scheme of voluntary and consensual exchanges.
Additionally, market systems that require heavy regulation are neither economically nor politically efficient. Regulation necessitates
a degree of complex rules, requiring judicial and legislative interpretation. In turn, market regulation of this sort also becomes the
embodiment of a recognized property right in one's body. As mentioned above, inviting the body to interpretation as property brings
its own set of ethical problems, as well as problems for procuring organs. By entering the body into the stream of commerce, people
would most likely seek enforcement of property rights to their body, including rights to privacy, [*80] control, and transferability.
People might also fear the possibility that their bodies could escheat over to the state once their body becomes a commodity in the
stream of commerce. The remedy to this result would be regulation, which in turn forecloses on individual autonomy.
In sum, the free market alternatives to the current system of altruism create rather than destroy social and ethical barriers to
efficient organ procurement. This section attempted to illustrate that although the exchange of organs on the free market appears to
provide individuals with a great degree of control over the disposition of their bodies, such control is dampened. That damper is
created in the face of ethical concerns relating to the exploitation of the poor, and the end result of having to provide for property
rights in the body.
B. Market Models Fail to Shape a Preference to Donate
Market paradigms purport to shape individual preferences to donate by insisting that people act in their own best interest. In other
words, a market paradigm attempts to create specific opportunities for the public so that the beneficial, logical preference for the
individual is to donate their organs. n63 In this sense, using a market strategy to provide organs must show that donating outweighs
social costs associated with selling organs. n64 This part proffers that the basic supply and demand market paradigm in which
money is exchanged for organs is ineffective in providing the public with the means to effectively weigh the social costs and benefits
of donating organs. In this sense, the prevailing societal preference under a market system would continue to deplete the organ
supply. Thus, any proposed market cure fails as a viable option to correct the current organ shortage.
Humans generally act in their own best interest, though, for the most part, they align with the sense of greater social values. Indeed,
some individuals act in accordance with what one author has termed, "socially responsible reasoning," which take humans beyond
being purely selfish actors. n65 Markets do not function on exchange alone; they inevitably encompass institutional values, such as
social preferences. n66 However, the prevailing social preference of a market in human organs might very well be corrupt at its core,
and thus, incapable of providing a structure that weighs the personal costs against the social benefits to organ donation.
The corruption lies not in the potential for market abuses, but rather in the existing social consciousness of the population. As
mentioned above, the six [*81] most popular reasons people give for not donating organs are: "hastiness of organ retrieval and a
feeling that declaration of death and immediate subsequent removal of organs interferes with the family's expression of grief;
mutilation; fatalism and superstition; religion; age and ignorance." n67 If the greater social value of organs is to prevent their being
interred without harvesting and to save lives, then the market must arrange itself around enabling people to weigh their cost or fear
concerning donation. But how is a market to do this when, in fact, the incentive is merely valued in fiscal terms? How can a market
theory, which relies on the wealth of its participants more so than the social justice of its actors effectively push social mores towards
weighing the benefits of giving over the cost of facing ones personal fears? It simply cannot. Though any market incentive might
push people towards realizing that money is preferable in exchange for needed organs, the market incentive simply fails to account
for the underlying fears of the people concerning donation.
The market cannot provide a structure in which ordinary people can rationally weigh costs and benefits of organ donation, because
the market lacks sufficient grounding in the irrational fears concerning donation. A pure incentive program that replaces altruism
with cash, or other necessities is inadequate as it falls short of effectively replacing existing social fears
connected with donating organs after death. If there really is to be any increase in the organ
supply, the answer lies in reshaping society not through a free market and property system, but
rather, through structuring discussion around changing social values at their core.
IV. The Conscription Cure: Mandatory Cadaveric Organ Donation
The general will is always right, but the judgment that guides it is not always enlightened. It is therefore necessary to make the
people see things the way they are<elip>to point out to them the right path they are seeking. Some must have their wills made to
conform to the reason, and others must be taught what it is they will. From this<elip>would result the union of judgment and will in
the social body. From that union comes the harmony of the parties and the highest power of the whole. n68
Earlier in this article, it was suggested that neither the current altruistic organ donation, nor trendy market proposals that seek to
cure the organ deficit work. n69 It has also been suggested that assigning property concepts to bodily organs, such as control,
transferability and privacy would neither efficiently deal with the organ shortage, nor incorporate a means of social change. In this
section, it [*82] will be proved that mandatory organ conscription is the most efficient way to cure the
deficit and reshape social values. Specifically, this part first discusses the doctrine of conscription, the details how
conscription purports to embrace social values and fears in such a way that will mold society into accepting cadaveric organ
conscription.
For the purposes of this article, the discussion will focus on the general policy of a conscription plan. Specific legislation would be
needed to implement such a plan, but I leave those details for later investigation. In doing so, I briefly touch on presumed consent
laws, because they closely relate to the goal of curing the organ deficit, and are a step on the same path as mandatory conscription.
A. Presumed Consent: A Step in the Right Direction
This section discusses the presumed consent system for organ procurement. Under this system, the presumption is that unless
otherwise expressed and recorded, the decedent has consented to the removal and donation of all needed organs after his or her
death. n70 In the European Union, this practice appears favored over other market remedies because a market approach seems
"inconsistent with the EU objective of a high level of consumer protection [and] the negative opinion of the European Parliament on
commercialization or organs<elip>." n71
Ideally, presumed consent systems eliminate the need to seek out the donative intent of the deceased through his family or other
means. Despite this intent, some European countries still insist on inquiring into the wishes of the family, while other countries
immediately remove organs at the point of death unless there is clear evidence the deceased desired otherwise. n72
Regardless of the standard employed, the European system is still more effective than the current altruistic system of the United
States. n73 Practically speaking, the European model has its advantages: no need to carry donor cards, no need for last minute
decision-making, and no need to ask for permission from families to harvest. This system also preserved the semblance of respect for
individual autonomy as individuals are on notice to object to harvesting. n74
This system is not without its imperfections. In practice, most physicians seeking donation still inquire into the family's wishes. n75
It also does not embrace [*83] the moral objections families or individuals have regarding donation. n76 In other words, those who
objected for moral or social reasons under the system of volunteerism will probably still object under the presumed consent system.
Thus, the goal of substantially increasing organ donation (as well as reducing transactional barriers) is not accomplished.
B. The Principles of Conscription
This section discusses the virtues of conscription. A general policy towards conscription of organs would empower every medical
provider to harvest "every cadaveric organ suitable for transplantation without regard to any contrary wishes expressed by the
decedent while he lives or by surviving relatives after he dies." n77 A system that permits the removal of all
necessary organs at death by medical providers is also the most efficient means of producing the
necessary supply of organs. A blanket rule such as this reduces judicial and legislative
deliberation over the interpretation of the rule, and demolishes the barriers created by thinking
of the body as property. Conscription would not require a "promotional campaign, compensation to donors, or even
attempts to gain permission from donors and their families." n78 Conscription would also remove some medical liability issues:
specifically, doctors would no longer be liable for failing to obtain consent, nor would they have to be burdened by seeking out
consent before donations could be made. n79
Other plans, such as the current volunteerism and the proposed market structures also purport to retain individual autonomy as well
as to operate within the framework of the Constitution. For example, advocates of volunteerism suggest that permitting individuals
to choose whether to donate encourages charity and generosity. n80 Under this system, generosity and charity drive donating;
conflicts between family and individual autonomy are eradicated; and individual autonomy is retained despite the degree of
legitimate coerciveness, as it implements greater social good and common will. n81 It is not individual autonomy in the sense of
choice, rather, it is individual autonomy in the sense that with enough organs available, a person's capabilities are increased should a
personal need for organs arise. Thus one can live freely and have a more productive life. n82
Some would argue that choice is the touchstone of American freedom, and choice includes the right to direct the disposition of one's
body. Yet, in times [*84] of national crisis (or even potential crisis) the population must be directed to join into the greater social
good; it is for this reason there is a military draft, as well as prohibitions against assisted suicide. n83 The law has always provided
for legitimate yet coercive means of shaping public attitude towards a greater public good. Conscription of organs is not unlike these
examples.
C. The Plan: How Conscription Shapes Social Values
Conscription merely purports to erase all notions of familial and individual property rights in dead bodies. In doing so, the body will
not and cannot be commodified, nor will it escheat over to the state. Instead, conscription will provide the medical community with
the resources it needs to fulfill a need for organs. Conscription is the most efficient bright line rule the
legal system can offer the public and the medical field. As stated in the introduction to this paper, discussions
regarding religious objections to conscription are outside the scope of this paper.
Ethically, understanding what it is that the public values and fears most about donating their organs will be crucial to initiating
social change towards conscription. Such values include the ability to grieve, individual autonomy, superstition, fear of mutilation,
fear of desecration, unwarranted governmental intrusion and religious objection. Arguably, conscription neither denies nor
promotes any of these common fears: families will not have to face the decision of whether to donate, and for all intents and
purposes, bodily forms stay intact after select organs are harvested; individual freedom is retained in the sense that human growth
potential and aligning with a common good will be promoted; and under conscription, the government relinquishes control to the
transplant community.
Conscription also alleviates the fear of exploiting the poor, and the over representation of wealthy recipients who have greater
bargaining power. Conscription does not favor the wealthy, nor does it prey on the poor. Conscription
creates no hold-out power for those whose organs are desperately needed.
V. Conclusion
There is a desperate need for organs in America. Patients lose their freedom and ability to live up to their potential: instead,
thousands awaiting transplantable organs are dying needlessly as thousands more healthy, viable organs are interred. Social
values and ideologies, as they stand today, can be flexed and molded into a new ideology: one of
ultimate giving. Conscription provides the cure for the needless deaths; though the rule is radical, it is appropriately coercive.
The conscription cure is able to flex social values into new values, such as placing the
highest priority in life on saving lives.

Perm is net negative even if sales are a last resort it causes global defection from
the organ regime
Budiani-Saberi, 9 - Dr. Budiani-Saberi is the Executive Director of the Coalition for Organ-
Failure Solutions (COFS). She is a medical anthropologist and has conducted extensive research
on organ trafficking, including longitudinal follow-up studies and outreach on commercial living
organ donors, assessing health, economic, social and psychological consequences (Debra,
Advancing Organ Donation Without Commercialization: Maintaining the Integrity of the
National Organ Transplant Act https://www.acslaw.org/publications/issue-briefs/advancing-
organ-donation-without-commercialization-maintaining-the-integ-0)

The OTPAs introduction of material incentives to organ donation would undermine these other
important initiatives and the potential they have to enhance organ supplies. Material incentives,
even as a final resort, should not be considered, particularly when there are significant
strides to be accomplished in advancing deceased and altruistic donation. Slavish devotion to
market-based solutions should not distract Congresss attention from these attainable solutions.
V. Conclusion
Transplants are said to be the most social of therapies. They rest on public trust in medicine.
Transplant commercialism and organ trafficking worldwide have exploited social vulnerabilities
to obtain organs for transplant. Although operating in various models, these practices inevitably
target the impoverished and lead to inequity and social injustice.
OTPAs aim to permit compensated organ donation is contrary to the global movement to
oppose commercial transplantation. The United States transplant policies are important
references for the rest of the world and are influential in shaping consideration of
material incentives in countries that would not necessarily commit to regulation or best
practices in donor care.
As illustrated at the beginning of this paper, Yuri resorted to selling a kidney when his poor
living conditions became especially destitute and the reward particularly appealing. Those
conditions drove him to the donation and he regretted the decision afterwards. Existing
transplant commercialism operates in countries that are, by definition, different from the
United States. Although proponents of compensated donation suggest that the experience would
be different in the U.S., individuals are similarly likely to resort to a donation when
compensation includes rewards such as comprehensive health care for life, health and life
insurance, disability and survivor benefits or educational benefits. Like the cash payment to
Yuri, these forms of compensation are considered to significantly enhance the life of an
individual who cannot afford these basic needs.
The United States must join the international community to rebuild, not compromise, trust in
transplants. This is especially important at this moment when markets have failed economic and
social needs in global and historical dimensions and altruism has become especially priceless.
Guided by the WHO resolution on organ transplants and the Istanbul Declaration, transplant
practices can advance standards of greater social equality rather than exploit people in poverty.
There are many opportunities to advance organ donation in the U.S. without subjecting
individuals to experiences such as Yuris.
Legalization of organ sales causes organ trafficking---it promotes inconsistent
norms and undermines enforcement mechanisms
Delmonico 11 (Francis L., Director of the Renal Transplantation Unit Massachusetts General
Hospital, Medical Director New England Organ Bank, The Declaration of Istanbul Is Moving
Forward by Combating Transplant Commercialism and Trafficking and by Promoting Organ
Donation, American Journal of Transplantation, 12(3), 515-516)

The commentary by Drs. Ambagtsheer and Weimer provide an interesting criminological

reflection regarding the Declaration of Istanbul in which they question whether efforts to
prohibit organ trade have been either realistic or effective since its widespread adoption (1).
They challenge the link of organ trafficking to transplant commercialism and drawing
comparison from other demand crimes, speculate that the regulation of commercialism would
be feasible and justified in the prevention of trafficking. However, the proposal to curtail
trafficking by the regulation of monetary payments for organs is not convincing. Organ
trafficking is indisputably linked to commercial profits and distinguishable from other demand
crimes. The prohibition of both transplant commercialism and trafficking is required as
essential to provide the criminological mechanism for detection and enforcement
efforts. The ultimate value of the Declaration of Istanbul as effective policy exists not only in its
prohibitionist stance but also in its promotion of effective donation and transplantation systems
to reduce the demand for transplant tourism that gives rise to organ commercialism and
trafficking.
Transplant commercialism is linked to organ trafficking:
The Declaration of Istanbul defines transplant commercialism as a policy or practice in which an
organ is treated as a commodity, including being bought or sold or used for material gain. The
recommendation of Ambagtsheer and Weimer to disassociate transplant commercialism from
organ trafficking is belied by the international realities (1). Organ trafficking exists only in the
realm of commercialismthe intent to make profit. Profit is what propels brokers to prey upon
refugees from the Sudan and victims of tsunami catastrophes or other vulnerable groups to sell
their kidneys.
The regulation of monetary payments for organs is not feasible and cannot be justified:
Financial incentives for organ donation that provide monetary gain cannot be regulated. Public
policy that promotes such incentives becomes veiled programs of organ sales. Once a scheme
that offers money as the motivation for donation becomes the policy or tolerated practice in
one country, it leads to the development of competitive schemes in other countries. Countries
are indeed soliciting thousands of patients to travel to foreign destinations for medical care. But
transplant tourism is different than medical tourism because of the documented harm that
occurs to paid donors. To cite programs that aim at harm reduction for prostitution as the
basis for supporting payments for organs debases organ donation as a medical procedure and is
contradicted by the harm that continues by regulated programs of prostitution.

Organ prohibitions are unique---criminalization provides a legal mechanism to

stop organ trafficking
Delmonico 11 (Francis L., Director of the Renal Transplantation Unit Massachusetts General
Hospital, Medical Director New England Organ Bank, The Declaration of Istanbul Is Moving
Forward by Combating Transplant Commercialism and Trafficking and by Promoting Organ
Donation, American Journal of Transplantation, 12(3), 515-516)

Member states of the WHO understandably reject such public policy because these schemes
quickly lead to the exploitation of individuals who are poor or destitute. The WHO is not alone
in denouncing this contention by Ambagtsheer and Weimer. The Directive of the European
Union on Human Tissues and Cells states the following: As a matter of principle, tissue and cell
application programs should be founded on the philosophy of voluntary and unpaid donation,
anonymity of both donor and recipient, altruism of the donor and solidarity between donor and
recipient (2). In July, 2010, the European Parliament and the Council affirmed that organ
donation must be voluntary and unpaid (3).
The difference between illicit drugs and transplantable organs as demand crimes:
The premise of Ambagtsheer and Weimer's position is that prohibitionist policies for demand
crimes are ineffective. However, unlike drugs or other demand driven crimes, organs are useless
unless transplanted. Successful organ transplantation requires sophisticated cooperation
between licensed professionals and licensed facilities to provide such medical care. In contrast,
drugs once purchased can be used illicitly without the involvement of medical professionals. For
this reason, Ambagtsheer and Weimer's citing the war on drugs as the primary illustration of
the failure for prohibition to reduce criminal behavior is not a valid comparison in the context of
organ trade. Trafficking requires a complicit surgeon. This comparative difference from other
demand crimes and its impact on the criminological value of the Declaration of Istanbul must be
considered.
The necessity of prohibiting transplant commercialism and organ trafficking:
Ambagtsheer and Weimer argue that the Declaration of Istanbul's prohibition will not be
effective in deterring organ commercialism and trafficking. However, it is the act of
criminalizing organ commercialism and trafficking through adoption of the Declaration
of Istanbul principles that provides the legal mechanism to organize detection and
enforcement efforts.
The ultimate value of prohibiting transplant commercialism and organ trafficking should not be
solely measured by commensurate reduction in criminal behavior. The necessity of prohibiting
organ trade is to sustain human dignity (otherwise clearly violated in the exploitation of the
destitute) and preserve organ donation as an altruistic gift.

The perm doesnt eliminate disads to living organ sales

Spital and Taylor, 8 Department of Medicine, Mount Sinai School of Medicine, New York,
New York (Aaron and James In Defense of Routine Recovery of Cadaveric
Organs: A Response to Walter Glannon Cambridge Quarterly of Healthcare Ethics (2008), 17,
337343

In one of our editorials we stated that under routine recovery there would be no need to
consider paying for organs. 2 Glannon points out that routine recovery would not eliminate the
possibility of buying organs from living vendors (note that one who sells is not a donor) and
therefore that ethical concerns about organ sales would persist. We agree. What we meant and
should have said in our editorial is that under routine recovery there would be no need to
consider paying for cadaveric organs. But the fact that our proposal would not eliminate the
possibility of organ sales and the ethical quandaries that accompany them has no bearing on its
acceptability.
 2NC HEALTH SCREENINGS PLANK
Their internal link is stupid getting healthy takes years but selling organs is a
short term decision to keep the lights on

Early screening means we are more likely to find illness that may cause death
WHO 08 World Health Organization Gaining health The European Strategy for the Prevention and Control of
Noncommunicable Diseases
Medical screening can prevent disability and death and improve quality of life, if it is effectively implemented and if
effective, affordable and acceptable treatment is available to those who require it. The number of proven screening tests to
identify individuals at high risk of disease is limited, and those that do exist require sufficient
health systems capacity for effective implementation. Screening, and then treating, individuals
for elevated risk of cardiovascular disease using an overall or total risk approach, which takes into
account several risk factors at once, is more cost-effective than focusing just on individual risk factors or on those
based on arbitrary cut-off levels of individual risk factors (7). In countries with sufficient resources to provide
appropriate treatment, it is also effective to screen individuals for early detection of breast and
cervical cancer, particularly if this takes place through organized, population-wide screening
programmes (8,9). Diabetic retinopathy is an easily identifiable and treatable complication of diabetes, but it is an important cause of visual loss
in Europe: regular screening, and treatment, of individuals at high risk could prevent blindness.
 2NC SOLVES ORGANS
More than enough can come from cadavers live donation is unnecessary
Carney, 7 - Scott Carney is an investigative journalist based in Chennai, India (The Case for
Mandatory Organ Donation Wired, 5/8,
http://archive.wired.com/medtech/health/news/2007/05/india_transplants_donorpolicy

Increasing the supply of cadaver organs is an obvious solution, but volunteer programs have not
produced enough organs to make a difference. Now some leading ethicists and doctors are re-
examining the principle of informed consent in government organ-donor programs, arguing
that harvesting from cadavers should be a routine procedure just like autopsies in murder
investigations.
"Routine recovery would be much simpler and cheaper to implement than proposals designed to
stimulate consent because there would be no need for donor registries, no need to train
requestors, no need for stringent government regulation, no need to consider paying for
organs, and no need for permanent public education campaigns," wrote Aaron Spital, a clinical
professor at Mount Sinai School of Medicine, and James Stacey Taylor, an assistant professor of
philosophy at the College of New Jersey, in a controversial article published this year by the
American Society of Nephrology.
This approach faces obvious and enormous obstacles, challenging as it does widely and deeply
held beliefs about the sanctity of the body, even in death. But it could be the only solution
that works.
Roughly half a million people around the world suffer from kidney failure and many are willing
to pay any price for a donor organ. They have two options: wait on impossibly long donation
lists or pay someone for a live donor transplant.
The United Network for Organ Sharing, which runs the current system of cadaver donation in
the United States, maintains lists of brain-dead patients around the country and actively tries to
match up prospective donors. At present there are more than 90,000 people waiting for kidneys
but only about 14,000 donors enter the system each year.
The shortage of donors isn't based on a shortage of brain-dead people in hospitals, but
on the shortage of people whose organs -- even after they have opted into a convoluted and
difficult organ-donation program -- never find their way to a viable patient. A 2005 Gallup poll
revealed that more than half the population of the United States was willing to donate organs
after death, but inefficiencies in the current system mean that even willing donors often end up
not donating because families raise objections or there is a question about consent.
Fewer than two out of 10 families opt to donate organs of relatives after death. Hospitals often
are unwilling to share organs from donors on their rolls and waste organs while waiting to set up
their own in-house transplants. Often, perfectly good transplant organs get lost in a bureaucratic
shuffle.
Routine organ donations would dramatically increase the supply of donor organs; with a little
effort it would be possible to set up a system to transport donation-worthy organs anywhere in
the world.

The CP procures almost 100% of organs with no risk of abuse

Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York
(Aaron, Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time
Has Not Yet Come Cambridge Quarterly of Healthcare Ethics (2005), 14, 107112)

The most important advantage of conscription is that under this plan, the efficiency of organ
procurement should approach 100%, which would dramatically increase the number of organs
available for transplantation. As previously noted, it is highly unlikely that any other approach could
do nearly as well. As a result of the increased availability of organs that conscription would provide, the lives of many more
patients with end-stage organ failure could be improved and extended.
Another advantage of conscription is that this system would be
much simpler and less costly than other
approaches to organ procurement. Under this plan there would be no need to search for the best approach for
obtaining consent, no need for expensive, labor-intensive educational programs designed to encourage more people to say yes, no
need to train requestors to obtain and document consent, no need to maintain donor registries, and no need for complex
regulatory mechanisms to prevent abuse as would be required were financial incentives allowed.
A third advantage of conscription is that because permission from the family would no longer be sought, this plan would eliminate
the added stress that devastated families now endure when asked to consider organ donation in the midst of the grief and shock that
follow the sudden death of a loved one. Furthermore, delays in organ recovery that result from the current
need to wait for family approval, and that jeopardize the quality of organs, would be eliminated.
A final advantage of conscription is that, in contrast to other approaches to organ procurement, it satisfies
the principle of distributive justice, which refers to equitable sharing of burdens and benefits by members of the
community. Under conscription, all people who die with usable organs would contribute to the cadaveric
organ poolthere would be no more free riders 1and all people would stand to benefit should
they ever need an organ transplant. This contrasts with our current system in which people can refuse to donate and yet compete
equally for an organ with generous people who choose to give.

Theyre conflating the shortage which is an annual rate with the size of the waiting
list---we provide enough organs to create an annual surplus which in turn reduces
the waitlist over time
David Kaserman 2, PhD in Econ from the University of Florida, Markets for Organs: Myths
and Misconceptions, 18 J. Contemp. Health L. & Pol'y 567 (2002),
http://scholarship.law.edu/cgi/viewcontent.cgi?article=1222&context=jchlp
For over three decades, there has been a severe and chronic shortage of cadaveric human
organs suitable for transplantation. The ongoing shortage of kidneys, hearts, livers, lungs, and other solid organs has
significantly hampered the ability of physicians to bring improved life-saving transplant technology to patients suffering from a
variety of debilitating and often fatal diseases. As a result, thousands of individuals die each year because of the failure to obtain a
suitable organ in time.' Thousands more are forced to undergo dialysis and other unpleasant but life-sustaining treatments while
waiting for an organ (or death, whichever comes first). It is noteworthy that this shortage of transplantable organs is not
attributable to an inadequate supply of potential organ donors. While estimates of the actual
number of deaths that occur each year under circumstances that would allow for removal and
transplantation of cadaver organs vary widely, all such estimates reveal a substantial pool of
potential organ donors who, for a variety of reasons, fail to supply the needed organs.2 A review of
these estimates conservatively suggests that organ donations could at least double, given the
existing number of potential donors. The failure of the current procurement system to collect a larger portion of the
cadaveric organs that are potentially available has spawned an extensive literature proffering a variety of proposals to alter the
existing system in various fundamental and not-so-fundamental ways. Among these proposals, perhaps the most promising is a
lifting of the legal ban on cadaveric organ purchases and sales that is contained in the 1984 National Organ Transplant Act, which
would allow markets to form and organ prices to rise to their equilibrium, market-clearing levels.3 To an economist, this proposal
provides an obvious and straightforward approach to resolving the organ or any other shortage. To many of the commentators on
medical policy issues who are contributing to the literature in this area, however, the organ market proposal is highly suspect and
has been challenged on both ethical and economic grounds.4 Significantly, most, if not all, of these challenges appear to be founded
upon rather blatant misconceptions involving some very fundamental economic issues.5 While errors involving economic concepts
may be inevitable in a literature that has been dominated by non-economists, correction of such errors is nonetheless necessary if
policy discussions and ultimate decisions are to be founded upon accurate information. The somewhat limited purpose of this paper
is to identify and correct some of the more prominent economic misconceptions involving the organ market proposal that currently
plague the literature in the hope that the resulting increased clarity will help to elevate the level of the ongoing debate. While I
certainly do not intend or expect this discussion to transform readers into economists, the clarifications offered in this article should
improve the overall understanding of the organ market proposal and how it can work to resolve this tragic shortage. II.
MISCONCEPTION 1: DEFINITION AND MEASUREMENT OF THE SHORTAGE Perhaps the most fundamental misconception
surrounding discussions of the organ shortage involves the very definition of the term "shortage," and the corresponding
measurement of the magnitude of that shortage. Specifically, several authors writing in this area have mistakenly interpreted the
number of patients on a transplant waiting list as a direct measure of the size of the shortage of a particular organ. Such a view fails
to recognize the crucial distinction between stocks and flows that is routinely emphasized in economic analysis. Economists define a
shortage as a condition in which the quantity of a product demanded exceeds the quantity supplied at the existing price! To
appreciate what this definition implies for the organ shortage, two fundamental aspects of the concepts of supply and demand must
first be understood. First, both of these concepts refer to schedules relating the quantities bought and sold to various prices paid
and received. That is, the term "demand" means a schedule, which may be expressed in the form of a table, graph, or equation that
shows the quantities that will be purchased at all possible prices. A specific quantity, at some point along that schedule, is then
referred to as the "quantity demanded" at the specified price. Similarly, "supply" is a schedule that indicates the quantities that will
be placed on the market for sale at all possible prices. "Quantity supplied" refers to a single point along that schedule. Thus, the
present shortage of transplantable organs is equal to the quantity demanded minus the quantity supplied
at the current price of organs. Under the existing U.S. organ procurement policy, that price is zero. Second, and extremely
important for the discussion here, the quantities referred to in the definitions of both supply and demand are flows, not
stocks. In other words, these quantities are expressed as some number of units of the product per some
interval of time. To say that the quantity demanded or supplied of product X is 100 units at a price of $10 per unit is
meaningless unless we specify the time period over which these 100 units will be purchased or sold.Obviously, the demand and
supply of a product will vary substantially depending upon the time interval over which they are defined. This second point is
crucial to understand, as it has been the source of considerable confusion in debates about the organ shortage and alternative
policies formulated to resolve it. Specifically, participants in these debates often have explicitly or implicitly
confused the number of patients on transplant waiting lists, which is a stock, with the concept
of a shortage, which is a flow.8 The size of the waiting lists for transplantable organs represents the
accumulation of the excess demands (shortages) of all preceding periods, adjusted for the attrition
that occurs from patients dying during the specified time interval. As such, observed waiting lists greatly
exaggerate the magnitude of the actual organ shortage on an annual (or any other time period) basis.
To illustrate this important distinction, data from the United Network for Organs Sharing (UNOS) indicates that the waiting
list for kidneys stood at 42,364 patients in 1998.9 However, the actual annual shortage of
kidneys is not equal to this number. Rather, the shortage is approximated by the increase in the number of people on the waiting
list over the preceding year's figure. It is that number-the annual change in the waiting list-that indicates the amount by which the
quantity demanded in 1997 exceeded the quantity supplied in that year. With UNOS reporting 38,236 people on this list in 1997,
the actual shortage in that year was only 4,128 (42,364 minus 38,236) kidneys, or just over 2,000
donors, if there is no adjustment for attrition due to deaths of patients on the list.'0 Note that this number is less than ten
percent of the number of patients on the waiting list." FOOTNOTE 8. See Evans et al., supra note 2, at 239; Randall, supra
note 6, at 1223; Siminoff & Leonard, supra note 4, at 20. All of these articles appear to confuse waiting lists
with shortages. That confusion, in turn, appears to lead these authors to conclude mistakenly
that the potential supply of cadaveric donors is insufficient to eliminate the organ
shortage at any conceivable collection rate (i.e., at any rate up to 100%). END FOOTNOTE
Obviously, if 4,128 additional kidneys had been supplied in 1997, the waiting list would have
remained stable at 38,236. That is, the backlog would not have grown. Further, if 42,364 kidneys had been supplied in
1998, the entire waiting list that had built up over all prior years of shortages could have been eliminated completely in a single year.
Then, if that number of kidneys continued to be supplied in subsequent years, an extremely large surplus would materialize
immediately. Of course, given the backlog of patients on the waiting list, an annual surplus is highly desirable for some
period into the future in order to reduce
that list over 12 time. Once the backlog is eliminated by this series of
surpluses, however, a simple clearing of the annual demand for kidneys will be sufficient to
prevent future backlogs from developing. Clarification of this issue is important, because it directly affects the
perceived ability of any policy change to eliminate the shortage under the constraint provided by the existing pool of potential organ
donors. Specifically, if one mistakenly views the shortage as being equal to the waiting list, one
might then conclude (incorrectly) that complete resolution of the shortage is not feasible under
any policy option. 3 In addition, overestimation of the shortage by reference to the waiting list would lead to a gross overestimate of
the price that would be required to equilibrate the market.1 4 Such an overestimate, in turn, would cause an underestimation of the
cost effectiveness of the organ market proposal. As a result, unbiased evaluation of that proposal requires a correct definition and
measurement of the shortage as a flow rather than a stock.
 AT: TAKINGS CLAUSE/5TH AMENDMENT
It doesnt violate the takings clause organs arent property and NOTAs ban on
sales means it cant be a takings.
Silver, 88 Assistant Professor of Law, Touro College, Jacob D. Fuchsberg Law Center.
(Theodore, The Case for a Post-Mortem Organ Draft and a Proposed Model Organ Draft Act
68 B. U. L. Rev. 681 (1988)

Whether "property" under the fifth amendment is defined according to positive law or "the
sphere of private autonomy which government is bound to respect," 167 it is evident that post-
mortem organs do not qualify. First, the common law expressly rejects the notion that dead
bodies are the surviving family's property, at most conferring upon them the status of "quasi-
property. ' 168 Regarding the donor himself, it might be argued that one's organs are his own
property during life. Clearly, his testamentary powers of disposal, however, are not. The power
to make a will is, in all common-law jurisdictions (except, perhaps, Wisconsin169), "in no sense
a property right or a so-called natural right.' 7 0 The power to make a will "is therefore not a
right protected by any of the constitutional provisions whereby property is protected ... it is
purely a statutory right, subject to the complete control of the legislature."'' Because the
surviving family has no property right in the cadaveric organs and the potential donor has no
property right in disposing of them by will, there remains only the possibility that the donor has
some property right in his organs after he is dead. It is unlikely that dead bodies have
constitutional rights.'7 2
Second, at least one attribute is necessary to qualify a thing as property under the fifth
amendment; it must have value susceptible to exchange between the owner and some other
party. 7 3 As Justice Frankfurter states: "The value compensable under the Fifth Amendment ...
is only that value which is capable of transfer from owner to owner and thus of exchange for
some equivalent.' 174 Since federal law now forbids any person to acquire or transfer a human
organ for valuable consideration,'175 post-mortem human organs are not susceptible to
exchange for value. 76 For this reason alone, post-mortem organs would seem not to qualify as
property under the fifth and fourteenth amendments; the Constitution, therefore, would seem
not to require any compensation to donors or their survivors when post-mortem organs are
conscripted to service. 177

This means regulatory takings is a disad to the permuation, not the CP which
creates an economic interest in the organ by allowing sales, and then has the
government steal the organ

The takings doctrine doesnt apply to organs their arg assumes the cadaver has
full property rights
Neri, 2 - Rebecca M. Neri, Esq., J.D. 2002, Syracuse University 2002; B.A. 1999, Hobart and
William Smith College. Ms. Neri is the Digest Form and Accuracy Editor and is an Associate of
Devorsetz, Stinziano, Gilberti, Smith & Heintz in Syracuse, New York (New Organ Donations
10 Digest 67, lexis)

2. The Impossibility of Applying Regulatory Takings Law to Organ Procurement - Somehave argued that removing
organs under legislative guidance without explicit consent from either the family or the deceased results in unjust
deprivation of property by the government. n39 Such a deprivation would require the legal system to apply constitutional
takings law to organ removal under the Constitution. The Fifth and Fourteenth Constitutional Amendments "[protect] an
individual's rights in property against deprivation by the state without due process." n40 Takings law subjects organ procurement to
judicial intervention in order to decide whether the procurement constitutes a governmental taking. Recall the holding in Brotherton
v. Cleveland, where the court stated that the deceased and a relative of the deceased has a "legitimate claim of entitlement" to control
the disposition of the cadaver. n41 The legitimate claim of entitlement granted by this court requires health care professionals to
obtain consent from families by law prior to removing organs. Obtaining such consent is usually impractical given the point of time
at which such consent is required (i.e., immediately after the death of the potential donor). But without such consent, any attempt by
the government to harvest organs will be construed as an unconstitutional taking, regardless of the proven, substantial public health
need for such taking. Adding takings regulations only subjects the procurement process to more judicial red tape. This additional red
tape and governmental interference would act as a disincentive to donating organs because the costs (including [*76] time, money,
and even emotional pain) do not outweigh the altruistic benefit one might get from donating.
An additional way of interpreting the juxtaposition of takings law and organ donation is that if courts insist on interpreting the rights
to one's body as property, then the government might be entitled to exercise its "taking power" under the Fourteenth and Fifth
Amendments. n42 This is subject to two restrictions: the taking must be for a substantial public
purpose, such as to remove a public nuisance, or the individual must be justly compensated. n43 One could
logically conclude that if the law by statute grants quasi-property rights in a dead body, regardless of consent requirements, the dead
body should be entitled to full constitutional protection. However, a per se "taking" of a bodily organ conjures Orwellian-type images
of a physical invasion by a government entity. n44 Permitting the government to have the power to physically invade a dead body
without consent for the greater public good of saving lives has merit and might effectuate the goal of increasing organ procurement.
But, the psychic effect of such sanctioned government invasion is damaging, and furthermore, it would likely constitute a substantial
invasion on individual and familial entitlements. Thus, even a showing of the greater public good (i.e., curing the organ deficit)
would not be enough to trump property and individual rights in the body, regardless of the constitutional protections offered.
Using a Kaldor-Hicks measure of efficiency, which promotes an efficiency-maximization rule at the expense of property rights, the
most promising solution to the organ deficit is the abolition of property rights in the body after
death and to not permit courts to reach the issue of entitlements after death. This circumvents both
the arduous quest for proper consent, and takings law requirements. In doing so, the transplant community will have the necessary
societal and legal authority to remove and transplant organs into individuals who can use them to become productive members of
society. The very act of transplantation maximizes "society's aggregate utility" by redistributing
value to where it is needed. n45 This contrasts the takings law analysis above in that takings laws
assume a property right in the first instance, and permit substantial governmental involvement.
Instead, I propose that we not even reach the issue of property or quasi-property rights in the body,
thereby avoiding completely the problems of governmental involvement.
 AT: PERM DO CP
It severs sales - Conscription isnt a sale, the CP has the government effectively
steal the organs
Richards, 6 (Abena, Dont take your organs to heaven. . . . Heaven knows we need them here:
Another Look at the Required Response System 366 NORTHERN ILLINOIS UNIVERSITY
LAW REVIEW [Vol. 26)

5. Conscription (Routine Salvaging)

This system is the strongest form of presumed consent.121 It does not require consent from
anyone, including the donor himself.122 This is an extreme way of solving both problems:
physicians do not have to ask for consent and surviving family members are not allowed to
object posthumously. 123 Owing to this lack of choice, this system has the potential to increase
organ procurement the greatest.124 However, also owing to this lack of choice, this system
faces the most constitutional and ethical challenges.125 However, some commentators are
hesitant to say that this policy would increase donation rates because organ suppliers do not
voluntarily donate organs under this system. Stolen would, perhaps, be a more appropriate
term.126
 AT: KILLS MEDICAL CARE
No chance of premature care withdrawal different teams are in charge of patient
care and organ removal
Spital and Taylor, 8 Department of Medicine, Mount Sinai School of Medicine, New York,
New York (Aaron and James In Defense of Routine Recovery of Cadaveric
Organs: A Response to Walter Glannon Cambridge Quarterly of Healthcare Ethics (2008), 17,
337343

Glannon suggests that if the requirement for consent for cadaveric organ recovery were eliminated, [t]his could put intensivists in a
conflict of interest between their primary duty to critically ill patients with viable organs and their secondary duty to promote
transplantation (p. 331). Glannon also suggests that given the urgent need of potential transplant recipients, under
routine recovery there might be a tendency to prematurely withdraw life support from and not
give appropriate care to patients (p. 331). For the reasons outlined below, we believe that these concerns are
unfounded.
First, we disagree
that intensivists or any other physicians caring for patients who are potential organ
sources have a secondary duty to other patients as organ recipients (p. 335). Over 20 years ago Dr.
Levinsky pointed out that, In caring for an individual patient, the doctor must act solely as that patients advocate, 3 a position we
support strongly. The physician is unable to do this if she is asked to balance the interests of one patient against those of another.
This realization has led to the widely accepted practice that the team caring for the dying patient must be totally independent of the
team that cares for transplant recipients and procures organs.4 When this guideline is followed, there should be no conflict of
interest for treating physicians. And despite Glannons claim to the contrary, removing the requirement for consent
to posthumous organ recovery would in no way compromise the ability to achieve independence
of critical care physicians and recovery teams.
Second, the fear of premature withdrawal of care is not unique to routine recovery.5 There is growing
support for the view that when it is known that the decedent had wanted to be an organ donor, that wish should be honored.6 In
such cases there is just as much reason to be worried about inappropriate withdrawal of care as there would be under routine
recovery. And this should not be a concern at all if the teams responsible for care and recovery are
entirely separate, as good practice dictates.

Limiting to cases of brain death solves the turns

Spital and Taylor, 8 Department of Medicine, Mount Sinai School of Medicine, New York,
New York (Aaron and James In Defense of Routine Recovery of Cadaveric Organs: A Response
to Walter Glannon Cambridge Quarterly of Healthcare Ethics (2008), 17, 337343

Third, we recommend that routine recovery be limited to brain dead subjects; in these cases,
death is declared on the basis of neurological criteria and before ventilatory support is
withdrawn. This restriction would eliminate the possibility that routine recovery could lead
to premature withdrawal of life support or conflicts of interest for treating physicians because
support would not be withdrawn before organ recovery and the subjects would be dead.
Although tissue oxygenation may be maintained for a short time by mechanical ventilation and
circulatory support, it is incorrect to refer to this as life support because the former patient is no
longer alive.
Finally, it is important to note that even if the treatment decisions of some physicians were
influenced by an awareness of the great need for organs, the expected effect of this would be to
maintain rather than reduce support of patients nearing brain death in order to maintain
organ viability.

There would be a net decrease in public anxiety regarding organ donation

Hershenov and Delaney, 9 Full Professor Philosophy Department University at Buffalo
(David and James Mandatory Autopsies and Organ Conscription Kennedy Institute of Ethics
Journal, Volume 19, Number 4, December 2009, pp. 367-391
We are aware that the prospect of organ conscription induces anxiety that mandatory autopsies do not. We suspect that the
real
root cause of the greater anxiety about nonconsensual organ procurement is based on the fear
that organs will be taken prematurely from those near death or that some life-saving measures will not be
pursued by doctors in a hurry to harvest organs.20 Such autopsies, it will be claimed, do not create the same kind of public fear and
anxiety as nonconsensual organ procurement because medical examiners have no capability or interest in causing or hastening
death for the sake of doing an autopsy.
Some people might respond that such concerns are irrational and that public policies should not be based upon them. We need not
take a stand on that issue. Instead we think the anxiety provoked by organ conscription can be offset if the policy is considered in the
wider context. We would think that there would be more anxiety if people recognize that the chances are greater that they someday
will need a life-saving organ transplant that is not available than that they someday might be shortchanged in their care so their
organs can be taken. Therefore the odds are much more likely that one will suffer the first type of anxiety under existing policies than
the second kind of anxiety under the advocated policy. Thus a new source of patient anxiety does not undermine our
argument for organ conscription because it will
be more than offset by a reduction in the anxiety due to
organ demand far exceeding organ supply.21 We do not even have to appeal to a contestable principle that says we
can ignore the irrational anxiety of those who are paranoid about organ taking conspiracies in order to save the lives of those in need
of organ transplants.
Moreover, organ conscription actually should lessen the anxiety that arises from worries that
doctors will not do everything in their power to keep patients alive in order that they become
donors. The vast increase of organs available for transplant would erase the motivation for the
illicit takings that stir the imaginations of writers and film makers and their readers and audiences who
then refuse to sign donor cards. So those worried about premature organ procurement will have less
reason to be anxious with the implementation of an organ draft.
But putting the discussion more firmly in the context of our thesis, we are arguing that there is no relevant
difference between existing mandatory autopsy laws and a policy of organ conscription. The
preceding discussion has been in large part an effort to compare the likely effects of such an organ conscription policy with those of
the current policy of voluntary organ donation with respect to the publics fears and anxiety about organ taking. All this takes for
granted that weighing the publics fears and anxiety is relevant to policy making. If it is not relevant, then the entire discussion is
moot and the reason fails to distinguish organ conscription from mandatory autopsy. But even if it is relevant, and high public
anxiety is potentially a reason not institute a given policy, we have shown that there is no good argument that an organ conscription
policy such as the one we have been discussing would be affected by it.

Links harder to markets

Caplan, 14 - Department of Medical Ethics and Director, Center for Bioethics, University of
Pennsylvania (Arthur, Contemporary Debates in Bioethics, ed: Caplan and Arp,. Google books)

There is every reason to believe that markets

will not produce a gain in kidneys. Major religious
groups such as the Catholic Church vigorously oppose sales in body parts (see, for example,
http://www.catholic newsagency.com/news/pope_condemns_organ_ transplant_abuses_as_abominable/)_ If major
religious organizations condemn markets and proscribe participation in any system that
tolerates them, then not only will there not be an increase in kidney avail- ability, but also there could
well be a drop in the availability of kidneys and of all other organs and tis- sues used in transplantation.
Introducing known and quite zealous major religious opposition to markets in body parts into
the realm of transplantation is a far more concrete reason to predict their failure than any of the
generalities about markets that Cherry offers in predicting their success.
 AT: WHO
Religious safeguards inev but nobody bothers using them
Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York
(Aaron, Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time
Has Not Yet Come Cambridge Quarterly of Healthcare Ethics (2005), 14, 107112)

Another concern is that allowing people to opt out on religious grounds could greatly reduce the
efficacy of the program if many objectors would claim this exemption regardless of their
religious beliefs. But this is unlikely if a strong burden of proof of religious objection is
required of those who attempt to invoke this exclusion, as was true for conscientious objectors
to military service. Furthermore, because conscription of cadaveric organs would cause little if
any harm, it is likely that for many objectors the benefit of getting out of the program would
not be worth the effort required to do so.
RISK ASSESSMENT
 IMPACT CALC
The aff is equally uncertain---the causal effect on the organ shortage is
unpredictable
Julia D. Mahoney 9, John S. Battle Professor of Law, University of Virginia School of Law,
ALTRUISM, MARKETS, AND ORGAN PROCUREMENT, Law and Contemporary Problems
Vol 72:17, http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1535&context=lcp
That the arguments for refusing to compensate organ sources are unpersuasive does not mean that instituting financial rewards would necessarily
prove to be a good policy choice. Introducing financial incentives raises significant challenges, not least among them overcoming the potential hostility
of procurement professionals, bioethicists, and others who fiercely espouse the principle of altruistic donation. Compounding such resistance are
formal and informal constraints on financial incentives.77 Removing, modifying, or declining to enforce the formal
constraintsthat is, the laws and regulations prohibiting compensation for organ sourceswill not
automatically dissolve the informal constraints of organizational practice and social
norms. That said, there is reason to suspect that informal institutional limits on financial incentives are malleable.78 At the very least, some forms
of financial incentives might prove both effective and acceptable. But, in assessing potential institutional modifications,
we are hampered by our limited knowledge of how societal attitudes change. Another
stumbling block is our rudimentary understanding of the organizational framework that
encourages and supports altruism in the context of organ donation.79 It is worthwhile to examine the four most prominent
financial-incentive proposals and assess their feasibility. Any such analysis is necessarily preliminary, for the long-
standing, strict proscriptions against compensating organ sources make it hard to predict how
procurement organizations and professionals, prospective donors, the general public, and others
will react to policy innovations.80

Precautionary approach key

Mark Jablonowski 10, Lecturer in Economics at the University of Hartford, Implications of
Fuzziness for the Practical Management of High-Stakes Risks, International Journal of
Computational Intelligence Systems, Vol.3, No. 1 (April, 2010), 1-7,
Danger is an inherently fuzzy concept. Considerable knowledge imperfections surround
both the probability of high-stakes exposures, and the assessment of their acceptability. This is due to the
complex and dynamic nature of risk in the modern world. Fuzzy thresholds for danger are most
effectively established based on natural risk standards. This means that risk levels are acceptable
only to the degree they blend with natural background levels. This concept reflects an evolutionary process
that has supported life on this planet for thousands of years. By adhering to these levels, we can help assure ourselves of thousands
more. While the level of such risks is yet to be determined, observation suggest that the degree of
human-made risk we routinely subject ourselves to is several orders of magnitude
higher.
Due to the fuzzy nature of risk, we can not rely on statistical techniques. The fundamental
problem with catastrophe remains, in the long run, there may be no long run. That is, we
can not rely on results averaging out over time. With such risks, only precautionary
avoidance (based on the minimaxing of the largest possible loss) makes sense. Combined
with reasonable natural thresholds, this view allows a very workable approach to achieving safe progress.

Rescher is neg
Rescher, Prof. of Philosophy, 83
Nicholas Rescher (Department of Philosophy at the University of Pittsburgh) 1983 Risk: A
Philosophical Introduction to the theory of risk evaluation, p. 67

Certain hazards are simply

In such situations we are dealing with hazards that are just not in the same league.
unacceptable because they involve a relatively unacceptable threatthings may go
wrong so badly that, relative to the alternatives, its just not worthwhile to run the risk, even in
the face of a favorable balance of probabilities. The rational man is not willing to trade off against one another by juggling
probabilities such outcomes as the loss of one hair and the loss of his health or his freedom. The imbalance or disparity between risks is just too great
to be restored by probablistic readjustments. They are (probablistically) incommersuable: confronted with such incomparable hazards, we do not
bother to weigh this balance of probabilities at all, but simply dismiss one alternative as involving risks that are, in the circumstances, unacceptable.

So is Yudkowsky
Yudkowsky 6 (Eliezer, Singularity Institute for AI Research Fellow and Director, 8/31,
Cognitive Biases Potentially Affecting Judgment of Global Risk,
http://www.singinst.org/ourresearch/publications/cognitive-biases.pdf)
Every true idea which discomforts you will seem to match the pattern of at least one psychological error.
if you believe someone is guilty of a psychological error,
Robert Pirsig said: "The world's biggest fool can say the sun is shining, but that doesn't make it dark out."

then demonstrate your competence by first demolishing their consequential factual

errors. If there are no factual errors, then what matters the psychology? The temptation
of psychology is that we can meddle in arguments where we have no technical
, knowing a little psychology,

expertise - i If someone wrote about an asteroid strike destroying

nstead sagely analyzing the psychology of the disputants. a novel modern

civilization, then someone might criticize that as apocalyptic novel extreme, dystopian, ; symptomatic of the author's naive inability to deal with a

We recognize this as a literary criticism, not a scientific one

complex technological society. should ; it is about good or bad novels, not good or bad
hypotheses. To quantify the annual probability of an asteroid strike in real life, one must study astronomy and the historical record: no amount of literary criticism can put a number on it. Garreau (2005) seems to hold that a scenario of a
mind slowly increasing in capability, is more mature and sophisticated than a scenario of extremely rapid intelligence increase. But that's a technical question, not a matter of taste; no amount of psychologizing can tell you the exact slope of that curve. It's harder to

abuse heuristics and biases than psychoanalysis. Accusing someone of conjunction fallacy leads naturally into listing the specific details that you think are burdensome and drive down the joint probability. Even so, do not lose track
of the real- world facts of primary interest ; do not let the argument become about psychology. Despite all dangers and temptations, it is better to know about psychological
biases than to not know. Otherwise we will walk directly into the whirling helicopter blades of life. But be very careful not to have too much fun accusing others of biases. That is the road that leads to becoming a sophisticated arguer - someone who, faced with any

what does you in is

discomforting argument, finds at once a bias in it. The one whom you must watch above all is yourself. Jerry Cleaver said: " not failure to apply some high-level, intricate, complicated technique. It's

overlooking the basics . Not keeping your eye on the ball." analyses should finally center on testable real-world
assertions . Do not take your eye off the ball.

Theyre wrong about predictions and voting for them makes it worse
Fitzsimmons, 7 Ph.D. in international security policy from the University of Maryland,
Adjunct Professor of Public Policy, analyst in the Strategy, Forces, and Resources Division at the
Institute for Defense Analyses (Michael, The Problem of Uncertainty in Strategic Planning,
Survival, Winter 06/07)
In defence of prediction Uncertainty is not a new phenomenon for strategists. Clausewitz knew that many intelligence reports in war are contradictory; even more are false, and
most are uncertain. In coping with uncertainty, he believed that what one can reasonably ask of an officer is that he should possess a standard of judgment, which he can gain
only from knowledge of men and affairs and from common sense. He should be guided by the laws of probability.34 Granted, one can certainly allow for epistemological debates
about the best ways of gaining a standard of judgment from knowledge of men and affairs and from common sense. Scientific inquiry into the laws of probability for any given
strate- gic question may not always be possible or appropriate. Certainly, analysis cannot and should not be presumed to trump the intuition of decision-makers. Nevertheless,
the burden of proof in any debates about planning should belong to the
Clausewitzs implication seems to be that

decision-maker who rejects formal analysis, standards of evidence and probabilistic reasoning.
Ultimately, though, the value of prediction in strategic planning does not rest primarily in getting the

correct answer, or even in the more feasible objective of bounding the range of correct answers. Rather, prediction requires decision-
makers to expose, not only to others but to themselves, the beliefs they hold regarding why a
given event is likely or unlikely and why it would be important or unimportant. Richard Neustadt and Ernest
May highlight this useful property of probabilistic reasoning in their renowned study of the use of history in decision-making, Thinking in Time. In discussing the importance of
probing presumptions, they contend: The need is for tests prompting questions, for sharp, straightforward mechanisms the decision makers and their aides might readily recall
and use to dig into their own and each others presumptions. And they need tests that get at basics somewhat by indirection, not by frontal inquiry: not what is your inferred
causation, General? Above all, not, what are your values, Mr. Secretary? ... If someone says a fair chance ... ask, if you were a betting man or woman, what odds would you put
on that? If others are present, ask the same of each, and of yourself, too. Then probe the differences: why? This is tantamount to seeking and then arguing assumptions
underlying different numbers placed on a subjective probability assessment. We know of no better way to force clarification of meanings while exposing hidden differences ...
Once differing odds have been quoted, the question why? can follow any number of tracks. Argument may pit common sense against common sense or analogy against analogy.
What is important is that the experts basis for linking if with then gets exposed to the hearing of other experts before the lay official has to say yes or no.35 There are at least
prediction enforces a certain
three critical and related benefits of prediction in strate- gic planning. The first reflects Neustadt and Mays point

level of discipline in making explicit the assumptions, key variables and implied causal
relationships that constitute decision-makers beliefs and that might otherwise remain
implicit. Imagine, for example, if Shinseki and Wolfowitz had been made to assign probabilities to
their opposing expectations regarding post-war Iraq. Not only would they have had to work
harder to justify their views, they might have seen more clearly the substantial chance that they
were wrong and had to make greater efforts in their planning to prepare for that contingency.
Secondly, the very process of making the relevant factors of a decision explicit provides a firm, or at
least transparent, basis for making choices. Alternative courses of action can be compared and assessed in like terms. Third, the

transparency and discipline of the process of arriving at the initial strategy should heighten the
decision-makers sensitivity toward changes in the environment that would suggest the need for
adjustments to that strategy. In this way, prediction enhances rather than under-mines
strategic flexibility. This defence of prediction does not imply that great stakes should be gambled on narrow, singular predictions of the future. On the
contrary, the central problem of uncertainty in plan- ning remains that any given prediction may simply be wrong. Preparations for those eventualities must be made. Indeed, in
many cases, relatively unlikely outcomes could be enormously consequential, and therefore merit extensive preparation and investment. In order to navigate this complexity,
While the complexity of the international security
strategists must return to the dis- tinction between uncertainty and risk.

environment may make it somewhat resistant to the type of probabilistic thinking associated
with risk, a risk-oriented approach seems to be the only viable model for national-security
strategic planning. The alternative approach, which categorically denies prediction, precludes
strategy. As Betts argues, Any assumption that some knowledge, whether intuitive or explicitly formalized, provides guidance about what should be done is a presumption
that there is reason to believe the choice will produce a satisfactory outcome that is, it is a prediction, however rough it may be. If there is no hope of discerning and
manipulating causes to produce intended effects, analysts as well as politicians and generals should all quit and go fishing.36 Unless they are willing to quit and go fishing, then,
strategists must sharpen their tools of risk assessment. Risk assessment comes in many varieties, but identification of two key parameters is common to all of them: the
consequences of a harmful event or condition; and the likelihood of that harmful event or condition occurring. With no perspective on likelihood, a strategist can have no firm
perspective on risk. With no firm perspective on risk, strategists cannot purposefully discriminate among alternative choices. Without purposeful choice, there is no strategy.
One of the most widely read books in recent years on the complicated relation- ship between strategy and uncertainty is Peter Schwartzs work on scenario-based planning, The
Art of the Long View. Schwartz warns against the hazards faced by leaders who have deterministic habits of mind, or who deny the difficult implications of uncertainty for
strategic planning. To overcome such tenden- cies, he advocates the use of alternative future scenarios for the purposes of examining alternative strategies. His view of scenarios
is that their goal is not to predict the future, but to sensitise leaders to the highly contingent nature of their decision-making.37 This philosophy has taken root in the strategic-
planning processes in the Pentagon and other parts of the US government, and properly so. Examination of alternative futures and the potential effects of surprise on current
plans is essential. Appreciation of uncertainty also has a number of organisational impli- cations, many of which the national-security establishment is trying to take to heart,
such as encouraging multidisciplinary study and training, enhancing information sharing, rewarding innovation, and placing a premium on speed and versatility. The arguments
advanced here seek to take nothing away from these imperatives of planning and operating in an uncertain environment. But appreciation of uncertainty carries hazards of its
own. Questioning assumptions is critical, but assumptions must be made in the end. Clausewitzs standard of
judgment for discriminating among alternatives must be applied. Creative, unbounded speculation must resolve to choice or else there will be no strategy. Recent history
suggests that unchecked scepticism regarding the validity of prediction can marginalise analysis,
trade significant cost for ambig- uous benefit, empower parochial interests in decision-making, and undermine

flexibility. Accordingly, having fully recognised the need to broaden their strategic-planning aperture, national-security policymakers would do well now to reinvigorate
their efforts in the messy but indispensable business of predicting the future.
CROWDOUT
 1NC CROWDOUT
Beards wrong the plan is more likely to cause crowd-out and exacerbate
shortages
Capron, 14 this evidence is responding directly to Beard who is cited in the
footnotes - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics,
University of Southern California (Alexander, SIX DECADES OF ORGAN DONATION AND
THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM
WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY PROBLEMS Vol.
77:25)

Free-market economists are quick to pronounce that the organ transplantation policies based on
the noncommercial model followed by most countries over the past three decades have failed.153 This seems
a rather blinkered assessment of a system that has extended and improved millions of lives
while also providing a dramatic affirmation of human generosity and solidarity. There is no question that more organs are needed,
but were all countries to adopt the best practices used by the organ-procurement programs with
the highest rates of donation, a huge increase in transplantation would be possible
without resort to paying for organs. Indeed, during the first decade of this century, a concerted effort by the
Department of Health and Human Services led to an increase of more than twenty-five percent in the rate of donation in the United
States.154 Moreover, if only a small fraction of the amount that would need to be spent to purchase
organs in a regulated market were instead used to improve the present system, further
substantial increases in the rate of donation would be possible.
But what of the claim that it is self-evident that paying for organs would increase the net rate of
donation?155 The extensive literature on crowding out suggests that many people who
are willing to donate in a voluntary, unpaid system would cease doing so once paid donation
became an accepted practice.156 It is not simply that one does not want to be played for a fool (by giving away what others are
paid for), but that the nature of the act changes when it is not experienced by the donor, and seen
immediately and universally by others, as something that is generous and ennobling. This change would be
especially pronounced if, as is likely to be the case, most organ vendors were understood to be
acting out of financial desperation.
Although todays most highly motivated donorsthose who are giving a kidney to a close relativemight be expected to be immune
to such a change, this has been found not to be the case.
[R]ecently, when the U.S. rules for allocating deceased donor kidneys were changed to give
children on the waiting list greater access to deceased adult donors kidneys, parental donations
fell by a larger amount, so that overall fewer pediatric kidney transplants are being done while some
potential adult recipients have been deprived of a kidney that went to a child instead.157
Likewise, the ready availability of vended kidneys and liver lobes would leave most potential
recipients disinclined to ask a relative or friend to donate. Who would want to ask for such a gift from a loved
one when his or her need for an organ can be met without imposing any burden on that person and without enmeshing oneself in all
the psychological and moral complexities that arise in the gift relationship?158 Summarizing observational and experimental
research over many decades by economists and social psychologists, Sheila and David Rothman conclude that although the case for
the hidden costs of rewards is certainly not indisputable, it does suggest that a market in organs might reduce altruistic donation
and overall supply.159
(Footnote 153)
153. T. RANDOLPH BEARD, DAVID L. KASERMAN & RIGMAR OSTERKAMP, THE GLOBAL
ORGAN SHORTAGE: ECONOMIC CAUSES, HUMAN CONSEQUENCES, POLICY RESPONSES
1 (2013).
 2NC CROWDOUT TURN
Legalization decreases supply crowd out effects are greater
Capron et al, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and
Ethics, University of Southern California (Alexander, Organ Markets: Problems Beyond Harms
to Vendors, American Journal of Bioethics, October, Volume 14, Number 10, 2014)

There are several reasons why a regulated market will not increase the net supply of organs.
First, experience shows that paid donation does not add to the organ supply but merely replaces
unpaid donation; conversely, prohibiting payment actually increases the supply. For instance,
several years ago, after Israel stopped paying for its citizens to go to countries where they could
get transplants with purchased kidneys, the numbers of both deceased and living related donors
rose dramatically (Lavee et al. 2013).
The phenomenon of crowding out occurs for two reasons. Psychic and reputational benefits to
donorsboth living individuals and the families of deceased patients disappear when organ
donation is no longer associated with altruism but with payment. Furthermore, potential
recipients are reluctant to enter into the complex gift relationship that arises when a relative
or friend donates an organ if instead they can obtain a kidney from a stranger in an arms-length
commercial transaction (Ghods, Savaj, and Khosravani 2000). Likewise, potential related
donors no longer feel obligated; recently, when the U.S. rules for allocating deceased donor
kidneys were changed to give children on the waiting list greater access to deceased adult
donors kidneys, parental donations fell by a larger amount, so that overall fewer
pediatric kidney transplants are being done while some potential adult recipients have been
deprived of a kidney that went to a child instead.
Further, in all settings where kidneys have been market commodities, the act of selling a kidney
is seen as debasing, something that a person would do only if he or she had no other means of
survival. A regulated market wont change that. Indeed, it is likely that means would arise
to circumvent the intended limitations on the incentives, such as financial entrepreneurs
arranging for poor kidney sellers to obtain a lesser sum in cash in exchange for the money
deposited into a retirement account for them. From the viewpoint of transplant programs, this
would have the advantage of producing more kidneys (since in all societies the poor are the
readiest source of organs), but very unjustly and by making a mockery of the notion of a
regulated market.

Even a small crowdout turns case

Prottas, 92 -- Brandeis University professor and Institute for Health Policy senior staff
[Jeffrey, Ph.D., "Buying Human Organs - Evidence that Money Doesn't Change Everything,"
Transplantation, June 1992, 53(6), Ovid, acccessed 8-27-14]

However this assumes that there would be no negative reaction to offering to pay for organs. This
is very likely to be an erroneous assumption. Hostility to payment is strongest among
those in the population presently most willing to donate. Of those who express a willingness to
donate, about 80% reject any payment system. Among families that have actually do- nated, an even greater
percentage reject the idea of payment. If the percentage who would refuse to participate in a paid system approach these numbers,
then a market system is a catastrophe. It would result in far fewer organs at far higher cost. But even much smaller refusal
rates would have a marked impact. If 30% of present donors decide to opt out of the system,
donation will drop by about 1200. This is, in effect, the breakeven point in terms of total supply. If
payment induces the cooperation of 50% of those now refusing to donate and causes 30% of the present givers to opt~out, then
the supply of organs remains about the same.
Global experience proves crowd-out
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and
Ethics, University of Southern California (Alexander, SIX DECADES OF ORGAN DONATION
AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM
WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY PROBLEMS Vol.
77:25)

Experience in countries around the world where recipients have paid for kidneys lend further
support to the results of research on crowding out. In the countries where purchases have been the principal
source of kidneys for transplantation, kidneys have not been procured at rates near those of countries that
rely on unpaid donation, in part because the availability of organs purchased from the poor
reduces the pressure to create a system of uncompensated deceased donation or of living-related
donation.160 The clearest evidence of this phenomenon is provided by Israel, which has overcome religious and
cultural barriers to deceased organ donation and has rapidly built a successful program that relies on both
deceased and living-related donors in place of sending its patients to China, South Africa,
Turkey, and the Philippines to purchase organs.161 The Israeli success, as described by Jacob Lavee and Avraham
Stoler,162 has depended on much more than a change in the law: It has relied on a concerted effort by the government and medical
leaders to convey to the public that organs for transplantation are a resource that will be available for people in need only if the
community makes them available.163
Some market proponents have argued that we should experiment with NOTAs prohibition on organ sales, perhaps by allowing
individual states to try out various forms of compensation or financial inducement164as though the natural experiments
with various forms of regulated and unregulated organ markets that have occurred around the world
over the past thirty years have not already demonstrated that payments crowd out unpaid
donations and prevent development and optimal use of unpaid deceased donation. Social-policy
experiments undertaken by the government have indeed produced useful results in a number of fields. These experiments have
involved altering government-supported benefit programs for some participants,165 so the ethical issue they raise is whether some
people may be treated differently than others for a period of time. In contrast, to experiment with the ban on organ purchases would
require the dubious assumption that one can experiment with a policy that rests on moral principles without in effect abandoning
those principles. Once established as a market commodity, how would kidneys go back to being something that cannot be bought
and sold? As Gneezy and Rustichini found in their famous nursery study, not only did the imposition of a penalty when the parents
were late picking up their children change parents perception of what the teachers provided from a generous, nonmarket activity
to something that could be bought, but even after the charge was eliminated, parents did not revert to the old norm: Once a
commodity, always a commodity.166

India, Israel and Iran prove substantial crowd-out from sale

Koplin, 14 PhD candidate in bioethics at Monash University, member of the Declaration of
Istanbul Custodian Group, managing editor of ERAS Journal, (Julian, Assessing the Likely
Harms to Kidney Vendors in Regulated Organ Markets The American Journal of Bioethics,
14(10): 718, 2014)

Furthermore, systems of paid donation may compromise altruistic donation. Anthropologists

working in India (Cohen 1999b, 161), Israel (Jacob 2012, 64), and the Middle East (Scheper-
Hughes 2009, 11) have explored how markets in kidneys reshape the way potential donors and
recipients think about donation. In particular, donation between family members can become
seen as inappropriate when it is possible to buy an organ from a stranger, thereby avoiding risks
to loved ones and feelings of indebtedness to the donor. Consistent with this research, one
Iranian study found that 81% of transplant patients selected a vendor kidney despite having
a potential living related donor (Ghods, Savaj, and Khosravani 2000), and in 2010 only 4% of
kidney transplants were sourced from living related donors (Kazemeyni and Aghighi 2012). The
risk that offering payments will undermine altruistic donation is speculative, but I believe it is
plausible. If few vendors are forthcoming once the poor are excluded from selling, organ
markets may fail to realize both of their most important benefits: to significantly increase the
supply of transplantable kidneys and to offer the desperately poor an opportunity to improve
their situation.
1NC OTHER
 1NC TRUST DA
Plan wrecks doctor-patient trust collapses health care and solvency
Caplan, 14 - Department of Medical Ethics and Director, Center for Bioethics, University of
Pennsylvania (Arthur, Contemporary Debates in Bioethics, ed: Caplan and Arp,. Google books)
Second, Cherry argues that medicine is a business: "Medicine is a commodity: its goods and services are bought and sold, valued
over against other goods and services, are the subject of economic choices, and are given a monetary equivalence. Hospitals,
physicians, and other healthcare workers demand payment for services rendered." Therefore, he concludes, we can have doctors
paid and patients paid to undergo surgery to take out their organs for no reason other than profits. Medicine is a business,
but it is also a professionone that relies on trust. If commercial concerns are seen as
overwhelming the protection of patient interests, then medicine will not long be able to
function. If doctors do useless tests on patients solely to make money, then patients come to
distrust recommendations for tests. If doctors will remove your kidney, cornea, lobe of liver, or limbs solely so that you
and they may turn a buck, patients soon will come to completely distrust their doctors.
Transplantation depends upon trustto obtain organs such as hearts and lungs, people must believe
their loved ones are truly dead before removal. Trust in that the surgeon will not give you an
inferior or infected organ just to get a paycheck. Trust in that you cannot bribe your way to
access to an organ ahead of those in greater need. There is nothing that will destroy trust more in
transplant than showing that doctors are quite willing to harm their patientsespecially those
who are poor or vulnerable solely and only for money.

Impact is bioterror
Jacobs, 5 MD; Boston University professor of medicine [Alice, director of Cardiac
Catheterization Laboratory and Interventional Cardiology, "Rebuilding an Enduring Trust in
Medicine," Circulation, 2005, circ.ahajournals.org/content/111/25/3494.full#xref-ref-3-1,
accessed 8-18-14]
To be sure, we will learn about the emerging science and clinical practice of cardiovascular disease over the next four days. But
there is an internal disease of the heart that confronts us as scientists, as physicians, and as healthcare
professionals. It is a threat to us allinsidious and pervasiveand one that we unknowingly may spread. This threat is
one of the most critical issues facing our profession today. How we address this problem will shape the future of
medical care. This issue is the erosion of trust. Lack of trust is a barrier between our intellectual
renewal and our ability to deliver this new knowledge to our research labs, to our offices, to the bedside of
our patients, and to the public. Trust is a vital, unseen, and essential element in diagnosis, treatment,
and healing. So it is fundamental that we understand what it is, why its important in medicine, its recent decline, and what we
can all do to rebuild trust in our profession. Trust is intrinsic to the relationship between citizens around the world and the
institutions that serve their needs: government, education, business, religion, and, most certainly, medicine. Albert Einstein
recognized the importance of trust when he said, Every kind of peaceful cooperation among men is primarily based on mutual
trust.1 In our time, trust has been broken, abused, misplaced, and violated. The media have been replete with commentaries, citing
stories of negligence, corruption, and betrayal by individuals and groups in the public and private sectors, from governments to
corporations, from educational institutions to the Olympic Organizing Committee. These all are front-page news. Perhaps the most
extreme example is terrorism, in which strangers use acts of violence to shatter trust and splinter society in an ongoing assault on
our shared reverence for human life. Unfortunately, we are not immune in our own sphere of cardiovascular medicine. The
physician-investigator conflicts of interest concerning enrollment of patients in clinical trials, the focus on medical and nursing
errors, the high-profile medical malpractice cases, the mandate to control the cost of health care in ways that may not be aligned
with the best interest of the patientall of these undermine trust in our profession. At this time, when more and more public and
private institutions have fallen in public esteem, restoring trust in the healthcare professions will require that we understand the
importance of trust and the implications of its absence. Trust is intuitive confidence and a sense of comfort that comes from the
belief that we can rely on an individual or organization to perform competently, responsibly, and in a manner considerate of our
interests.2 It is dynamic, it is fragile, and it is vulnerable. Trust can be damaged, but it can be repaired and restored. It is praised
where it is evident and acknowledged in every profession. Yet it is very difficult to define and quantify. Trust is easier to understand
than to measure. For us, trust may be particularly difficult to embrace because it is not a science. Few instruments have been
designed to allow us to evaluate it with any scientific rigor. Yet, trust is inherent to our profession, precisely because
patients turn to us in their most vulnerable moments, for knowledge about their health and disease.
We know trust when we experience it: when we advise patients in need of highly technical procedures
that are associated with increased risk or when we return from being away to learn that our patient who became ill waited
for us to make a decision and to discuss their concerns, despite being surrounded by competent colleagues acting on our behalf.
Many thought leaders in the medical field understand the importance of trust.3 When asked whether
the public health system could be overrun by public panic over SARS and bioterrorism, C enters for
D isease C ontrol and Prevention Director Julie Gerberding replied, You can manage people if they trust
you. Weve put a great deal of effort into improving state and local communications and scaled up our own public
affairs capacitywere building credibility, competence and trust.4 Former H ealth and H uman S ervices
Secretary Donna Shalala also recognized the importance of trust when she said, If we are to keep
testing new med icine s and new approaches to curing disease, we cannot compromise the trust
and willingness of patients to participate in clinical trials.5 These seemingly intuitive concepts of the
importance of trust in 21st century medicine actually have little foundation in our medical heritage. In fact, a review of the early
history of medicine is astonishingly devoid of medical ethics. Even the Codes and Principles of Ethics of the American Medical
Association, founded in 1847, required patients to place total trust in their physicians judgment, to obey promptly, and to entertain
a just and enduring sense of value of the services rendered.6 Such a bold assertion of the authority of the physician and the
gratitude of the patient seems unimaginable today. It was not until the early 1920s that role models such as Bostons Richard Cabot
linked patient-centered medical ethics with the best that scientific medicine had to offer,6 and Frances Weld Peabody, the first
Director of the Thorndike Memorial Laboratory at the Boston City Hospital, crystallized the ethical obligation of the physician to his
patient in his essay The Care of the Patient.7 In one particularly insightful passage, Peabody captures the essence of the two
elements of the physicians ethical obligation: He must know his professional business and he must trouble to know the patient well
enough to draw conclusions, jointly with the patient, as to what actions are indeed in the patients best interest. He states: The
treatment of a disease may be entirely impersonal: The care of the patient must be completely personal. The
significance of the intimate personal relationship
between physician and patient cannot be too strongly
emphasized, for in an extraordinarily large number of cases both diagnosis and treatment are
directly dependent on it. Truly, as Peabody said, The secret to the care of the patientis in caring for the patient.7
This concept that links the quality of the physician-patient relationship to health outcomes has
indeed stood the test of time. Trust has been shown to be important in its own right. It is essential to
patients, in their willingness to seek care, their willingness to reveal sensitive information, their
willingness to submit to treatment, and their willingness to follow recommendations. They
must be willing for us to be able.

Extinction
Sandberg, 8 -- Oxford University Future of Humanity Institute research fellow [Anders,
PhD in computation neuroscience, and Milan Cirkovic, senior research associate at the
Astronomical Observatory of Belgrade, "How can we reduce the risk of human extinction?"
Bulletin of the Atomic Scientists, 9-9-2008, thebulletin.org/how-can-we-reduce-risk-human-
extinction, accessed 8-13-14]
The risks from anthropogenic hazards appear at present larger than those from natural ones. Although great progress has been made in reducing the
number of nuclear weapons in the world, humanity is still threatened by the possibility of a global thermonuclear war and a resulting nuclear winter.
We may face even greater risks from emerging technologies. Advances
in synthetic biology might make it possible to
engineer pathogens capable of extinction-level pandemics. The knowledge, equipment, and
materials needed to engineer pathogens are more accessible than those needed to build nuclear
weapons. And unlike other weapons, pathogens are self-replicating, allowing a small arsenal to
become exponentially destructive. Pathogens have been implicated in the extinctions of many wild
species. Although most pandemics "fade out" by reducing the density of susceptible populations,
pathogens with wide host ranges in multiple species can reach even isolated individuals. The
intentional or unintentional release of engineered pathogens with high transmissibility, latency, and
lethality might be capable of causing human extinction. While such an event seems unlikely today, the likelihood may
increase as biotechnologies continue to improve at a rate rivaling Moore's Law.
 1NC TPA
Obama is all out on TPA, but PC is key the impact is leadership
Freeman, 2/2/15 --International Principal at Forbes-Tate, LLC, former USTR official, he
advises companies in support of TPA and TPP (Charles, Trade -- Can Obama get it done?
http://www.washingtonexaminer.com/trade-can-obama-get-it-done/article/2559487, JMP)
The day after the 2014 election, Senate Republican Leader Mitch McConnell was asked what kind of
proposals his new majority could work on with President Obama. Trade agreements, McConnell
said, adding, The President and I were just talking about that before I came over here."
And when Obama called on Congress during his State of the Union speech this month to pass
legislation supporting new trade agreements, it was one of the few subjects that did not raise Republican ire. It
did not meet with much enthusiasm from Obama's fellow Democrats, however, who lined up to pan the
president's proposal to push the trade agenda forward. No problem, said a White House aide several days
later, the President will steamroll them.
The politics of trade have long broken down along fairly strict partisan lines; pro-business Republicans are for trade and pro-labor
Democrats are against it. Freed from narrow constituent politics, however, Democrats in the White House have pushed for greater
openness to trade, largely because expanding trade is a necessarily an important part of the foreign policy
agenda of any president interested in maintaining the United States global leadership.
President Clinton famously passed the North American Free Trade Agreement and permanent normal trade relations with China. So
it isnt surprising that Obama views new trade deals as central to his foreign policy legacy.
Still, getting new trade agreements through Congress is tough sledding for presidents of any
party. Populist demagoguing and popular myth still hold that trade kills American jobs. Many voters of all stripes believe this.
Butressing America's international leadership makes for far less compelling images than
those of shuttered factories that have lost their competitive edge to job-stealing firms on the other
side of the planet. The misery of the few who lose out in the shuffle of trade liberalization has huge political resonance, even if the
overall economic benefit to Americans significantly outweighs the detriment.
The policy landscape is littered with competing studies that demonstrate the success or failure of trade agreements. Depending on
who you believe, NAFTA has cost or delivered millions of jobs. Permanently normalized trade relations for China resulted in the
greatest and worst transfer of wealth in human history, unless actually it didnt. The obvious reality is that trade liberalization
produces some losers, even if the rest of us are winners. But stories about the collapse of American manufacturing and televised
portraits of out-of-work breadwinners make for more sympathetic news stories than the fact that a new trade deal has added a few
hundred dollars to the purchasing power of the average family.
The way policymakers talk about trade is often disingenuous. Trade agreements these days are about reducing barriers to trade in a
supply chain that can wend through many countries. They are about standardizing approaches to information gathering and policy
making. They set rules for economic governance that limit discrimination and encourage greater opportunities for an increased
number and kind of enterprises in the economy. And importantly, they set the rules for trade in services, which is the forgotten giant
in international trade.
This is all wonky stuff, so when forced to talk about trade without putting its audience to sleep, the administration finds itself
reverting to simplification. When in doubt, Obama and the administration, like previous Republican and Democratic
administrations, talk about how trade agreements are about exports, as the president did when he proposed in his 2010 State of the
Union speech to double U.S. exports in five years. We didnt come close, but it was a worthy aspiration.
The global economy and the role of the United States in that economy has changed dramatically since the 1950s, but the politics of
trade is still very much grounded in that long-ago epoch. Back then, you made a finished product in one country and sold it to
another. The way trade data is gathered still assumes a 1950s approach; the country in which a products assembly is finalized gets
full credit for the value of that product. So China gets full credit for the value of an iPhone it assembles from component parts made
in other countries, including the lions share of the value that iPhone represents: its design, which really never left Cupertino, Calif.
The enduring, alluring image of the good (manufacturing) job at good wages from the days in the 1950s in which manufacturing
employed 60 percent of American workers, is tough to shake in the public and political consciousness. Despite the fact that fewer
than 10 percent of Americans work in manufacturing and that Americas role in international trade is increasingly focused on design
and technological development, and providing services, the iconic assembly line worker is the poster child for U.S. trade policy.
He or she isnt doing as well these days.
So even pro-trade members of Congress are wary of trade votes. No politician wants to hear the wrath of out-
of-work constituents on local TV news or splashed across negative campaign advertising come election time. Obama
and his
team have plenty of hard work ahead to convince even Republicans that a vote in
favor of his trade deals wont be Exhibit Number 1 when a political opponent want to suggest
that he or she has lost touch with voters. One otherwise pro-trade GOP lawmaker
privately said, Give us an excuse not to vote on trade. Steamrolling Democrats into a
pro-trade vote may prove even harder.
The common wisdom is that Republicans
need a sizable corpus of Democrats to fall on their swords and
vote yes on trade deals. That number could be as few as 20 in the House, but the smaller the
number, the greater the chance recalcitrant Republicans who feel electorally vulnerable will
refuse to go along.
At primary issue is the Trans-Pacific Partnership, a free trade agreement being negotiated with 11 other countries in the Asia-Pacific
region. The economic rationale for the TPP is significant. Trade within Asia has been booming, largely in
component parts that have been assembled into finished products in China and exported
primarily to the United States and Europe. The TPP would draw the United States closer to the
boom.
But the economics are changing because Asians are getting richer. This is having two effects. First, Asians are increasingly able to
buy more things from abroad. Second, the United States as a manufacturing center is becoming more viable as production in Asia is
becoming more expensive, although dont expect many new jobs on the assembly line here, unless you are a robot or a
semiconductor chip. So putting the TPP in place is a way to set the table for American competitiveness
in the broader regional economy as it develops.
Whatever its economic merits, it is the strategic imperative of TPP that may be driving the White House to demand its passage.
Getting an agreement in place would be the signature piece in the presidents platform to rebalance or
pivot to the worlds fastest growing region. The trade deal would cement the role of the
United States as the prime mover on regional economic and strategic architecture.
If TPP fails, the international power, prestige and economic clout of the United
States will suffer a grave setback. The stakes are large.
The presidents trade team, led by U.S. Trade Representative Mike Froman, is composed of the most canny
and skilled negotiators on the planet. Negotiations are largely closed to public scrutiny. A more public process would
gum up the works, although there is genuine and reasonable concern about the lack of transparency among lawmakers, who view the
regulation of commerce as a congressional power. But those who have had access to the current text of the
agreement are encouraged by what theyve seen. But even Fromans team cannot overcome what the 11 other
countries in the negotiations know, which is that Congress has final constitutional authority to establish the terms on which the
United States trades. Without some method of preventing Congress from amending TPP, the final deal will look almost nothing like
what Asian nations agree with Obama's negotiators.
This is why other all America's trade partners are waiting anxiously for Obama to be granted trade
promotion authority (TPA). Until he gets it, they will not give their final, best offers to the his
negotiators. TPA would force an up-or-down vote on the deal the president sends to Congress. But who in Congress,
Republican or Democrat, is eager to give the president a blank legislative check on any issue
these days? Republicans, particularly those on the Right, are loath to provide him with powers the the Constitution otherwise
reserves to Congress. Democrats, smarting from their election losses of 2014, which many ascribe to Obamas unpopularity, arent
keen on helping him burnish his legacy, particularly with an issue that splits his base. Talk of steamrolling probably doesnt do
much to advance the cause.
Supporters of trade and the TPP are hoping that the presidents alternatively vaunted and
lampooned skills as a community organizer will be brought to bear and knit
together this fractious community. Similar efforts by the Clinton and Bush administrations
involved all hands on deck and late-night phone calls by the president to individual
lawmakers.
The pro-trade community is cheered by recent talk that Obama will create a whip group of
cabinet officers chaired in the White House to rally support for first TPA and then TPP (and then,
possibly, for a trans-Atlantic trade and investment partnership with Europe). But if the President is truly going to launch a campaign
with the kind of retail politicking necessary to drive "yes" votes on trade, it would be a solitary outlier in the otherwise-aloof
legislative strategy practiced by this White House. After all, the presidents signature piece of legislation, the Affordable Care Act,
was notoriously passed with a White House legislative strategy that consisted primarily of cheering from the sidelines.
If the legislative activity on trade is as buzzing as some in the administration suggest, its a little alarming that few if any of the key
members and staffers on the Hill seem to have heard from anyone at 1600 Pennsylvania Ave. purporting to be whipping their votes.
Froman has thus far been the frontman selling the trade agenda, but despite his strengths, he
cant deliver the votes to pass the agreements he is negotiating with other countries.
Whats in the TPP will affect the politics involved in passing it. There is a delicate balance in the construction
of trade agreements. The administration almost certainly will attempt to inject new provisions into it
that will reduce the ability of other countries to use lax labor and environmental regulations as a
competitive trade advantage. These provisions aim to respond to demands from the Democratic
base that, to paraphrase opponents of the deal, trade agreements shouldnt only be about trade. However, strong labor and
environmental provisions are far from likely to win votes from lawmakers who fundamentally
dislike trade.
The primary beneficiaries of trade liberalization are, after all, private sector companies whose agenda is held in deep suspicion by
the Left. Despite the fact that only around 15 percent of the private sector workforce is organized, the labor movement is deeply
antagonistic to market-opening trade agreements that are perceived to place U.S. workers under new pressures. The environmental
movement views trade agreements as race-to-the-bottom exercises, and will lobby bitterly against a TPP regardless of new
provisions to raise environmental standards.
If the president wants progress on other parts of his policy agenda the trade agenda only took up 15
sentences of an hour-long State of the Union address he
will need the support of his base. And traditional
progressive constituencies have warned that spending too much political capital on trade
will imperil their support on other issues.
If the Obama administration will find it difficult to appease the Left, a TPP that seems focused more on left-of-center concerns than
on opening markets will undermine the interest of the business community in rallying support for passage. As a trade association
executive lamented recently, Theres a big difference between business saying its for trade legislation and it will be almost as a
knee-jerk reaction and actually committing resources and CEO time to lobby on behalf of that legislation. Thus far, not much
time or money have been committed by the business community to get out the vote on either TPA or TPP. Business leaders, and not
just Washington representatives of American businesses, will need to make the trek to Capitol Hill personally for members to be
comfortable voting for trade.
Appeasing all these constituencies is complicated. Further complicating the task is the fact that the political
process in Washington has a global audience, and the messaging behind a pro-TPP narrative is read far beyond the Beltway. Other
TPP members will attempt to read the process with a view to finalizing their offers, which in some cases will be complicated by
domestic political events back home. Some will rush to complete TPP even before TPA is granted to avoid the appearance of being
captive to U.S. politics. Although some analysts believe that TPP could be passed through Congress
even absent TPA, it would make an already fraught process that much riskier. I hope, said one
Republican trade staffer, theyre smarter than that.
Even beyond the TPP countries, other eyes are watching goings-on in Washington carefully. During the State of the Union speech,
the president raised the specter of competition with China as a reason to pass trade legislation. "China wants to write the rules for
the world's fastest-growing region, he said. It may have been a message intended only for the Hill fodder for the China paranoia
that sometimes drives legislation. But the administration has for years been trying to convince China that the TPP and the pivot to
Asia were not about containing Chinas rise. The State of the Union speech complicated that message, and official and unofficial
Chinese reactions were blistering. The White House will have to smooth over those ruffled feathers to manage that most important
strategic relationship, even if it is very likely that anti-China rhetoric will be an important part of the overall narrative behind the
whip votes on Capitol Hill.
Momentum behind a TPA bill could pick up quickly. Rumors that the Senate Finance
and House Ways & Means Committees are moving to mark up bills in February and March
could begin to crank up the political machinery. And that will start to test the ability of the
White House to cajole individual members into supporting the bill. That will take a
willingness to respond to district-by-district requests for favors in areas other than trade. It will
require the administrative to help develop narratives that provide members with answers to the question: Why did you vote for this
bill. Figuring out what members want for their votes and delivering on those asks is new territory for this White House, and will
take an awful lot of support from pro-business lobbyists with which this White House has sought to avoid contact since the start of
the Obama presidency.
Finally, the reality of the political calendar is lost on no one. With the Presidents term now ticking
down to 23 months left, and with little love lost between Republican leaders and the White
House, it's possible that the GOP might pass trade promotion authority in hope of handing it off
to the next president, whom they hope will be a member of their party. Trade promotion authority with a
the TPP deal is not a legacy either the president or his fellow Democrats would be proud of.
It would also be playing poker with American power and prestige abroad. The stakes are high. But the politics of trade are low
indeed.

Massive backlash to organ sales and the link alone turns case
Caplan, 7 NYU bioethics division head and professor [Arthur, Ph.D. in the history and
philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and
head of the Division of Bioethics at New York University Langone Medical Center in New York
City, "Do No Harm: The Case Against Oran Sales from Living Persons," Living Donor
Transplantation, ed by Henkie Tan, p432-434, google books, accessed 8-27-14]
What little data exist show that health-care providers are opposed to markets (19). If they are not willing to
support markets out of moral reservations, then markets simply will not be effectively
implemented. Even more important than a patent lack of enthusiasm for markets among those who would be expected to serve
them, majorreligions and cultural views in the developed world will not countenance a market in
living body
parts (20-22), Various Popes, for example, have made quite clear the Catholic Church's
aversion to markets in organs. Anglo-American law, ever since the days in which markets in body parts resulted in
graveyards being stripped to supply medical schools with teaching materials, has not recognized any property interest in the human
body and its organs (22). Alienating religions and cultures which do not view the body as property
would have a devastating impact on the supply of organs available. Indeed, some sub-populations in
the United States, particularly African Americans, are as likely to be turned off by the institution of a
market in body parts because of their historical experiences with slavery and a keen distrust of
medicine, as they are to be motivated to become sellers to the rich (23-26). The argument that increasing the supply of organs
through sales will be efficient and cost- effective is not persuasive. It will take real and expensive resources to try to regulate and
police a market in organs. Since markets, even regulated ones, would shift the supply of organs toward
those who can afford to buy them, those who cannot might well withdraw from participation in the
deceased-donor organ system, thereby putting in peril any overall increase in the pool of organs
available to transplant. The case for kidney sales is not persuasive. Existing experience with markets has been
dismal. The notion that free choice supports the creation of markets in human body parts does not square with the reality of what
leads people to be likely to want to sell them. The devastating moral cost to medicine of engaging in organ-brokering is far too great
a price to pay for the meager benefit in supply that might be had by those in need of transplants. The storm of opposition
that markets will trigger in many individuals based on religious or cultural objections may
actually produce a decrease rather than an increase in the overall pool of transplantable organs- an
outcome that by itself would make calls for the creation of markets dubious.

Global nuke war

Freidberg & Schoenfeld, 8 --*Professor of Politics and IR at Princetons Woodrow Wilson
School, AND **senior editor of Commentary and a visiting scholar at the Witherspoon Institute
in Princeton (10/21/2008, Aaron and Gabriel, The Dangers of a Diminished America, Wall
Street Journal,
http://online.wsj.com/article/SB122455074012352571.html?mod=googlenews_wsj)
With the global financial system in serious trouble, is America's geostrategic dominance likely to
diminish? If so, what would that mean?
One immediate implication of the crisis that began on Wall Street and spread across the world is that the primary instruments of U.S. foreign

policy will be crimped. The next president will face an entirely new and adverse fiscal position. Estimates of this year's federal budget deficit already show that
it has jumped $237 billion from last year, to $407 billion. With families and businesses hurting, there will be calls for various and expensive domestic relief programs.
In the face of this onrushing river of red ink, both Barack Obama and John McCain have been reluctant to lay out what portions of their programmatic wish list they might defer
or delete. Only Joe Biden has suggested a possible reduction -- foreign aid. This would be one of the few popular cuts, but in budgetary terms it is a mere grain of sand. Still, Sen.
we may be headed: toward a major reduction in America's world role,
Biden's comment hints at where

and perhaps even a new era of financially-induced isolationism.

Pressures to cut defense spending, and to dodge the cost of waging two wars, already intense
before this crisis, are likely to mount. Despite the success of the surge, the war in Iraq remains deeply unpopular. Precipitous withdrawal --
attractive to a sizable swath of the electorate before the financial implosion -- might well become even more popular with annual war bills running in the hundreds of billions.
Protectionist sentiments are sure to grow stronger as jobs disappear in the coming slowdown. Even before our current woes, calls to save jobs by restricting imports had begun to
In a prolonged recession, gale-force winds of protectionism
gather support among many Democrats and some Republicans.

will blow.
Then there are the dolorous consequences of a potential collapse of the world's financial

architecture. For decades now, Americans have enjoyed the advantages of being at the center of
that system. The worldwide use of the dollar, and the stability of our economy, among other things, made
it easier for us to run huge budget deficits, as we counted on foreigners to pick up the tab by
buying dollar-denominated assets as a safe haven. Will this be possible in the future?
Meanwhile, traditional foreign-policy challenges are multiplying. The threat from al Qaeda and Islamic terrorist affiliates has not been extinguished. Iran and North Korea are
Russia's new militancy and
continuing on their bellicose paths, while Pakistan and Afghanistan are progressing smartly down the road to chaos.

China's seemingly relentless rise also give cause for concern.

If America now tries to pull back from the world stage, it will leave a dangerous power vacuum.
The stabilizing effects of our presence in Asia, our continuing commitment to Europe, and our
position as defender of last resort for Middle East energy sources and supply lines could all be
placed at risk.
In such a scenario there are shades of the 1930s, when global trade and finance ground nearly to a halt, the
peaceful democracies failed to cooperate, and aggressive powers led by the remorseless fanatics
who rose up on the crest of economic disaster exploited their divisions. Today we run the risk
that rogue states may choose to become ever more reckless with their nuclear toys, just at
our moment of maximum vulnerability.
The aftershocks of the financial crisis will almost certainly rock our principal strategic
competitors even harder than they will rock us. The dramatic free fall of the Russian stock market has demonstrated the fragility of a state whose economic
performance hinges on high oil prices, now driven down by the global slowdown. China is perhaps even more fragile, its economic growth depending heavily on foreign
investment and access to foreign markets. Both will now be constricted, inflicting economic pain and perhaps even sparking unrest in a country where political legitimacy rests
on progress in the long march to prosperity.
None of this is good news if the authoritarian leaders of these countries seek to divert attention
from internal travails with external adventures.
As for our democratic friends, the present crisis comes when many European nations are struggling to deal with decades of anemic growth, sclerotic governance and an
impending demographic crisis. Despite its past dynamism, Japan faces similar challenges. India is still in the early stages of its emergence as a world economic and geopolitical
power.
What does this all mean? There is no substitute for America on the world stage. The choice we have before us is between the
potentially disastrous effects of disengagement and the stiff price tag of continued American leadership.
 1NC CP
Counterplan: The United States should legalize and implement a uniform, federal,
dollar for dollar refundable tax credit, regardless of income, for nearly all
donation of human organs.

Solves case and avoids backlash

Clamon, 8 -- clerk for Judge Melloy of the US Court of Appeals for the Eighth Circuit [Joseph,
J.D. University of Iowa, he has held adjunct professorships in the Drake University Law School
and Drake University College of Pharmacy and Health Sciences, as well as serving as an
instructor at the Northwestern University School of Law, "Tax Policy as a Lifeline: Encouraging
Blood and Organ Donation Through Tax Credits," Annals of Health Law, Winter 2008, 17 Ann.
Health L. 67, l/n, accessed 8-31-14]
IV. Possible Tax Policy Alternatives
An alternative to compensation or noncommercial systems, which raise serious ethical and practical concerns, is the use of
tax policy to encourage blood and organ donation. As Parker and Winslade state in their article Tax Policy and the Blood
Supply in which they advocate of the use of a charitable deduction for blood donations: Tax incentives would enhance a
potential donor's willingness to give by reflecting the value society ascribes to the gift rather than
by creating an economic incentive in and of itself ... [the tax incentive would be] only a simple
acknowledgement of generosity, a gesture of appreciation, or a token of esteem - not a financial
incentive or reward. n191 This type of favorable tax treatment would accomplish four important objectives: "(1)
provide an incentive designed to stimulate corporate sponsorship of blood drives; n192 (2) in some manner recognize the generosity of
blood donors; (3) protect the safety of the blood supply; and (4) accommodate established ethical norms." n193 To accomplish
these goals, donations could be encouraged either by permitting a charitable deduction for donating either blood or organs or providing a tax credit.
This section will explore both options, and explain why the tax credit is the stronger proposal. A. Offering a Charitable Deduction for Donations
Allowing taxpayers to take a charitable deduction for donations of blood or organs offers numerous advantages. First, it would preserve the altruistic
nature of donation. n194 Second, "it would not conflict with the ethical proscription against the exploitation of disadvantaged groups." n195 Because
the tax structure is progressive in nature, the value of the deduction would become greater the more income earned by the taxpayer, and conversely, its
value would diminish the less income earned by the taxpayer. n196 At the lower levels of the income scale the deduction would be "swallowed" by [*91]
the personal exemption and standard deduction. n197 A charitable deduction would not serve as a disproportionate incentive to the poor, but rather,
using a charitable deduction might actually "unfairly deprive the less affluent donor of a benefit." n198 Third, it is unlikely that the tax incentive poses
as significant threat to the safety of the blood supply as would a direct cash payment. n199 Fourth, a tax incentive would not produce an inequitable
allocation of organs, but rather would preserve the current allocation system under UNOS. n200 Fifth, offering a charitable deduction would not
undermine the basic ethics and morality that underlie the current foundation of our donation system. n201 Despite all of these advantages,
implementing a charitable deduction for donation would require significant alterations to the tax code and would pose daunting administrative
challenges. The tax code does not consider the human body to be property and does not permit deductions for contributions of services. n202 To allow
a deduction, the IRS would have to allow deductions for contributions of services or classify the human body as property. Either change would be a
significant policy shift. If the body were to be considered property, the IRS would face many complicating issues, including: (1) whether "during life or
upon death, [a person] could actually generate ... additional income, gift, or estate tax liability"; n203 (2) how to determine the fair market value of the
human body, organs, and blood; (3) whether blood or organs constitute a long-term capital gain; (4) the basis in a human body; and (5) whether some
blood and organs are worth more than others. n204 These questions are complex and controversial. A strict interpretation of the tax code would not
make a distinction between a taxpayer who donates blood or an organ and any other commercial activity. n205 "For example, the Tax Court has found
that income derived from the sale of blood plasma [*92] is conceptually the same as that generated by the sale of any other product, without regard to
"the sanctity of the human body.'" n206 Thus, "the excess of the fair market value of [blood or organs] received over the cost or other basis" of the
transferred blood or organ constitutes taxable income. n207 If it is taxable income, fair market value would have to be determined. Courts have held
that fair market value is "the price at which property would change hands between a willing buyer and a willing seller, neither being under any
compulsion to buy or to sell..." n208 Applying this notion to the human body is exceptionally complex. Parker and Winslade state, "the very idea that a
"willing' buyer could act without "compulsion' in a contract involving the exchange of a life-giving thing is an anomaly of thought." n209 Furthermore,
as discussed in Sections II.A.2.d and e, "the law precludes the existence of a legitimate market in which buyers and sellers may trade in these "goods' ...
." n210 This fact does not "render them without value, as the market in illicit drugs so readily attests," but it does make valuation difficult and would
likely prompt substantial debate and increase the possibility of costly litigation. n211 To provide a charitable deduction for donation it would also be
necessary to determine the basis in a human body. n212 Parker and Winslade explain that: Because we do not purchase our bodies or otherwise acquire
them in a transaction from which we can derive any identifiable cost, it would appear that we have a basis of zero in these, our most physical of assets.
Accordingly, a participant in [an organ] exchange would realize income in an amount equal to the full value of the organ received, which could be
significant. n213 If the basis is not zero, would the basis in all bodies be equal? Since the fair market value of the donated organ or blood would have to
be determined, would the blood or organ of a younger person be worth more than that of an older person? Would the blood or organ of a healthy person
be worth more than that of a person who engaged in "unhealthy" activities such as smoking or drinking? Would someone whose blood type is O, the
most common blood type, be worth more or less than type AB, the least [*93] common type? n214 How would such values be substantiated? These are
just a few of many difficult questions that are created by such a system. A charitable deduction for donation also has implications for the gift and estate
tax provisions in the tax code. n215 The IRS General Counsel stated: If blood is property, then any part of the human body is property. Gift tax is
imposed ... on the transfer of property by gift. If any part of the body is property then a gift tax should be levied on the gift of a kidney for transplant if it
is not given through a charitable organization. Likewise, a taxpayer's estate includes the value of all property in which he had an interest at death. The
value of a decedent's body should therefore be includible in his estate. In today's world where transplants take place daily, these issues are not illusory.
n216 Finally, the current tax code requires that a charitable deduction be made ""to or for the use of' a qualified charitable organization." n217 The IRS
would likely have to either alter or clarify this regulation as well. Accordingly, the tax code would have to be significantly amended to provide a
charitable deduction for blood or organ donation. Implementing a charitable deduction poses other administrative challenges. One administrative
challenge, especially for blood donors, is that donors would be subject to "the same substantiation requirements imposed on taxpayers who claim
deductions for other forms of charitable contributions." n218 Another administrative obstacle is that current FDA regulations require that blood be
labeled as having been collected from either paid or volunteer donors. n219 Permitting a charitable deduction would likely require either an alteration
or clarification of these FDA rules. Accordingly, there are administrative obstacles in addition to tax law issues that would encumber implementation of
a charitable deduction for blood or organ donation. B. Granting a Tax Credit for Donations The
creation of a tax credit for
donations is a less administratively complex means of reaching the same objectives without
opening the Pandora's Box of deciding whether the human body is property and how to
[*94] determine the fair market value of a donor's blood and organs. Under this proposal, a person would receive a tax credit
for agreeing to be a donor. n220 The tax credit system offers the same advantages as the charitable deduction, but does not
require the IRS to change its interpretation that the human body is not property. Further, the tax
credit would not require any fair market value analysis of blood or organs. The credit would also
preserve the altruistic nature of the donation and would not exploit the disadvantaged. n221
Additionally, a tax credit, like the deduction system, would not pose a threat to the safety of the blood supply and would not produce an inequitable
allocation of organs. Similar to the charitable deduction, a
tax credit would not undermine the basic ethics and
morality that underlie the foundation of the current donation system. As with almost all of the proposals made
to date, the tax credit would incur the same substantiation problems, FDA regulation issues, and the question regarding the "to or for the use of"
requirement as the charitable deduction. Yet, unlike the charitable deduction, a tax credit would not force significant changes to be made to the rest of
the tax code. The IRS would not have to choose whether to allow deductions for services or classify the body as property. This problem is not created by
a credit. A tax credit does not raise sensitive questions regarding the fair market value of body parts and fluids, or whether some people's organs and
blood are worth more than another person's blood or organs. People would neither have to claim their bodies as assets upon their death nor would they
have to determine their basis. Thus, a tax credit offers the same benefits as the charitable deduction without the statutory consistency problems created
by a deduction. A
tax credit creates an incentive to attract potential donors without creating a
commercial market, changing the donation system to an "opt out" approach, defining the body as property, or imposing any other significant
policy choices. In almost all of the literature on methods of encouraging organ donation, five main concerns are consistently raised: (1) destroying the
benefits of altruism; (2) coercion of the poor; (3) inequitable allocation of organs; (4) creating family conflict; and (5) concerns of basic morality. n222
A tax credit for blood and organ donation does not raise any of these concerns, but rather protects the values they espouse. [*95] Moreover, the tax
credit proposed would attain at least three of the four objectives set forth by Parker and Winslade in their charitable deduction proposal: (1) recognizing
the generosity of donors; (2) not endangering the safety of the blood supply; and (3) accommodating established ethical norms. n223 The fourth
objective, encouraging corporate sponsorship of blood drives, n224 could easily be accomplished by creating a provision in the proposed tax credit
statute offering corporations a tax credit for organizing blood drives. n225 Similar to the individual incentive in the model statute in this article, which
gives incentives for donating more than once, the credit could increase for each additional blood drive, up to a defined limit. Two issues that must be
addressed to use a tax credit to encourage blood and organ donation are whether the tax credit should be refundable or nonrefundable and when the
taxable event is realized and recognized such that the taxpayer may obtain the tax credit. Parker and Winslade propose the use of a refundable tax
credit, which can reduce one's tax liability below zero. n226 "[A] refundable credit is applied first to reduce or eliminate one's tax liability, with any
unused amount being paid out to the taxpayer in cash; the amount of any credit in excess of the recipient's tax liability would, in effect, represent a
government subsidy to him." n227 A refundable tax credit would therefore not only cause the federal government to lose essential tax revenue, but
would also force the government to spend money that could otherwise be allocated to address other significant public policy issues. Refundable tax
credits are typically used only in circumstances where the government wishes to allocate money to achieve a fundamental societal objective, for
example the earned income tax credit is intended to assist the poor. n228 Taking into consideration the economic implications of a refundable tax
credit, in particular its impact on the availability of government resources for other public policy priorities, this article proposes the use of a
nonrefundable tax credit, which would not permit taxpayers to receive a refund if their tax owed was reduced below zero. This type of credit would
attain the objective of encouraging donation, but would not financially overburden the government. Blood and organ donation could effectively be
encouraged through the use of a nonrefundable tax credit without requiring [*96] the government to spend money that could be used for other public
policy purposes. Further, if empirical data demonstrates after several years that the nonrefundable tax credit provides insufficient incentive, the tax
credit could be transformed into a refundable tax credit if necessary. The second issue concerning the timing of when the taxable event is realized and
recognized has significant implications for organ donation. Should a person realize and recognize the tax credit when he or she pledges to donate blood
or organs? Or should it be when a person actually makes the donation? For example, if a person promises to donate her organs at the time of death
when she is twenty-five and she dies at eighty-five, may she obtain the benefit of the tax credit at twenty-five or at the time of her death? This issue is
not as significant for blood donation, because blood donation can generally occur immediately within a given fiscal year in which the taxpayer seeks the
tax credit. Parker and Winslade propose a refundable tax credit that is realized and recognized at the time when the taxpayer agrees to donate his
organs irrespective of when death occurs. n229 This article proposes the use of a tax credit that must be realized and recognized at the moment of
donation, not upon a promise of future donation because it achieves the stated objective of encouraging donation while avoiding potential conflict that
might arise under a system in which persons could take the tax credit prior to actual donation. The IRS does not treat a contribution as permanently set
aside unless the chance that the contribution will not be applied to the donor's intended charitable purpose is so remote that it is negligible. n230 As
discussed earlier, the chance that a potential organ donor's contribution will not be applied is not remote, but rather substantial n231 Parker and
Winslade intelligently suggest that a database, akin to the National Practitioner Data Bank, could be used to document a taxpayer's promise to donate
and that such a promise would thereafter make donation mandatory. n232 Further, Parker and Winslade pragmatically suggest immunizing providers
from liability when they rely in good faith on the database when retrieving organs. n233 These solutions, though beneficial, are insufficient. Given the
history of conflict over donative intent, disputes between family members regarding organ donation, and questions of capacity of the donor, substantial
controversy and costly litigation is likely [*97] to arise under such a system. This conflict is avoidable if the tax credit is permitted only at the time of
donation. As discussed above, this position is consistent with current IRS guidance. n234 Thus, a nonrefundable tax credit realized and recognized at
the time of giving is a unique vehicle through which blood and organ donation can be encouraged, while guarding against the hazards of a commercial
system and maintaining the current tax treatment of charitable giving and the human body. The following are two model statutes that offer guidance as
to how a nonrefundable tax credit section in the tax code might operate. These statutes are by no means the only way a tax credit could work. They are
intended to be but one example of how donation could be encouraged through the use of a nonrefundable tax credit. XXX. Qualified Blood Donation
Programs (a) Allowance of credit. (1) In general. - There shall be allowed as a credit against the tax imposed by this chapter for the taxable year with
respect to each qualifying donation of blood products by the taxpayer an amount equal to the per donation amount. (2) Per donation amount - For the
purposes of paragraph (1), the per donation amount shall be determined as follows: In the case of any taxable year in which the The per donation
amount taxpayer donated blood products: is - Once in the taxable year $ 500 Twice in the taxable year $ 1000 Three to six times in the taxable year
n235 $ 2000 (b) Limitation based on adjusted gross income - (1) In general - The amount of the credit allowable under subsection (a) shall be reduced
(but not below zero) by $ 50 for each $ 1000 (or fraction thereof) by which the taxpayer's adjusted gross income exceeds the threshold amount. (2)
Threshold amount. - For purposes of paragraph (1), the term "threshold amount" means - (A) $ 110,000 in the case of a joint return [*98] (B) $ 75,000
in the case of an unmarried individual, and (C) $ 55,000 in the case of a married individual filing a separate return. (c) Qualifying blood product
donation - For purposes of this section - (1) In general - The term "qualifying blood production donation" means any donation of: (A) Blood products
derived from human blood used for purposes of transfusion into another person or for federally-approved biomedical research. (B) Any other products
formulated via removal of human blood used for purposes of transfusion into another person or for federally-approved biomedical research. (d) Blood
products - For purposes of this section - (1) In general. The term "blood products" shall include human blood of any type, red blood cells, white blood
cells, platelets, plasma, and any other federally-approved blood-derived product that may be legally donated under the National Organ Transplant Act.
(2) Sperm, ova, and hair are not covered by this section. n236 (e) Donation to self exception - (1) In general. The term "qualifying blood product
donation" shall not include the removal of human blood from one individual and replacement of that blood into the same individual at the same or a
later time. XXX. Qualified Organ Donation Programs (a) Allowance of credit. - (1) In general. - There shall be allowed as a credit against the tax
imposed by this chapter for the taxable year with respect to each qualifying human organ donation(s) by the taxpayer an amount equal to the per
donation amount. (2) Per donation amount - For the purposes of paragraph (1), the per donation amount shall be- (A) $ 5,000 for the donation of at
least one human organ to either another individual or individuals, a medical center for donation to an unspecified person(s), to the cause of science. (B)
$ 10,000 for the donation of all of the taxpayer's organs to either another individual or individuals, a medical center for donation to unspecified
person(s), to the cause of science. [*99] (b) Limitation based on adjusted gross income - (1) There shall be no limit on the amount of credit allowable
under subsection (a) based on adjusted gross income. (c) Qualifying organ donation(s) - For purposes of this section - (1) In general - The term
"qualifying organ donation(s)" means any donation of: (A) A part or structure of the human anatomy adapted for the purpose of some specific function
or functions. (B) Sperm, ova, and hair are not covered by this section. n237 (d) Donation to self exception - (1) In general. The term "qualifying organ
donation" shall not include the removal of human organ(s) from one individual and replacement of the organ(s) into the same individual at the same or
a later time. V. Conclusion The demand for blood and human organs will continue to grow as society's ability to save and improve lives by transplanting
more parts of the body increases. To have any chance of meeting the ever-increasing level of demand for blood and organs, the current donation system
must be modified to encourage donation in order to substantially increase the quantity of available healthy, compatible blood and organs. Some
individuals, such as pure altruists, "would donate without any external stimulus," n238 while others would never donate regardless of the incentives
offered. Some may be attracted to a direct compensation system, but many people vehemently object
to such an outright offer of remuneration. n239 A reasonable alternative is the use of a tax credit
as an incentive to "attract the attention of those potential donors who wouldn't be willing to sell their
blood in a purely commercial transaction" but who would accept favorable tax treatment as a
"token of public appreciation of their generosity." n240 It may even "arouse existing but
dormant inclinations toward altruism." n241 For these reasons, tax credits are an effective, ethically
acceptable, and perhaps even ethically preferable means of encouraging blood and organ donation.
 SHORTAGES
Few people voluntarily sell it wont alleviate the shortage
Varjavand, 13 - Associate Professor of Economics and Finance at the Graham School of
Management, Saint Xavier University (Reza, Legalized Market for Human Kidneys: A Wrong
Solution to a Right Problem Journal of Management Policy and Practice vol. 14(4) 2013)

Shortage, in the U.S. is not caused by economic factors like lack of price; there is no concrete
evidence to prove that. People do not wish to donate a kidney in expectation of pecuniary gains
especially in affluent countries like the United States. Unlike the peasants living in the rural
areas of a less developed country who are the major source of kidneys that are for sale, I believe
the poor in the U.S. are not so depredate they would sell their body parts for money, even if it
were legal. And, if a few of them do, it is not going to change the prospect of the persistent
shortage. In addition, because people are well-informed about the possible health risks and the
harm they may suffer because of the possible side effects, they cannot be lured into selling a
kidney against their wishes. So I think an attempt to boost supply through monetary incentives
may not be as effective as it sounds. Likewise, people do not seek a kidney because it is cheap or
expensive; they need it because they suffer from an unfortunate medical condition and they
hope that there is a matching donor somewhere out there who can help save their life. Again,
shortage is not a pricing problem and should not be dealt with by finding a monetary solution.

Squo solves
A subpoint: 3-D printing
Gilpin, 14 -- TechRepublic staff writer, citing Dr. Jay Hoying, the Division Chief of
Cardiovascular Therapeutics at the Cardiovascular Innovation Institute at Louisville
[Lyndsey, "New 3D bioprinter to reproduce human organs, change the face of healthcare," Tech
Republic, 8-1-14, www.techrepublic.com/article/new-3d-bioprinter-to-reproduce-human-
organs/, accessed 8-28-14]

New 3D bioprinter to reproduce human organs, change the face of healthcare

Researchers are only steps away from bioprinting tissues and organs to solve a myriad of injuries and
illnesses. TechRepublic has the inside story of the new product accelerating the process. If you want to understand how
close the medical community is to a quantum leap forward in 3D bioprinting, then you need to look
at the work that one intern is doing this summer at the University of Louisville. A team of doctors, researchers, technicians, and
students at the Cardiovascular Innovation Institute (CII) on Muhammad Ali Boulevard in Louisville, Kentucky swarm around the
BioAssembly Tool (BAT), a square black machine that's solid on the bottom and encased in glass on three sides on the top. There's a
large stuffed animal bat sitting on the machine and a computer monitor on the side, showing magnified images of the biomaterial
that the machine is printing. This team stands at the forefront of research in 3D bioprinting, as they methodically take steps toward
printing a working human heart. As part of this work, the
team is also pioneering breakthroughs in printing
human stem cells -- a move that could remove the raging ethical dilemmas associated with stem
cells and potentially take regenerative medicine to new heights. The combination of these stem cells
and 3D bioprinting is going to help repair or replace damaged human organs and tissues, improve surgeries, and ultimately give
patients far better outcomes in dealing with a wide range of illnesses and injuries. But, there are problems with BAT -- as advanced
as it is from its surprising background as a military project. It's way too slow and printing anything with it is a tortuously manual
process. The printhead runs on a three-axis robot that doesn't handle curves very well. No one at the lab knows the limitations and
challenges of BAT better than a summer intern named Katie, an undergrad from Georgetown University. She's in Louisville as part
of a summer program for the Howard Hughes Medical Institute that exposes students to cutting edge research and lets them
participate in groundbreaking work. Katie's not sure what she wants to do when she finishes her bachelor's degree in mathematics
but she has thrown herself into her work at the CII with full intensity this summer. A big part of what Katie does is build intricate
scripts to tell BAT what to print. It's similar to a computer programmer writing in assembly language to give a computer system an
exact set of instructions. It's an incredibly laborious process and it involves Katie going back and forth with Dr. Jay Hoying, the
Division Chief of Cardiovascular Therapeutics at CII and one of the leaders of the 3D bioprinting project. "What's interesting is
Katie's background in mathematics," said Hoying, "which is really essential here because it's basically a geometry problem." But
Hoying and his team are about to get a new 3D bioprinting solution that will accelerate their work
so significantly that what has taken Katie half the summer will soon take half a day, according to Hoying. This new solution's
hardware, BioAssemblyBot (BAB), runs as a six-axis robot that is far more precise than BAT. The real difference, however, is in the
software: Tissue Structure Information Modeling (TSIM), which is basically a CAD program for biology. It takes the manual coding
out of the process and replaces it with something that resembles desktop image editing software. It allows the medical researchers to
scan and manipulate 3D models of organs and tissues and then use those to make decisions in diagnosing patients. And then, use
those same scans to model tissues (and eventually organs) to print using the BAB. "It's a big step forward in the
capability and technology of bioprinting," said Hoying, "but what someone like me is really excited about is now it
enables me to do so much more." Hoying went back to the example of his highly-capable intern, Katie. "Katie has spent half the
summer just understanding and scripting up and doing this," he said. "Now if Katie can do that in half a day, I can do more biology, I
can do more experiments. I can explore new cell combinations.... In that same half a summer I could have explored different
structures, different cell-[to]-cell combinations, experiment here growing them up, etc. Where she's taking half the summer to
understand the geometry, script it out, test it... with the BAB and the TSIM, I would have finished a handful of experiments."
Bioprinting's new robot BAB and TSIM are an integrated package built by Advanced Solutions, a private biotech company located in
suburban Louisville. The new solution officially launches today -- Friday, August 1, 2014 -- and Hoying's CII is not the only lab ready
to jump on it. In fact, Hoying is concerned that demand could be so strong that it could interfere with his facility getting one as soon
as he would hope, although that seems unlikely considering Hoying was an important collaborator and consultant for Advanced
Solutions in creating the product. While the lab where Katie and Dr. Hoying run their experiments is downtown next to the hospitals
and cutting edge medical facilities, the Advanced Solutions office is about 20 miles east, tucked away in a suburban office park that's
also home to a tree care service, a construction company, a dental association, a US Postal Service branch, and a handful of small
healthcare companies. The building that houses Advanced Solutions sits just down a hill off Nelson Miller Parkway, and less than
1000 feet from the I-265 interstate highway. From the outside, there's little indication that the single story brick structure houses a
team of 65 people who are working on a hardware and software solution that could revolutionize modern medicine. Advanced
Solutions has been around since 1987. During most of the time since then, it has been a software provider building solutions on top
of Autodesk for specific industries. But, in October 2010, Advanced Solutions CEO Michael Golway took an alumni tour of the CII --
since Golway is a University of Louisville alum and the university is a key partner of the facility. Golway told TechRepublic, "At the
end of the presentation, Dr. Stu Williams passionately summarized the CII business model and I was not only impressed by the CII
innovation, team of researchers and focus on cardiovascular solutions but intrigued by the possibilities that Advanced Solutions
engineering know-how could contribute in a positive and profound way to helping his team. I followed back up with Dr. Williams
one-on-one and we became fast friends." That began the journey that would lead to the integrated solution that Golway and his team
devised to meet the needs of Williams, Hoying, and researchers and hospitals throughout the world. "Over the course of 2.5 years we
would periodically meet and I learned about some of the technological workflow challenges that slowed his team from advancing the
biology research to achieve the Total Bioficial Heart," Golway said. "Dr. Williams and eventually Dr. Hoying also invested time in
learning more about the Advanced Solutions team and our capabilities. After 2.5 years of building a terrific working relationship,
listening, learning and collaborating I brought forward an engineering design concept for Dr. Williams and Dr. Hoying to consider
that was intended to solve the tissue design technology problem." Hoying and Williams, who is the division chief of the bioficial
heart program at the CII, are both widely respected cell biologists who came to Louisville from Arizona to work together. They were
obviously impressed that Golway's solution could get them closer to their goal of creating that "Total Bioficial Heart." Golway
continued, "In March 2013, Advanced Solutions Life Sciences, LLC was formed as a wholly owned subsidiary of Advanced Solutions,
Inc. to engineer, fabricate and commercialize the technology in support of that initial concept design. Today the BioAssemblyBot and
[the] TSIM software integrated solution are the work product from that endeavor." Beyond the launch of his company's product,
Golway views this work as part of a larger trend of digitizing the medical and biological space, which is destined to
unleash other new advances as well. "What's been really interesting to me is that we're on a trajectory here where
we're really treating biology as more of an information technology," Golway said. "That's incredibly exciting to us because IT grows
exponentially -- instead of just the hardcore traditional discovery that biology has been tracking on, if we can translate that into IT
we can take that experimentation and rapidly start looking at optimization. How to combine cell types in a way to create cell types
and structures. The exponential curve is already there but this technology allows you to take the next
step."

B subpoint: organ cloningtech exists now

Aronson, 13 -- Organ Transplant Initiative founder
[Bob, "Artificial and Bioengineered Organs Can End the Shortage," 2-10-13,
https://bobsnewheart.wordpress.com/category/ending-the-organ-shortage-solutions/,
accessed 8-28-14]

In June 2011, an Eritrean man entered an operating theater with a cancer-ridden windpipe,
People had received windpipe transplants before, but this one was different. His was the first
organ of its kind to be completely grown in a lab using the patients own cells. The windpipe is
one of the latest successes in the ongoing quest to grow artificial organs in a lab. The goal is
deceptively simple: build bespoke organs for individual patients by sculpting them from living
flesh on demand. No-one will have to wait on lengthy transplant lists for donor organs
and no-one will have to take powerful and debilitating drugs to prevent their immune systems
from rejecting new body parts. Scaffolds for Tissue Repair energy pulsar Researchers are making use of advances in knowledge of stem cells, basic cells
that can be transformed into types that are specific to tissues like liver or lung. They are learning more about what they call scaffolds, compounds that act like mortar to hold
cells in their proper place and that also play a major role in how cells are recruited for tissue repair. Tissue engineers caution that the work they are doing is experimental and
costly, and that the creation of complex organs is still a long way off. But they are increasingly optimistic about the possibilities. Bioartificial Liver Boston company HepaLife is
working on a bioartificial liver using a proprietary line of liver stem cells. Once the patients blood is separated into plasma and blood cells, a external bioreactor unit with
those stem cells inside can reduce levels of toxic ammonia by 75% in less than a day. Bioartificial Hand Smarenergy coming from a handtHand is a bioadaptive hand that can
actually feel. Its 40 sensors communicate back and forth directly with the brain using nerve endings in the arm. The hand sends its sensory input to the brain, and the brain
sends instructions for movement to the hand. The result? It can pick up a plastic water bottle without crushing it, or pour a drink without spills. BioLung MC3 BioLung is a soda-
can-shaped implantable device that uses the hearts pumping power to move blood through its filters. Its designed to work alongside a natural lung, exchanging oxygen from the
air with carbon dioxide from the bloodstream. So far, its been tried on sheep, where six of the eight animals on the BioLung machine survived for five days. Human trials are
expected within the next couple of years. 3D Organ Printing Organ printing, or the process of engineering tissue via 3D printing, possesses revolutionary potential for organ
transplants. The creation process of artificial tissue is a complex and expensive process. In order to build 3D structures such as a kidney or lung, a printer is used to assemble
cells into whichever shape is wanted. For this to happen, the printer creates a sheet of bio-paper which is cell-friendly. Afterwards, it prints out the living cell clusters onto the
paper. After the clusters are placed close to one another, the cells naturally self-organize and morph into more complex tissue structures. The whole process is then repeated to
Using the
add multiple layers with each layer separated by a thin piece of bio-paper. Eventually, the bio-paper dissolves and all of the layers become one.

patients own cells as a catalyst, artificial organs may soon become mainstream practice
among treatment centers worldwide. As the health of the nation delves down to record
negatives, organ printing may be the establishments answer to a number of preventable
conditions. The above alternatives to human organs are but the tip of the iceberg. Medical
science and technology are on the verge of incredible breakhroughs that will extend life
and, at some point, end the need for human organ donation, anti-rejection drugs and
maybe even invasive surgery.

No shortage- data is distorted and donation is up

Segev, 10 -- Johns Hopkins professor of surgery
[Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of
Public Health, Department of Mathematics, United States Naval Academy, "Terminology
Influences Many Aspects of the Market/Incentives Debate," American Journal of
Transplantation, 2010, 10, 2375, ebsco, accessed 8-27-14]

In seeking more precise terminology, we wish to clarify two other terms critical to this debate.
Carefully examining the kidney waiting list reveals that the 'tremendous organ shortage' is
widely distorted, with totals on the waiting list inflated by inactive candidates who are
not eligible for a transplant (approximately one-third of the list). For exam- ple, between 2002
and 2007, McCullough and colleagues showed that the active kidney waiting list grew by only
10%, indicating a near steady-state of new eligible regis- trants and transplants for them, while
the inactive kidney waiting list grew by 282% (2). Furthermore, live donation rates are often
said to have 'stalled' since 2004. However, living donation rates tripled in the preceding 15 years
(3). The level donation rates since 2004 suggest sustainability of these historic highs in
donation. Some areas of living donation have seen exponential growth in the last few years.
Nondirected donation grew from 2 in 1998 to 56 in 2002 to 137 in 2009 (4,5). Paired donation
grew from 3 in 2000 to 39 in 2004 to 419 in 2009 (5,6). These donors do not comprise a large
proportion of the living donor pool at this early stage and so do not con- tribute to a visible
overall rise in kidney donation. As they continue to increase, however, these sources of donors
will likely play a more obvious role in the future. In fact, the rise in living donation between
2008 and 2009 is partly attributable to these novel modalities.