Moral Reasoning Essay
_
In
the United States, there are more than 100,000 people waiting for organ
donations (Pitney). Of that 100,000, “more
than three-quarters” are in need of a kidney, which is the only organ that can be
given by a live donor (Pitney).
While all would recognize that this is a problem, not much is being done
to correct it. In recent decades,
economists have come up with the idea of providing monetary incentives for live
donors and the families of the deceased to encourage more donations, thus
decreasing the shortage. However, many
question the morality of selling organs.
According to the National Organ Transplant Act of 1984, this is illegal
in the United States. And, according to
the National Kidney Foundation, “offering direct or indirect economic
benefits in exchange for organ donation is inconsistent with our values as a
society” because it “diminishes human dignity” ("Financial Incentives for Organ Donation"). These conclusions ignore the fact that a
system that allows just compensation for organ donation has the unique
potential to eliminate the organ shortage without impeding upon human
dignity.
The issue some have with selling organs is that it allegedly “diminishes human dignity” ("Financial Incentives for Organ Donation"). The theory is that an item that can be sold is property. Thus, if one can sell their organs, the organ becomes a form of property. The human body in our society, and in most others, is something sacred – something that a price can’t be placed upon. But is it a necessarily bad thing to put a price on an organ? In our society, compensation is provided for many things – risk, time, etc. While there is shown to be little risk in having a kidney removed for donation purposes, there is always a risk when going under the knife. Also, there is a lot of time that goes into recovering after donating – “for several weeks after surgery, a donor must limit physical activities” (Pitney). For many, several weeks aren’t available to them. Most people can’t afford to take that much time off from work without compensation– not only will one not get paid during those weeks, but also there is a chance of losing the job entirely. Additionally, there is the issue of what insurance covers. While the surgery is typically covered by insurance, “a donor’s out-of-pocket expenses may run into the thousands of dollars” (Pitney). These expenses, along with the money lost taking time off from work, have the effect of eliminating majority of potential donors. If others can be compensated for risk and time, it only seems right to compensate donors, as well.
To that end, economists argue that an equilibrium price could be found for organs, as every item has an equilibrium price. An equilibrium price is a “price at which the quantity of a product supplied matches the quantity demanded” (“Equilibrium Price”). The equilibrium price is thus the “perfect price” that would eliminate the shortage of organs, but wouldn’t create a surplus either. This theory has already been put into practice, as well. In 1988, Iran “legalized living non-related donation of kidneys” (Major). Kidney donors received monetary compensation from the government, free health insurance, and additional payments from a third-party independent association or the recipient (Major). In eleven years, “the renal transplant waiting list was completely eliminated” (Ghods). If the United States could adopt a similar model, maybe we too could eliminate our shortage.
Another issue some take with selling organs is how to deal with those who have already donated organs. The National Kidney Foundation suggests that giving monetary compensation for organs would be an “affront to the thousands of donor families and living donors who have already made an altruistic gift of life and it could alienate Americans who are prepared to donate life-saving organs out of humanitarian concern” ("Financial Incentives for Organ Donation"). This suggests that for those who have made the decision to donate previously, this new donation process may make them feel as though the importance of their actions have diminished. This also suggests an effect not only on previous donors, but also upon future donors. Indeed, the quote theorizes that future donors who would have donated as an altruistic act may be less inclined to do so if they think the act doesn’t hold as much meaning to our society anymore. These suggestions diminish the ultimate goal of all organ donations – to save lives. This system would save more lives, and those prior donors and donor families no doubt have the capacity to appreciate that fact. Simply stated, being paid to donate an organ doesn’t take away from the importance of saving a life.
Another issue brought up by those in opposition to this model is that if money were paid for organs, the majority of the organs would come from people in the lower classes. According to the National Kidney Foundation, doing this would be “characterized as exploitation” ("Financial Incentives for Organ Donation"). This concern can be dealt with fairly easily because it is merely a red herring. This is so because it assumes that it is a bad thing for a poor person to be able to supplement his or her income by selling a non-vital organ. There is no evidence that removing a kidney, a non-vital organ because there are two, causes any short or long term damage. There is “a 0.02% risk of death during surgery and its immediate complications and less than a 1% risk of other morbidities” (Major). Also, there is “no significant acceleration in decrease in glomerular filtration rate (beyond that expected due to aging) in kidney donors fifteen years after transplantation” (Major). So, the risk of danger is minimal for kidney donation, but the costs to the donor are prohibitive. This system allows people to save a life, but also afford the process.
A concomitant concern is that the rich will go to the front of the line with regard to organ transplants because they can afford to pay. Indeed, there is evidence debunking this concern, as well. In the Iranian model, “there are ‘no significant differences’ in groups of donors and recipients when compared in terms of socioeconomic background… Thus significant social exploitation is not occurring” (Major). What this tells us is that it is possible to have a system where monetary compensation is given for organ donation and it does not result in the rich going to the front of the line, or the poor being left behind.
And, there is a similar model that may assuage further the concerns of the opposition. It has been proposed to provide non-monetary compensation, such as health insurance, to those who donate. Additionally, this would be fully government sponsored, to avoid the issue of direct payment from the recipient, as in the Iranian model. With the elimination of “extra” compensation from the recipient, the problem of rich preference would also be eliminated. In 2008, former Pennsylvania senator, Arlen Spector, attempted to pass legislation called the Organ Donor Clarification Act (Pitney). This bill stated that the language of the National Transplant Act of 1984 is “unclear about noncash incentives” and, therefore, they should be permitted (Pitney). While this model may not hit the equilibrium price and completely eliminate the shortage, it would eliminate the so-called moral debate about compensation while decreasing the shortage and save many lives.
In the final analysis, a system that compensates organ donation is a system that allows people to do the right thing and get paid for it – whether it is via live donation or an after death donation. The simple fact of the matter is that the vast majority of people waiting for organs could be saved if we allowed this model to be put in place. The opposition’s concerns, ethical and otherwise, cannot outweigh the logic, altruism, and economic strength of a system that provides compensation to those who voluntarily sell their organs. Those who make such a sacrifice are no less noble for having been justly compensated.
Bibliography
"Equilibrium Price." BusinessDictionary.com. Web. 22 Apr. 2012. <http://www.businessdictionary.com/definition/equilibrium-price.html>.
"Financial Incentives for Organ Donation." The National Kidney Foundation. 1 Feb. 2003. Web. 27 Apr. 2012. <http://www.kidney.org/news/newsroom/positionpaper03.cfm>.
Ghods, Ahad J., and Shekoufeh Savaj. "Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation." Clinical Journal of the American Society of Nephrology. 2006. Web. 26 Apr. 2012. <http://cjasn.asnjournals.org/content/1/6/1136.abstract>.
Major, Rupert. "Paying Kidney Donors: Time to Follow Iran?" McGill Journal of Medicine. Jan. 2008. Web. 26 Apr. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322914/>.
Pitney, Jr, John J. "Providing Legal Incentives and Rewards for Organ Donation: A Firsthand Look at the Issue." Encyclopedia Britannica Online. 4 Dec. 2008. Web. 27 Apr. 2012. <http://www.britannica.com/blogs/2008/12/providing-legal-incentives-for-organ-donation-a-firsthand-look-at-the-issue/>.
The issue some have with selling organs is that it allegedly “diminishes human dignity” ("Financial Incentives for Organ Donation"). The theory is that an item that can be sold is property. Thus, if one can sell their organs, the organ becomes a form of property. The human body in our society, and in most others, is something sacred – something that a price can’t be placed upon. But is it a necessarily bad thing to put a price on an organ? In our society, compensation is provided for many things – risk, time, etc. While there is shown to be little risk in having a kidney removed for donation purposes, there is always a risk when going under the knife. Also, there is a lot of time that goes into recovering after donating – “for several weeks after surgery, a donor must limit physical activities” (Pitney). For many, several weeks aren’t available to them. Most people can’t afford to take that much time off from work without compensation– not only will one not get paid during those weeks, but also there is a chance of losing the job entirely. Additionally, there is the issue of what insurance covers. While the surgery is typically covered by insurance, “a donor’s out-of-pocket expenses may run into the thousands of dollars” (Pitney). These expenses, along with the money lost taking time off from work, have the effect of eliminating majority of potential donors. If others can be compensated for risk and time, it only seems right to compensate donors, as well.
To that end, economists argue that an equilibrium price could be found for organs, as every item has an equilibrium price. An equilibrium price is a “price at which the quantity of a product supplied matches the quantity demanded” (“Equilibrium Price”). The equilibrium price is thus the “perfect price” that would eliminate the shortage of organs, but wouldn’t create a surplus either. This theory has already been put into practice, as well. In 1988, Iran “legalized living non-related donation of kidneys” (Major). Kidney donors received monetary compensation from the government, free health insurance, and additional payments from a third-party independent association or the recipient (Major). In eleven years, “the renal transplant waiting list was completely eliminated” (Ghods). If the United States could adopt a similar model, maybe we too could eliminate our shortage.
Another issue some take with selling organs is how to deal with those who have already donated organs. The National Kidney Foundation suggests that giving monetary compensation for organs would be an “affront to the thousands of donor families and living donors who have already made an altruistic gift of life and it could alienate Americans who are prepared to donate life-saving organs out of humanitarian concern” ("Financial Incentives for Organ Donation"). This suggests that for those who have made the decision to donate previously, this new donation process may make them feel as though the importance of their actions have diminished. This also suggests an effect not only on previous donors, but also upon future donors. Indeed, the quote theorizes that future donors who would have donated as an altruistic act may be less inclined to do so if they think the act doesn’t hold as much meaning to our society anymore. These suggestions diminish the ultimate goal of all organ donations – to save lives. This system would save more lives, and those prior donors and donor families no doubt have the capacity to appreciate that fact. Simply stated, being paid to donate an organ doesn’t take away from the importance of saving a life.
Another issue brought up by those in opposition to this model is that if money were paid for organs, the majority of the organs would come from people in the lower classes. According to the National Kidney Foundation, doing this would be “characterized as exploitation” ("Financial Incentives for Organ Donation"). This concern can be dealt with fairly easily because it is merely a red herring. This is so because it assumes that it is a bad thing for a poor person to be able to supplement his or her income by selling a non-vital organ. There is no evidence that removing a kidney, a non-vital organ because there are two, causes any short or long term damage. There is “a 0.02% risk of death during surgery and its immediate complications and less than a 1% risk of other morbidities” (Major). Also, there is “no significant acceleration in decrease in glomerular filtration rate (beyond that expected due to aging) in kidney donors fifteen years after transplantation” (Major). So, the risk of danger is minimal for kidney donation, but the costs to the donor are prohibitive. This system allows people to save a life, but also afford the process.
A concomitant concern is that the rich will go to the front of the line with regard to organ transplants because they can afford to pay. Indeed, there is evidence debunking this concern, as well. In the Iranian model, “there are ‘no significant differences’ in groups of donors and recipients when compared in terms of socioeconomic background… Thus significant social exploitation is not occurring” (Major). What this tells us is that it is possible to have a system where monetary compensation is given for organ donation and it does not result in the rich going to the front of the line, or the poor being left behind.
And, there is a similar model that may assuage further the concerns of the opposition. It has been proposed to provide non-monetary compensation, such as health insurance, to those who donate. Additionally, this would be fully government sponsored, to avoid the issue of direct payment from the recipient, as in the Iranian model. With the elimination of “extra” compensation from the recipient, the problem of rich preference would also be eliminated. In 2008, former Pennsylvania senator, Arlen Spector, attempted to pass legislation called the Organ Donor Clarification Act (Pitney). This bill stated that the language of the National Transplant Act of 1984 is “unclear about noncash incentives” and, therefore, they should be permitted (Pitney). While this model may not hit the equilibrium price and completely eliminate the shortage, it would eliminate the so-called moral debate about compensation while decreasing the shortage and save many lives.
In the final analysis, a system that compensates organ donation is a system that allows people to do the right thing and get paid for it – whether it is via live donation or an after death donation. The simple fact of the matter is that the vast majority of people waiting for organs could be saved if we allowed this model to be put in place. The opposition’s concerns, ethical and otherwise, cannot outweigh the logic, altruism, and economic strength of a system that provides compensation to those who voluntarily sell their organs. Those who make such a sacrifice are no less noble for having been justly compensated.
Bibliography
"Equilibrium Price." BusinessDictionary.com. Web. 22 Apr. 2012. <http://www.businessdictionary.com/definition/equilibrium-price.html>.
"Financial Incentives for Organ Donation." The National Kidney Foundation. 1 Feb. 2003. Web. 27 Apr. 2012. <http://www.kidney.org/news/newsroom/positionpaper03.cfm>.
Ghods, Ahad J., and Shekoufeh Savaj. "Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation." Clinical Journal of the American Society of Nephrology. 2006. Web. 26 Apr. 2012. <http://cjasn.asnjournals.org/content/1/6/1136.abstract>.
Major, Rupert. "Paying Kidney Donors: Time to Follow Iran?" McGill Journal of Medicine. Jan. 2008. Web. 26 Apr. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322914/>.
Pitney, Jr, John J. "Providing Legal Incentives and Rewards for Organ Donation: A Firsthand Look at the Issue." Encyclopedia Britannica Online. 4 Dec. 2008. Web. 27 Apr. 2012. <http://www.britannica.com/blogs/2008/12/providing-legal-incentives-for-organ-donation-a-firsthand-look-at-the-issue/>.