December 1979 I/4
ON SELLING ORGANS
A recent article ("On Selling Organs," J. Lachs, Forum on Medicine, Nov.1979, p.746-747) states that "people have a right to sell their organs as portions of their bodies..., because no one has a right to stop them from disposing of their assets as they will." Should we advocate an open market on kidneys, or even hearts, or whatever organs may be transplantable in the immediate future? Should we let people sell their organs, even if it means death to the donor, under the assumption that we cannot stop a person from disposing of his or her assets? In order to answer this question from an ethical point of view, three questions must be considered:
1. can we justify transplants from one living person to another?
2. should one sell an organ for transplant?
3. should there be laws against/selling organs for transplants?
1. Can we justify transplants between living persons?
Two types of transplants are possible: one involving an organ or tissue taken from a dead person and given to a living person; and the other involving an organ taken from a living person and given to another living person. When an organ is taken from a dead person and given to a living person, there is no ethical issue by reason of the transplant. If any ethical issue does arise, it stems from another source; for example, there might be a question as to whether the person from whom the organ is taken is truly dead (see Ethical Issues, n.3).
There are ethical issues, however, directly involved in the question of transplants between living people. When the question of organ transplants between living persons was first discussed, many physicians and philosophers thought it was wrong. They had some good reasons for their position. Prior to this time, the only reason for removing an organ from the human body was disease or malfunction of the organ which endangered seriously the function of the whole body. As a surgeon might have put it, one does not have the right to mutilate a healthy body. The ethical way of expressing this argument is to say that the integrity of the body should not be sacrificed unless there is a serious physiological danger to the whole body. (Principle of Totality.)
However, one of the pioneers in the field of bioethics, Father Gerald Kelly, SJ, long associated with Saint Louis University, added another idea to the debate concerning transplants. He pointed out that anatomical integrity of the body is not the same as functional integrity, and at times we might sacrifice anatomical integrity without sacrificing functional integrity. if an arm would be transplanted, this would involve a loss of functional as well as anatomical integrity. But if a kidney is transplanted, anatomical integrity is sacrificed but functional integrity is maintained because one kidney can serve the needs of the whole body. True, some future risk may be foreseen if the donor's other kidney should malfunction. But this type of potential risk is present even if the transplant does not occur. The risk of future difficulty might be a bit greater, but it is not of a different nature. In order to justify the risk and the loss of anatomical integrity that does occur, Kelly posited that the motivation for the donor should be charity, that is, the love of a fellow human being. Paul Ramsey, another pioneer in the field of bioethics, added that the common good of the community would be enhanced by reason of the love displayed on the part of the donor. Organ donation is not an obligation in justice then, rather it is something to be chosen in the freedom of charity. Moreover, a healthy human organ is much more than "an asset to be bought or sold." It is an integral part of the human personality and should not be sacrificed unless functional integrity is maintained and proper motivation is present.
2. Should one sell an organ for transplant?
If the justification for donating an organ should be charity, then it seem contradictory to state that ethically one could sell his/her organ. The anatomical integrity of the human person is a great good and should be sacrificed only for the highest of motives. Moreover, we can imagine the moral chaos that will ensue if organs were sold to the highest bidder. One might argue that a person in dire poverty may need the money that would come from an organ donation to support his family. But if a person is in dire poverty, society should find other ways to help him support his family rather than through being forced to sell something that should be given only in freedom.
Some might object that since people are paid for their blood, they should be paid for their organs as well. There is a difference between donating blood which the body replaces and donating an organ which is not replaced. There is less risk in the case of giving blood and hence it could be justified with a less lofty monetary motive. However, it does seem to me that the nation would be better served if people were not paid for blood donations. Rather than offer a motivation of money, the motivation of helping other people should be offered. A general education campaign could be instigated which would encourage people to donate blood periodically. In sum, buying or selling human organs is unethical, (1) because it is contrary to the dignity of the human body/person entity, and (2) because those who need such a gift should receive it, rather than only those who can pay for it. periodically.
3. Should there be a law against selling organs?
If the ethical rights and obligations are being observed in society, there is usually no need for a law. At present, there is no commercial traffic in human organs and therefore there does not seem to be a need for a law. If immunization problems are overcome in the future, transplants would increase and there might be more tendency to sell organs. But even if this happens, it would be better to depend upon the integrity and ethical value system of the medical profession to guarantee that the present system is maintained. Through education and emphasis upon the help that we should offer one another, it seems that enough organs would be donated and the proper ethical values would be maintained. At the same time, as education in regard to organ donations continues, some thought should be given to reviewing the methods by which blood is obtained.
Kevin O'Rourke, OP
(Thanks to Dean David Challoner, MD, for suggesting this topic.)
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