In the performance of their duties, medical practitioners need to follow ethical guidelines. These guidelines inspire the practitioners to ensure that their actions safeguard the health of their patients and promote the image of the medical profession (Baillie et al., 2013). Most professionals endeavor to follow the ethical guidelines. However, there are various ethical issues that create confusion and hamper the efforts of practitioners to deliver care. Paid organ donation is among these issues. In the United States and other countries, a crisis of organ shortage is being witnessed (Sebayel et al., 2014). There is a long list of people who desperately require organs from donors. The supply of the organs is not sufficient to meet the demand. In an effort to encourage organ donation, some institutions have developed programs through which they offer monetary incentives to organ donors. While it is believed that these incentives could encourage people to sign up for organ donation, it is feared that the incentives have created complex ethical challenges (Sebayel et al., 2014). Unless the ethical challenges are addressed, paid organ donation will remain a contentious issue that will threaten the delivery of medical services.
Literature review
The ethics of paid organ donation has been the subject of scholarly investigation. Many scholars have attempted to establish if the positive impact that paid organ donation outweighs the ethical challenges that it presents. Anya Adair and Stephen Wigmore are among the scholars who have examined this issue. In an article that they authored, they explore the attitudes of the medical community and the general public regarding paid organ donation. They state that “the notion of organ donation as a ‘gift’ is highly valued” (Adair & Wigmore, 2011). Essentially, Adair and Wigmore are saying that organ donation should be voluntary because those who donate their organs are providing those who need them with a gift. It is not possible to place a price on this gift. Adair and Wigmore are not alone in their exploration of the controversy surrounding paid organ donation. Robert Gebelhoff adds his voice to this issue. In an article that featured in the Washington Post, he sheds light on how lucrative paid organ donation is. He offers the example of a program that offers a whopping $45,000 to individuals who donate their kidneys (Gebelhoff, 2015). Gebelhoff also discusses the motivation behind this program. He states that the government hopes to motivate people to donate their organs, thereby tackling the organ shortage crisis. Gebelhoff also adds that organ donation is a taboo within the medical community (Gebelhoff, 2015). He joins Adair and Wigmore who state that voluntary organ donation is highly valued while paid donation is frowned upon. His discussion allows one to understand why paid organ donation is a contentious issue in the United States and other countries across the world.
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The discussion on paid donor donation would not be complete without a look at the views of the American people regarding this issue. Joining forces with other scholars, Thomas Peters set out to understand whether the American public approves paid organ donation. The result of their investigation is intriguing. They established that a majority of the American people are in favor of paid organ donation. Peters and his team also found that most Americans would agree to donate their kidney if presented with an offer of $50,000 (Peters, 2016). This finding is indeed interesting. It appears that the American public and the medical community have assumed conflicting stances on the issue of paid organ donation. While the American people approve and would accept cash payment for their organs, most medical professionals regard paid organ donation with disdain and are strongly opposed to it. This difference underscores the contentious and controversial nature of paid organ donation.
Patricia Warren and a team of other scholars have also sought to shed further light on the controversy surrounding paid organ donation. In their article, they examine some of the factors that encourage donors to accept payment in exchange for their organs. The costs that the donors incur as they offer their organ are among these factors (Warren, 2014). Agreeing to part with their organs is a remarkable sacrifice that the organ donors make. It is therefore unfair and unacceptable that these donors should incur costs as they are engaged in selfless and altruistic acts. The monetary compensation that they are offered makes the financial burden that they carry much lighter (Warren, 2014). It is for this reason that many choose to accept payment for their organs. Warren and his team suggest that paid organ donation is unacceptable. They state that instead of offering financial incentives, other measures that eliminate the costs that the organ donors incur should be implemented (Warren, 2014). This, they argue, will make paid organ donation less attractive and encourage people to voluntarily donate their organs.
The case for paid organ donation
There are many who have voiced their support for paid organ donation. These people attempt to make a compelling case to support their approval of paid organ donation. Rhonda Shaw and Lara Bell authored an article in which they explore the views of those who support paid organ donation. In their article, they state that organ donors incur expenses in terms of time and money (Shaw & Bell, 2014). These expenses make it difficult for them to donate their organs. They add that the financial compensation that they are offered alleviates the inconvenience and hardships that they endure as they donate their organs. Essentially, Shaw and Bell state that while donors have a strong desire to voluntarily offer their organs, they recognize that they “can’t live on love” alone (Shaw & Bell, 2014). The financial compensation basically motivates them to offer their organs. Bell and Shaw do not neglect to point out that the people whom they involved in their study are opposed to the commercialization of organ donation. Their only desire is to be compensated for the expenses that they incur. From Bell and Shaw’s discussion, it is evident that compensating organ donors is only fair since they incur costs while performing a noble and selfless act.
Tong Allison teamed up with other scholars to examine the attitudes of the public regarding paid organ donation. In an article that they penned, they reiterate that a majority of the public is in support of paid organ donation (Tong et al., 2013). Many view this initiative as the key to addressing the shortage of organs. Allison and his team also found that many members of the public have concerns regarding the risks that are associated with organ donation (Tong et al., 2013). One may develop health complications or even die while donating an organ. Those in support of paid organ donation hold that the monetary reward serves as compensation for the risk that the donors are exposed to. The strong support that paid organ donation enjoys from the public helps to build the case for offering financial rewards to donors. Moreover, the compensation rewards the donors for the courage that they display in the face of the health risks that organ donation presents.
From the discussion this far, it is evident that those in support of paid organ donation present strong arguments to justify their position. Janet Radcliffe-Richards joined forces with other scholars to add even more support to the importance of paid organ donation. In their discussion, they focus mostly on the experiences of patients who need organ transplants. They argue that these patients endure “much suffering and death” (Radcliffe-Richards et al., 2015). They add that most patients lack adequate access to medical treatment. The example of developing countries which lack the dialysis machines needed to treat patients with kidney complications is provided (Radcliffe-Richards et al., 2015). This example allows readers to recognize why all measures should be used to address the plight of the patients. Radcliffe-Richards and her team call for the ban on the sale of kidneys to be lifted. They assert that reopening the kidney market will provide donors with incentive while ensuring that patients have access to life-saving treatment.
Radcliffe-Richards and their colleagues highlight the plight of patients in need of kidney transplants. While their discussion is enlightening, it does not go far enough in painting a compelling picture of the suffering that the patients endure. Writing for the Wall Street Journal, Gary Becker and Julio Elias provide key figures and statistics that allow for a clearer understanding of the experiences of patients to be gained. For example, they point out that the costs that patients incur for dialysis treatment is $80,000 (Becker & Elias, 2014).They add that to receive a kidney transplant, these patients have to wait an average of 4.5 years. Furthermore, the kidney transplant is a costly undertaking. A typical operation costs as much as $150,000. Becker and Elias add that those who do not receive the transplants and rely on dialysis only live for 8 more years (Becker & Elias, 2014). On the other hand, kidney transplants extend the lives of the patients by over 30 years. The statistics that Becker and Elias provide are indeed important as they give patients a bigger voice. They allow patients to focus the world’s attention on their suffering. The statistics and figures also add strength to the case for paid organ donation. When donors are incentivized using monetary rewards, they are inspired to do more to respond to the plight of the patients in dire need of organ transplants.
The arguments offered so far are indeed valid. However, they can be deconstructed as they fail to establish that paid organ donation is actually effective in addressing the organ shortage and alleviating the suffering of patients. Rupert Major investigated the impact that paid organ donation has. He focused on the paid donation program that the Iranian government implemented. This program was adopted in response to the sharp organ shortage that the country was grappling with (Major, 2008). Major states that this program has been hugely successful. Only five years following the implementation of the program, Iran managed to double the number of kidney transplants that it carried out (Major, 2008). What this means is that the thousands of people who would otherwise have died had their lives extended. The example of Iran and the success that it has achieved with its paid organ donation program is clear and compelling evidence that these programs are indeed effective. In addition to alleviating the suffering of patients, the programs actually address the organ shortage.
The case against paid organ donation
Not everyone is in support of paid organ donation. There are many who are convinced that paying donors for their organ is unethical. Adair and Wigmore are among the scholars who have expressed strong opposition to paid organ donation. Their opposition is not empty. They provide a number of compelling arguments to defend this opposition. One of their arguments focuses on the profile of those who are paid to donate their organs. They argue that most donors are poor and illiterate (Adair & Wigmore, 2011). They do not fully understand the implications of donating their organs. Adair and Wigmore add that most of the donors in such countries as Pakistan are in slave-like conditions that force them to part with their organ for money. Some use the money that they receive to settle debts (Adair & Wigmore, 2011). Others use the money to pay for education. There are also some who use the money to finance drug addiction. The argument that Adair and Wigmore make is that paid organ donation reinforces slavery and unhealthy lifestyles (Adair & Wigmore, 2011). Essentially, those who pay for organs are encouraging the donors to continue to abuse drugs. They are also lending support to the institution of slavery. Adair and Wigmore take a solid stand against paid organ donation and call on their readers to reject it. Their plea is indeed passionate and highlights the terrible conditions that force poor and illiterate donors to risk their lives in exchange for a small amount.
Benjamin Hippen joins the many scholars who have explored the issue of paid organ donation. While responding to an essay which examined the impacts of paid organ donation, he identifies some of the objections that those opposed to paid organ donation raise. He cites the opponents of paying donors who argue that paid organ donation creates illegal black markets where organs are traded (Hippen, 2008). It is believed that organs are already being traded on black markets across the world. The fact that donors are offered higher amounts is among the factors that have fueled the rise of the black markets. These markets have been blamed for human trafficking. People are uprooted from their homes and moved to the markets where their organs are extracted. Many do not receive any payment for the organs and others develop health complications because the organs are extracted using crude and dangerous methods. The fear that paying donors for organs could facilitate the establishment of black markets is valid. To ensure that these markets do not thrive, it is important to oppose paid organ donation.
Respecting the dignity of patients is one of the ethical guidelines that guide the conduct of medical professionals. These professionals need to treat their patients with respect at all times. Those opposed to paid organ donation are concerned that it amounts to a violation of the dignity of donors. In 1984, the United States enacted the National Transplant Act that declared paid organ donation illegal (Cha, 2016). The legislators behind this law sought to protect poor organ donors from exploitation. They feared that the wealthy would use their financial strength to entice the poor into giving up their organs. The legislators also set out to safeguard the dignity of donors. They believed that paid organ donation robs the donors of their humanity and dignity (Cha, 2016). That paid organ donation is illegal lends support to those who are opposed to this kind of donation. If human dignity is to be secured, the world needs to stand together in its opposition to paid organ donation. It needs to make it clear that human beings are not sources for organs.
In the discussion above, it has been pointed out that medical practitioners have an obligation to uphold ethical guidelines in their practice. Shielding their patients from harm is among the ethical obligations that they have. This obligation extends to self-inflicted harm. In their exploration of paid organ donation, Adair and Wigmore examine the life of donors who are paid for their organs. They observe that most of these donors are usually drawn back into poverty and that the money that they are paid does not have any meaningful impact on their financial situation (Adair & Wigmore, 2011). Adair and Wigmore state further that these donors often develop health complications that hamper their capacity to engage in economic activity. This duo essentially suggests that paid organ donation is harmful. They remind medical practitioners and the wider public that all efforts should be instituted to protect the donors from the self-inflicted harm (Adair & Wigmore, 2011). Ensuring that paid organ donation is not permitted is among these efforts.
Respecting the will of patients and obtaining consent before performing a medical procedure are some of the key ethical guidelines that medical professionals need to follow (Mahmood, 2016). Adair and Wigmore continue their examination of paid organ donation. They posit that paid organ donation violates the right of an individual to give consent (Adair & Wigmore, 2011). The donors often face intense pressure from their families who hope to gain financially. The pressure that the donors face makes it difficult for them to critically examine issues and make decisions freely. They are basically forced to part with their organs in exchange for meager amounts that do not delivery any meaningful benefit. That paid organ donation strips the donors of their independence and amounts to a violation of ethical guidelines add weight to the argument against paid organ donation.
Current state of debate and personal reflection
The discussion above has shed light on the divide in the paid organ donation debate. On one hand, there are people who believe that paid organ donation will present patients with the opportunity to easily obtain organs. These people also believe that paid organ donation helps to lift donors out of poverty. On the other hand is a camp that is fiercely opposed to paid organ donation. Those in this camp argue that paid organ donation encourage the formation of black markets and fuels human trafficking. They add further that paid organ donation does not have a significant effect on the financial status of the donors. If anything, it pulls them deeper into poverty and hardship. The challenge of determining the approach to take falls on the shoulders of legislators, policy makers and the medical community. These stakeholders need to critically examine all sides of the debate. The policies that they implement should be geared towards alleviating the suffering of the thousands of patients who have waited for years for organ transplants. This is the way forward.
I find the debate on paid organ donation to be rather complex yet intriguing. I think that the two sides in the debate have presented valid and solid arguments. However, after examining the key arguments, I have to support paid organ donation. I feel that paid organ donation does more good than harm. It offers hope to the patients who desperately need transplants. It also incentivizes people to donate organs. The shortage crisis that the US and other countries are facing can easily be addressed through paid organ donation. This initiative has proven effective in such countries as Iran. As observed earlier, Iran has managed to double the number of transplants. The success that it has achieved is clear indication that other nations need to follow suit. I recognize that paid organ donation presents some challenges that cannot be ignored. For example, it has been linked to the emergence of black markets. While I feel that this challenge is serious, I think that it can be addressed through regulation. I would advise concerned stakeholders to develop policies, structures and institutions whose duty will be to ensure that paid organ donation takes place in safe environments.
That the US and the rest of the world are dealing with an organ shortage is clear. This shortage has compounded the problems that patients on waiting lists face. These patients have to wait for many years and thousands die every year. Paid organ donation has been proposed as a promising solution to this challenge. It is recommended that donors should be compensated for the risk that they take and the expenses that they incur. In addition to helping to address the organ shortage, paid organ donation also incentivizes donors and improves their financial position, at least in the short term. Paid organ donation has also been linked to some negative consequences that include the establishment of black markets. Despite these negative impacts, paid organ donation remains a promising solution. Stakeholders need to develop regulatory frameworks that would allow donors to receive compensation in exchange for their organs.
References
Adair, A. & Wigmore, S. J. (2011). Paid Organ Donation: The Case Against. Annals of the Royal College of Surgeons of England, 93 (3), 191-192.
Baillie, H. W., McGeehan, J., Garrett, T. M. & Garrett, R. M. (2013). Health Care Ethics. Sixth Edition. New York: Pearson.
Becker, G. S. & Elias, J. J. (2014). Cash for Kidneys: The Case for a Market for Organs. Wall Street Journal. Retrieved 24th October 2017 from http://there--www.lkdn.org/cashforkidneys/WSJ_Cash_for_kidneys.pdf
Cha, A. E. (2016). What would happen if Americans were paid to donate their kidneys? Retrieved 24th October 2017 from http://www.chicagotribune.com/lifestyles/health/ct-kidney-donations-paid-20160323-story.html
Gebelhoff, R. (2015). Compensation for Organ Donors: A Primer. (2015). Retrieved 24th October 2017 from https://www.washingtonpost.com/news/in-theory/wp/2015/12/28/compensation-for-organ-donors-a-primer/?utm_term=.b402b71c21c1
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Mahmood, K. (2016). Informed Consent and Medical Ethics. Annals of King Edward Medical University. DOI: https://doi.org/10.21649/akemu.v11i3.1012
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Warren, P. H., Gifford, K. A., Hong, B. A., Merion, R. M. & Ojo, A. (2014). Development of the National Living Donor Assistance Center: Reducing Financial Disincentives to Living Organ Donation. Progress in Transplantation, 24 (1), 76-81.
