Governments should let people trade kidneys, not convict them

for it

Science Photo Library

IF THEY were just another product, the market would work its usual
magic: supply would respond to high prices and rise to meet surging
demand. But human kidneys are no ordinary commodity. Trading them
is banned in most countries. So supply depends largely on the charity
of individuals: some are willing to donate one of their healthy kidneys
while they are still alive (at very little risk to their health); others
agree to let their kidneys be used when they die. Unsurprisingly, with
altruism the only incentive, not enough people offer.

Kidneys are the subject of a quietly growing global drama. As people in

the rich world live longer and grow fatter, queues for kidneys are
lengthening fast: at a rate of 7% a year in America, for example,
where last year 4,039 people died waiting. Doctors are allowing older
and more sluggish kidneys to be transplanted. Ailing, rich patients are
buying kidneys from the poor and desperate in burgeoning black
markets. One bigwig broker may soon stand trial in South Africa (see
article). Clandestine kidney-sellers get little medical follow-up, buyers
often catch hepatitis or HIV, and both endure the consequences of
slap-dash surgery.

The Iranian model

In the face of all this, most countries are sticking with the worst of all
policy options. Governments place the onus on their citizens to
volunteer organs. A few European countries, including Spain, manage
to push up supply a bit by presuming citizens' consent to having their
organs transplanted when they die unless they specify otherwise.
Whether or not such presumed consent is morally right, it does not
solve the supply problem, in Spain or elsewhere. On the other hand, if
just 0.06% of healthy Americans aged between 19 and 65 parted with
one kidney, the country would have no waiting list.

The way to encourage this is to legalise the sale of kidneys. That's

what Iran has done. An officially approved patients' organisation
oversees the transactions. Donors get $2,000-4,000. The waiting list
has been eliminated.

Many people will find the very idea of individuals selling their organs
repugnant. Yet an organ market, in body parts of deceased people,
already exists. Companies make millions out of it. It seems perverse,
then, to exclude individuals. What's more, having a kidney removed is
as safe as common elective surgeries and even beauty treatments (it
is no more dangerous than liposuction, for example), which sets it
apart from other types of living-organ donation. America already lets
people buy babies from surrogate mothers, and the risk of dying from
renting out your womb is six times higher than from selling your
kidney.

With proper regulation, a kidney market would be a big improvement

on the current, sorry state of affairs. Sellers could be checked for
disease and drug use, and cared for after operations. They could, for
instance, receive health insurance as part of their payment—which
would be cheap because properly screened donors appear to live
longer than the average Joe with two kidneys. Buyers would get better
kidneys, faster. Both sellers and buyers would do better than in the
illegal market, where much of the money goes to the middleman.

Instinct often trumps logic. Sometimes that's right. But in this case,
the instinct that selling bits of oneself is wrong leads to many
premature deaths and much suffering. The logical answer, in this case,
Politicans will rob this nation left and right.
it's tragic, it's risky & it should be illegal if these poor people don't get the proper
medical/surgical procedures & attention due for such an operation.

A COMMUNITY WITHOUT KIDNEY: A TRAGEDY?

Analysis of the Moral and Ethical Aspects of Kidney Organ
Donation*
FRANCIS AGUILAR and LALAINE SIRUNO
Department of Philosophy, CSSP
University of the Philippines
Diliman, Quezon City 1101
PHILIPPINES
Email: lhsiruno@yahoo.com
ABSTRACT
Kidney failure remains one of the most serious health risks of our time. While
transplantation
proves to be the best solution to this, thousands of people still die each year waiting
for a
kidney. Since a person can function normally with a single kidney, some people
decide to
donate one of their kidneys, in exchange to some monetary gain. This paper
analyses the moral
and ethical aspects of kidney organ donation. More specifically, it discusses the
arguments in
favor and against compensated organ donation with the organ donors of Baseco as
backdrop.
Four kidney donors from the area were interviewed and their accounts are hereby
incorporated.
After a critical evaluation of the issues involved, it is concluded that the arguments in
favor of
compensated organ donation are stronger than those against. However, there is
reason to
doubt the viability of such a system when fitted against the nagging situation of some
Baseco
dwellers, and as it cannot be ascertained whether or not kidney donors from the
area fully
understand the implications of their decisions and actions. As the trade is going on
anyway, we
accede to proposals of an ethical market in human organs. However, lump sum
payment is not
encouraged as it is proven problematic, and schemes of postponing compensation
for the organ
donors are found to be the better alternative.
COMMUNITY WITHOUT KIDNEY
Throughout the years, Brgy. 649, Zone 68, District V in Port Area, Manila has
acquired
many names. The sprawling 52 hectares of land, or island more specifically, resulted
from the
dredging of a portion of Manila Bay as ordered by then First Lady Imelda Marcos in
preparation
for the coming of Queen Elizabeth II, whose royal ship is to drop anchor at the South
Harbor.
The first residents of the island were the workers of the adjacent company, NASCO
* Paperpresented at the Fifth Asian Bioethics Conference (ABC5) and Ninth Tsukuba International
Bioethics
Roundtable (TRT9) at the University of Tsukuba, Tsukuba Science City, Japan on Feb. 12-16, 2004.
2
Stevedoring, and consequently, the place was called the Engineering Island of
Nasco. That was
year 1975. In 1982, Nasco Island was renamed Isla Baseco, quite aptly and
ironically.
BASECO stands for Bataan Shipyard and Engineering Company, owned by no less
than the
family of the First Lady. The name was subsequently changed in 1998 to Brgy.
Bagong Lupa (1)
but it did not become so familiar that the name Baseco stayed. Isla Baseco is
classified as an
urban poor community, or in everyday language, a depressed or squatter’s area. As
of January
of 2001, Baseco has a total population of 45, 017 – composed of 5, 515 families
living in 3, 499
houses (2). The place has acquired an obvious notoriety for its poorness and
desolateness. The
residents try hard to make ends meet mostly by stevedoring, fishing and selling.
People live in
shanties and makeshift houses and children crowd the mud-sputtered streets. Ms.
Vida
Florendo, a resident and tanod of Baseco, describes their place as the “poorest of
the poor”.
Nowadays, it has a new label derived from a growing enterprise of kidney donating,
or selling.
Isla Baseco is now called by the inhabitants themselves Isla Walang Bato.
Such a namesake is not at all surprising (though more aptly, it should be Isla Isang
Bato). According to Baseco Brgy. Captain Teresita Lumactud, approximately 3, 000
residents
from their barangay, men and women alike, have donated one of their kidneys – for a
cause
and/or for a cost. These residents decided to meet the demand for kidneys by
donating one of
theirs. In return, each donor received a sum ranging from PhP70, 000 to PhP120,
000. Their act
can be seen as purely profit-oriented and materially motivated for it seems as if they
were
selling their kidneys. Most donors however would deny this and claim that their act is
based
primarily on the intention to be of help to those in need, or more particularly, to
prolong and save
the lives of kidney patients. That they received money in return should not
overshadow that fact,
they would say. Besides, an act of kindness should beget just the same, and very
poor people
like them deserve an act of kindness more than anyone else.
TRAGEDIES?
Surely, what can you do when you have no decent and stable job and your child is
sick
and dying in a hospital ward? What would you do if you do not have a house to call
your own
and your family is starving? What would you do if you have only a few pesos in your
pocket,
never had anything more than a few hundreds and suddenly an opportunity comes
offering
P100, 000 for “simply” donating a kidney? Money can indeed make a big difference
when you
are hungry and desperate. P100, 000 is definitely a lot of money for poor people like
the Baseco
3
dwellers, definitely more than the value it is actually worth to people belonging above
the socalled
poverty line of our economic strata.
NAME* AGE OCCUPATION EDUCATIONAL
ATTAINMENT
HOME
PROVINCE
NO. OF
YEARS
IN
BASECO
CHILDREN YEAR OF

DONATIONHOSPITAL
Candy 27 Cigarette
vendor
1st yr. HS Samar 5 - 2000 NKTI
Lorenzo 25 Stevedore Grade 6 Samar 9 2 1998 St. Luke’s
Rafael 19 -- 1st yr. HS Cotabato 6 1 2001 St. Luke’s
Edwin 22 Cigarette
vendor
Grade 2 Samar 3 1 2002 Cardinal
Santos Mem.
Hospital
* The interviewees gave the authors permission to use their real names.
Candy, 27, was a native of Samar. Five years ago, he decided to make his way to
the
city in search of so-called greener pastures. He found work as a helper in a rock
garden
somewhere in Muñoz, Quezon City. In the year 2000, he found out that his amo
(employer) was
very ill and in bad need of a transplant. A related donor cannot be found and upon
knowing the
situation, Candy volunteered to give one of his kidneys. He said that he attended
seminars on
organ donation and transplantation. He also underwent the preliminary medical
examinations
which revealed that his blood and tissues matched with that of his employer. An
operation was
immediately scheduled at the National Kidney and Transplant Institute (NKTI) and
fortunately, it
was a success. Candy received some amount he decided not to disclose to as a
“gift” part of
which he used to buy a house (in fact, a shanty) in the Baseco compound and some
he used to
buy some basic household appliances. Jokingly, or perhaps seriously, he said that
he used the
money to buy himself borloloy or accessories, adding, “kase alam mo na, bakla ako
kaya
kailangan ko yun” (“You know, I’m gay so I need those things.”) Interestingly, one
Barangay
Tanod prior to our personal interview with the donors told that Candy sold his kidney
in order to
support his vice, illegal drugs that is. Aling Vida shares, “Ah yung bakla… Nagbenta
ng bato
para makabili ng bato” (“That gay sold a kidney to buy illegal drugs.”). We felt it
awkward to ask
Candy about this however. In any case, up to now, the recipient of his kidney is in
one-way or
another helping him and his family. Candy says he can no longer count the various
ways his
former employer has helped him. He never regretted his decision. In fact, he says
that if
someone would come to him for one of his eyes, he would gladly donate it. He thinks
he is
justified in donating parts of his body. “Wala silang pakialam, sarili ko ‘to, sarili ko
ang
pineperwisyo ko” (It’s not of their business… It’s myself I’m harming), Candy says.
4
Similarly, 25 year-old Lorenzo left Samar in 1994 and came to Manila looking for
better
life opportunities. He worked as an all-around assistant/helper in Binondo, Manila.
His income
was just enough, if not less, to make ends meet – to feed his wife and two kids three
times a
day. In 1998, “dahil gipit ang buhay” (because life is hard) and “with the intention of
helping” as
he claims, he voluntarily searched for a kidney agent. From the horses’ mouth itself,
Lorenzo
declares, “Gusto ko ring makatulong… syempre nangangailangan sila ng karugtong
ng buhay
nila kaya ibinahagi ko na ang katawan ko… kusang loob ko lang talaga.” (I also
wanted to help.
They need to prolong their life so I just shared my body… It was voluntary.) Soon
after, a patient
willing to pay was found and Lorenzo underwent all the necessary pre-transplant
medical
examinations at St. Luke’s Medical Center. After the operation, he received P100,
000.00 from
his unknown recipient. He does not consider this as kabayaran (payment) but as
tulong
(assistance). He used this money for the medication of his ailing parents. He also
bought some
household appliances. Until now, however, his parents are not aware that the money
their son
in the City sent them was from selling one of his kidneys. He does not wish to tell
them because
he says that they might get disappointed. He now works as a stevedore and he says
that the
operation did not affect him at all. He still could carry up to 150 kilos of load like he
used to. He
also does not regret his decision and adds in jest that he could have given not only
one but two
kidneys.
Meanwhile, Rafael, a Muslim, was only 14 years old when he traveled from North
Cotabato to Manila in 1997. He was not able to find a stable job since. In spite of his
situation,
not to mention having a wife and a child to support, he still says that life in Manila is
better than
the countryside. Three years later, “dahil sobrang gipit”, his friend accompanied him
to a kidney
agent who immediately found a possible recipient. At the hospital waiting for the
removal of one
his other kidney for transplantation to an Arabian national, he saw and heard
someone
screaming and crying from pain. This scared Rafael and he impulsively ran away
and went back
to his home province. He tried to consult the matter with his mother but she did not
agree with
the idea of Rafael “donating” his kidney. He went back to Manila and pushed by the
same
financial instability, he looked for another agent and this time the transplantation
materialized.
He received P115, 000.00 he used to but a shanty in the Baseco area. On Black
Saturday of
2002 (i.e., April 16), a fire broke out and swept away around 10 hectares of
residential area
leaving homeless about 500 families, or 3,000 residents including Rafael and his
family. This
was not his only share of misfortunes. Soon after losing his house, he also lost his
mother.
When she finally discovered Rafael’s act, she had a heart attack and died. When
asked about
5
what he felt with it, Rafael smiled sheepishly and in resignation said that he could
have done
nothing. Surprisingly, he does not regret his act and says that given the chance to
modify
situations, he would have done the same.
Edwin, another native of Samar arrived in Baseco in 2000. In January 2002, his one
and
only child, two months old at that time, acquired Hepatitis-B and had to be
immediately brought
to the hospital. It was a crisis for the Divisoria cigarette vendor father. The need for
immediate
money pushed him to reconsider the offer he received from a kidney agent. In three
days time,
he was operated and one of his kidneys transplanted to an unknown patient. His son
passed his
ordeal with the money Edwin was given for his kidney. He was also able to buy a
house and
some appliances and support his also ailing mother. Like Candy, Lorenzo and
Rafael, he does
not regret having donated his kidney.
COLLECTIVE (UN)CONSCIOUSNESS
All of them say that except for feeling weak occasionally, it seems as if nothing has
changed. They can still function normally as if they have two kidneys intact. They
also claim that
they were fully informed about the operation and transplantation processes – the
expected
results, even the risks. They were also given assurance that their better kidney is for
them to
keep.
All four of them believe that there is nothing wrong with what they did and their act is
justified because even if they received some sort of compensation for their kidneys,
the fact
remains that they were able to help. They do not think that there is something
morally repugnant
on what they did. They just happen to be a part of a reality within which selling a part
of their
body is commonplace, a fad so it seems. They care not if it is against the law. They
need money
and when an opportunity comes to have some, it is so hard to say no. They did not
even saw
the matter from a religious point of view; they never felt the need to. “Hindi na namin
naisip yan,”
(We were no longer able to consider that) they say. For Rafael, if later the Lord will
question him
about the removal of his kidney, he would say that he was not the one who removed
it.
Meanwhile, Candy believes that if God is against what he did, He could have
stopped it while he
was being operated. Unlike Candy who knows the recipient of his kidney, Lorenzo,
Rafael and
Edwin never met their recipients. if possible, they want to know them. “Para din
makita ang
6
pangalawang buhay na naipagkaloob ko,” (To see the second life I gave) says
Lorenzo. “Baka
sakaling maawa pa rin,” (Maybe they would still pity us) according to Rafael.
REALITY BITES
According to the National Kidney and Transplant Institute Renal Disease Control
Program (NKTI ReDCoP) 2001 Report, there are an estimated 11, 250 Filipinos
nationwide
developing End-Stage Renal Disease (ESRD) annually. It is estimated that half of
these ESRD
patients are suitable kidney transplant candidates but only five percent are actually
transplanted
to date because of insufficient organ supply and the unaffordability of the operative
procedure to
most patients. Kidney transplantation can cost as much as P850, 000 in government
hospitals.
This does not yet include the more costly anti-rejection and post-transplant care.
If a patient has advanced and permanent kidney failure, the only remaining option to
prolong life is to have a transplant. According to the data gathered by the NKTI, the
survival
rates for kidney transplants were registered at 90-95% for living-related donors and
about 80-
85% for cadaver donors. These rates are very encouraging, especially when dialysis,
though it
can surely prolong a patient’s life is expensive and painful. In the NKTI, a 2-3
session per week
of dialysis treatment can cost P32, 000-P54, 000 per month (3). Although
transplantation is not
a cure but an ongoing treatment that lasts for the rest of the recipient’s life, it still
proves to be
the cheaper and better alternative because it allows the patient to live as if his/her
kidneys never
failed. A transplanted kidney, if not rejected by the recipient’s body can indeed be a
“new lease
on life”.
Traditionally, there were only two sources of kidneys for transplantation – cadavers
and
living-related donors (LRDs). The former of course refers to brain-dead patients, and
the latter
includes blood relatives. However, these two sources cannot meet the very high
demand for
kidneys. Moreover, waiting for a compatible kidney from a cadaveric donor may take
a long
time, and it is not always easy to find a suitable match from a family member.
Thousands and
thousands of patients with ESRD die each year due to the inadequacy of
transplantable organs.
7
With such a situation and the ever-increasing demand, some kidney patients resort
to
transplants from living non-related donors (LNRDs). LNRDs are of two types –
voluntary donors
who bear close emotional ties with the patient and those who have no consanguine
and direct
emotional ties with the recipient but who donate out of benevolence; and the so-
called kidney
vendors or commercial donors who offer one of their kidneys for a valuable
consideration (4).
Quite obviously, only the rich can afford to have a transplant because they have the
means –
not only to pay the hospital bills but also to look and pay for a kidney if they cannot
have a
suitable one for free.
There are 13 hospitals conducting transplants in the Philippines. A total of 306 kidney
transplants was done in the country in 2002 more than 50 percent of which were
performed in
the NKTI. Ninety percent of kidney transplants in the Philippines are from living
donors while
only 10 percent come from cadaver donors. The pressing issue is that the majority of
transplants from LNRDs are actually from commercial vendors. By and by, the
practice of
kidney selling is becoming commonplace, even if it is against the law. In Section IV
of
Administrative Order No. 124 s. 2002 issued by Health Secretary Manuel Dayrit
entitled
National Policy on Kidney Transplantation from Living Non Related Donors, it is
clearly and
explicitly stated that organ selling is prohibited. To wit:
Sale and purchase of kidney organs by kidney vendors is
prohibited. All health and health-related facilities and
professionals shall not allow the trade of kidney vendors.
Violators shall be penalized through cancellation of licenses and
other sanctions.
In spite of this order, kidney selling remains as ordinary as it can be, and the health
professionals are aware of it. One of our interviewees, Rafael, said that the doctor
herself
handed him the money as payment for donating his kidney.
In an article posted at abcnews.com (5), it is said that,
“Some men from the Philippines gave up one of their kidneys for
$1,000. It's not a choice you might make, but no one forced
them. They're poor, and they wanted $1,000 more than they
wanted two kidneys.”
Such a statement is loaded and interpretations of it can be very ambivalent.
Proponents
of compensated organ donation will argue that organ-selling is justifiable on the
grounds that
every person has the right to their own bodies and choosing what to do with it is a
matter of
individual choice, but then again it appears almost certainly that with the aggravating
8
circumstances of the donors, they really did not have a choice. They could do
nothing better
than sell their kidneys.
Moreover, the organ donors of Baseco are apt to justify their act by appealing to the
Filipino concept of utang na loob. They believe that the recipients of their kidneys are
in reality
simply fulfilling their culture-bound duty of paying a debt of gratitude by giving their
donors
money for after all they owe them their life. The problem with this however is that
utang na loob
in this context is seemingly misconstrued. Pagtanaw ng utang na loob which is
actually an act of
pagbabalik ng kagandahang-loob is not a form of exchange, of giving and receiving
something
in return as is the seeming case with organ trade.
Whenever money is involved, it seem as if it is difficult not to be a skeptic. Some
sees
the organ donors from Baseco as acting not out of compassion but as motivated by
“painful
poverty and human despair” (6). If they had a choice, i.e., other source of income to
be able to
live decently, they would not even think of giving away a part of their body. People
like Dr. H.
Barry Jacobs are ridiculed for advocating the selling of kidneys. His International
Kidneys
Exchange, Ltd. was quite infamous among the so-called moralists.
NO TO ORGAN TRADE
Why is it that some people find compensated organ donation as morally repugnant?
Here are some of the arguments presented by those strongly against organ selling:
1. Human organs are priceless and as such, cannot be equated with monetary value.
Selling of any part of the human body is corrupting the very meaning of human
dignity.
2. Organ trade is tantamount to commodification and it reduces the human body to a
commodity.
3. The Church decrees that we are only “care-takers” of our body and we do not
have any
right to take away any part of it.
4. The act of organ donation should be based solely on altruistic motivation.
5. Organ trade may be coercive to the poor. Such a system would be unfair because
only
the rich can afford to buy a body part to prolong their life. The poor thus become
vulnerable to abuse and exploitation. This creates an “income disparity” with the poor
selling body parts to the rich.
9
Arguments against compensated organ donation are usually grounded on the
concept of
commodification and the preservation of human dignity. It is commonly argued that
human
organs should not be bought or sold. Different countries have legislated against the
purchase or
sale of human organs. In the United States for instance, there is the National Organ
Transplant
Act of 1984, in Canada the Human Tissue Gift Act, and in the Philippines the
National Policy On
Kidney Transplantation From Living Non Related Donors. The rationale behind these
directives
is perhaps embedded in the words of Cohen as cited by De Castro (7):
Human beings… are of incomparable ethical worth and
admit of no equivalent. Each has value that is beyond the
incontingencies of supply and demand or of any other relative
estimation. They are priceless. Consequently, to sell an integral
body part is to corrupt the very meaning of human dignity…
When we or our integral body parts are sold, our dignity as
human beings is denied… Indeed, we feel so strongly that
organs integral to human functioning have a certain dignity that
we are reluctant to sell them even after we have died and no
longer need them.
Dr. Francis L. Delmonico, a transplant surgeon at the Massachusetts General
Hospital
also shares this view:
Any attempt to assign a monetary value to the human
body or its body parts, even in the hope of increasing organ
supply, diminishes human dignity and devaluates the very
human life we seek to save (8).
Now this probably has religious roots. It is said that our body is a “temple of God.”
God
created man according to his image and likeness and thus, He is present in our body
as much
as in our soul. Explicitly, one account in Genesis states that “…And God said, let us
make man
in our image, after our likeness… So God created man in his image, in the image of
God
created he him; male and female” (Genesis 1:26-27). Consequently, man has the
duty to
preserve the body that God has shared with him. This duty includes not abusing,
misusing and
corrupting our body. This duty includes, in other words, not dismembering any part of
it for
whatever purpose.
Organ donation is also traditionally construed as a purely altruistic act. The very
notion
of donation requires the kindness and compassion of the giver. Organ donors should
act on the
basis of altruistic motivation meaning, the giver should not expect any personal
benefit other
than perhaps the feeling of satisfaction in donating a part of his body. Payment or a
promise of a
payment is not a precondition and prerequisite of the donation. It is the satisfaction of
giving that
motivates one to do such act. The donor’s interest lies on the idea of saving the life
of another
10
person. They give a part of themselves out of benevolence and genuine concern on
the welfare
of a fellow human being. The idea of compensation seems totally at odds with the
very notion of
giving a donation.
Moreover, other moralists fear that legislating compensated organ donation could
bring
about the abuse and exploitation of the poor. Dr. Nancy Scheper-Hughes, a
professor of
medical anthropology at the University of California, Berkeley and co-founder and
director of
Organs Watch writes thus:
In today's thriving kidney market, an Indian kidney fetches
as little as $1,000, a Filipino kidney $1,300, a Moldovan or
Romanian kidney yields $2,700, while a Turkish seller can
command up to $10,000 and an educated Peruvian can receive
as much as $30,000 (9).
Discrimination among organ sources is very evident here. People from the so-called
less
developed countries are very vulnerable to exploitation. Dr. Scheper- Hughes
continues:
The new consumerist medical ethics that is gaining
acceptability creates the semblance of ethical choice (for
example, talk of “the right” to buy a kidney) in an intrinsically
unethical context. Bioethical arguments about the right to sell an
organ are based on cherished notions of contract and individual
“choice.” But the social and economic contexts that make the
“choice” to sell a kidney in a Calcutta slum, a Brazilian favela or a
Philippine shantytown are anything but free.
In another article, she says further:
It seems to me a violation of the very nature of what
medicine is about, to suggest that the poor should be allowed to
dismantle themselves bit by bit with the help of the medicinal
profession." (10)
Other probable repercussions of offering financial incentives to organ donors include
the
lowering of the quality of organs for transplantation. Again, according to Dr.
Delmonico,
payment could “undermine the integrity of the donor pool” (11). The system would be
prone to
fraud because other people may manipulate his/her own medical history or that of
his/her family
in order to sell an organ and get some money.
KIDNEYS FOR SALE, WHY NOT?
On the opposite side of course are those who advocate compensated organ
donation.
They appeal primarily to the numerous beneficial consequences of adopting a
system of
compensated organ donation and to the notion of fundamental rights of human
beings.
11
1. It is a fundamental right of persons to do whatever they want with their body, and
this
includes selling an organ if desired and buying one if necessary and possible.
2. Financial incentives could increase the supply of organs for transplantation and
when
the supply meets the demand, there would be no more long waiting lists and
unnecessary deaths.
3. It would permit donors to gain something for themselves and their family. This is
just fair
because under the present system, everybody gets something except the donor. The
recipient gets a new kidney thus a new life, the transplant doctors get their salary,
the
hospital gets profit and everyone else that makes the transplant possible except the
donor who gets nothing but some pain and a long scar after the operation.
4. As trade is going on anyway, regulating and controlling it would minimize the
exploitative
upshots of the black market.
Proponents of compensated organ donation cite neo-libertarian principles in arguing
for
the justifiability of giving financial incentives to organ donors. They evoke the
concepts of selfownership
and patient autonomy. They say that buying and selling organs is a matter of
individual choice. Those able to purchase and those who agrees in selling an organ
should not
be prevented from doing so. Moreover, they say that it is our duty to save lives and
to reduce
human suffering if we are capable of doing so. Candy voices this line of reasoning
when he told
us: “Wala silang pakialam, sarili kong katawan ‘to, katawan ko ang pineperwisyo ko.”
And so
does Lorenzo: “Wala silang pakialam sa buhay ko dahil ginusto ko ito.”
This argument from individual choice is supported and reinforced by Professor
Savulescu (12) of the University of Oxford. He says that he sees no enough reason
in banning a
market of human organs when people are allowed to damage their bodies for
pleasure, for
example, smoking or skiing. If having money is the means for some people to realize
other
goods in life, and selling an organ is an option to have some money, then so be it.
Professor
Savulescu argues:
It is double injustice to say to a poor person: “You can’t have
what most other people have and we are not going to let you do
what you want to have those things.”
We cannot rely on altruism because it is surely not working. In face of the nagging
reality
that avoidable and untimely deaths result from the shortage of organs for
transplantation, some
ethicists felt the need to propose “an ethical market in human organs”. The idea is
that having a
12
market of organs could increase the supply because cash payments could
encourage more
people to donate their organs. Moreover, it is predicted that by having an increased
supply,
more transplants would be successful because there will be more alternatives and
the patient
could have the best match, and thus, there will be more successful transplants. It is
also likely
that the prices of organs will be a cheaper and so, more people can afford to have a
transplant.
Professors Charles Erin and John Harris (13), for example argue that trade in organs
should not
be banned as it proves to be a good option so as to meet the high demand for
transplant
organs. Trade however, should be regulated and the commercial scheme equipped
with
adequate safety nets to avoid exploitation, discrimination and injustice. The
proposed ethical
market runs thus:
The market would be confined to a self-governing political
area such as a nation state or indeed the European Union. Only
citizens resident within the union or state could sell into the
system and they and their families are equally eligible to receive
organs… There would be only one purchaser, an agency like the
National Health Service (NHS), which would buy all organs and
distribute according to some fair conception of medical priority.
There would be no direct sales and purchases, no exploitation of
low-income countries and their populations (no buying in Turkey
or India to sell in Harley Street). The organs would be tested for
HIV, etc, their provenance known, and there would be strict
controls and penalties to prevent abuse… Sellers of organs
would know they have saved a life and would be reasonably
compensated for their risk, time, and altruism, which would be
undiminished by sale.
WHERE DO WE GO NOW?
The idea of selling an organ is surely squeamish for some but the arguments in favor
of
compensated organ donation are more tenable than those against it. The arguments
appealing
to the notion of human life and dignity can be easily refuted by the fact that a change
in the
bodily location does not alienate an organ from its integral function. The
commodification
argument is also weak, as it is “not sufficiently grounded in reality.” In the present
state of
affairs, organs are already regarded as commodities despite the laws and directives
against it.
The underground market is thriving and the donors are exploited in the process. This
can be
avoided if trade could be regulated (14).
CONCLUSION
Pragmatically speaking, the arguments in favor of compensated organ donation are
stronger than those against it. Many people would benefit from a market in human
organs. But
13
then again, such a system before it takes effect should be carefully planned and
examined. It
should not just be any other market; it should be ethical. We have to face the fact
that it leaves
the poor in a very vulnerable situation and this seems to be the exact case with
some of the
organ donors from Baseco. They may have freely consented in donating their kidney,
but their
miserable situation may have forced them to do so. In Filipino, maaaring di sila
pinilit, pero sila
ay napilitan dahil sa kahirapan. There is a difference between consenting and free
willing. Dr.
Scheper-Hughes could be right when she said these words:
“The idea of consent is problematic when a seller has no
other option left but to dismantle his or her own body. Putting a
market price on body parts – even a “fair” one – exploits the
desperation of the poor, turning their suffering into an opportunity
for a more affluent person.”
Candy, Lorenzo, Rafael and Edwin may have wanted to help and indeed they were
able
to. But more than helping the other person, they wanted to help themselves. They
may have
consented to give one of their kidneys but in reality they were pushed into doing so.
Either they
do not realize this or they simply (have to) deny it. Their common denominator is that
they were
primarily motivated by the financial reward that awaited them, because they need the
money to
support their needs. We should be sorry for Lorenzo, Rafael and Edwin, and more
sorry for
Candy if indeed he used the money he got to support his vice. Baseco Barangay
Captain,
Teresita Lumactud is very much against these persons’ decision, saying that there
are other,
decent alternatives to earn money but of course, no one would listen to her. For
people who
have been living a miserable life ever since, P100, 000.00 seems to be everything.
Manong
Avila, though he would not admit that he himself is a broker, says,
“Hindi na iniintindi ang konsensya, pagkumita ka ng libo tanggal
na ang konsensya mo. Talagang mawawala ang konsensya mo
kapag ganon (P20, 000) ang kikitain mo. Iisipin, paano kapag
nakonsensya ako, wala akong P20, 000. Eh kung wala akong
konsensya, meron akong P20, 000. Saan ka – sa konsensya o
sa P20, 000? Sa P20, 000 ako.”
There is also reason to doubt whether or not the organ donors fully understand the
consequences and implications of their acts. None of them said that they regretted
their
decision to give away their kidney but if we go back for example, to Candy’s earlier
pronouncement, he had an idea that he was harming himself – “sarili ko ang
pineperwisyo ko”
(It’s my own self that I’m harming) which of course matters not if there is cash
involved. If they
were not in such a deplorable economic situation, they would never have thought of
donating
their kidney. Arguably of course, the scheme of compensated organ donation will not
work if no
14
one needs the money. It would be inconceivable in a world not in want of cash and
patients
would just have to rely on the genuine kindness of some people willing to give an
organ.
Unfortunately, there are millions of poor people in the Philippines and thousands of
patients
waiting for transplants. When there are people willing to pay, the needy find it hard to
turn his
back. With P100, 000, anyone from the slums would find it hard to calculate what is
best for him
and fail to reason through the options very well. They would fail to maximize their
self-interest,
and the brokers would take advantage of it.
We agree that organ donors deserve incentives for their heroic acts but lump sum
payment seems to be a not so good idea. Professors Charles Erin and John Harris’s
ethical
market proposal seems okay if it can be conscientiously implemented. We believe
however, that
rather than directly paying the donors, the recipient, the state, or whoever manages
the system
and is in-charged of reward-giving should offer them something other than cash,
which could be
easily wasted. A “futures market” for organs seems to be best alternative as of now,
or any
scheme of postponing compensation. Donors could make better use of a decent job
and home
perhaps, livelihood assistance, or a health insurance. We do not think these are too
much for a
kidney. They are perhaps even much less for a new life.
15

Who will buy ... my beautiful kidney?

Donating v selling. The eternal debate. Should you

get paid for donating blood? How about sperm? Or an egg? How about, say, a
kidney? The ethics of organ donation have always been pretty clear. If you want
to give, you give. You don't sell. Yes, we've all heard the urban myth about
going out for a quick martini and waking up in an alley minus a kidney, and
we've all seen the episodes of Casualty/ER where some desperate soul has sold
a kidney on the black market then gets kicked in their remaining organ and
winds up in dire straits. But now two US doctors have suggested that sales of
organs, such as the 'spare' second kidney, should be legalised (Via BBC News
Online).

This bothers me for many reasons. Firstly, that 2nd kidney aint a spare. It
shouldn't be made easier to sell it off. If pushed, you can manage with just the
one. Particularly if it means saving the life of a loved one. But if your
remaining one fails, you're screwed. It's not like a spare tyre that you can sell
and replace. Secondly, people like me aren't going to be the ones posting pics
of their internal organs on auction sites. Making legislation about selling organs
(aka legitimising it) will surely lead to the poorer members of society selling
body parts. Third world anyone? Not good. Thirdly, I'll bet one of the reasons
that governments might want to legalise the organ trade is cos there's gold in
them there black markets and they want to get their grubby paws on it. The
doctors calling for this legislation reckon a kidney could sell for £23,000.
Wonder how much of that would go to Mr Breadline in India... not so much I'll
wager.

The legalising argument sort of makes sense in terms of safety and guarantees,
but it only goes so far. Making it legal doesn't make it a good idea. It's all very
well and good to charge a quid or two for the odd cup of sperm or pint of
blood, but body fluids are naturally replaceable. Kidneys not so much. You can't
just grow another. Is it just me or is this idea insane?