The Ethics of Organ transplant donation (US )

As of Tuesday, October 18, 2011, more than 112,000 Americans are waiting for a transplant donation (US Department of Health and Human Services). Eighteen people die every day waiting for an organ that never materializes. While the number of men, women, and children who are waiting for an organ is growing by leaps and bounds, whether or not donors should being compensated is a topic on which there is little agreement. Would compensation for pain, suffering, and inconvenience encourage those who are hesitant to donate?

The organs that come from cadavers do not come close to meeting the demand for those who wait on the Organ Transplantation list. A live donor is preferred as there is a higher rejection rate with cadaver harvested organs. There are countries that are attempting to regulate compensation for organ donation. Currently, the United States does not compensate individuals but is working on a system that would offer benefits such as medical coverage or life insurance (Guttman). Organs can be purchased in China, Pakistan, Turkey, Egypt, Colombia and the Philippines (The Irish Times 4).

Kidneys appear to be the organ in greatest need. Sometimes the organs are brokered, sometimes the organ donors are holding out for the highest bidder. In some countries, such as Pakistan, a woman can be forced to sell her organs as the belief system regards that her father or husband hold domain over her body. One might argue that the donor receives compensation for his or her organ and that compensation should suffice. However, the money stemming from the donation does not lift the donor out of poverty. Just the opposite happens when the donor’s health fails due to lack of follow up care after the donation.

This will leave the person or family worse off than before the donation. The underprivileged of developing nations, uneducated and desperate, are prey to the unscrupulous brokers who supply organs to the world’s wealthy. The health and welfare of these paid donors are just as important as the wealthy recipients of the organ. There is a common plight among the poor in developing nations similar to that of Henrietta Lacks and her family; both are taken advantage of by those who are better educated and whose goal is to pad their wallets.

The organ donors are paid a pittance compared to what an organ broker profits. In Pakistan, a kidney donor will receive between $1,200-1,800, while the broker receives $80,000 for his endeavors. Pakistan has a steady stream organ trafficking as private hospitals run advertising campaigns to lure the needy (British Medical Journal). Those who are selling organs are the unemployed young men, students, and those who are struggling to raise a family. While there has been a long standing debate to establish a controlled market, according to David J.

Rothman of Columbia University College of Physicians and Surgeons “almost every article advocating legalization opens by noting there is a shortfall of (50,000 people await a kidney) and the resulting increase in morbidity and mortality” (1524). The conflicting argument of altruistic donations is the need protection of the impoverished living in countries where it is already legal to sell organs. There is no board or panel in place questioning where the organs come from, who the recipient is, and sometimes whether or not the organ is viable and healthy.

In some scenarios, the organ is stolen. The donor is told that he or she is in need of surgery. The kind of surgery is not important as this is just a ruse. While under anesthetic, an organ is removed and sold to the highest bidder. This similar to what Henrietta Lacks experienced when she was admitted to Johns Hopkins. Lacks’ cervical cells were biopsied while she was unconscious and being treated for cancer (Skloot 33). These cells were removed without her knowledge or permission.

Henrietta’s cultured cells have made biotech companies such as Invitrogen and BioWhittaker sizable sums of money (194). However, Henrietta’s children live in poverty. There are concerns with whether or not incentives for organ donation should be intrinsic or extrinsic. It is felt that the intrinsic rewards, such as moral duty, would be crowded out by the extrinsic reward of cash or tax breaks. While the idea of trading in organs may not sit well with most individuals, neither does allowing people to die unnecessarily.

There is also concern that paid donations will hinder the altruistic donation. Would payment lead all donors to become paid donors? According to Rothman, in countries where blood is a saleable item, when sales are prohibited consequently donations increase (1525). This would lead one to think that the opposite would be true as well. If sales of organs become legal in the global market place, donations will diminish. I believe that there should be a system to reimburse donors for their contributions, whether it is cash or benefits.