People are dying for want of donor organs. Some people argue that allowing a free market in organs is a possible solution. But giving people in poverty the option to legally sell organs they can live without, such as kidneys or pieces of lung or liver, would harm them through no fault of their own, and this explains why live donor organ markets should remain prohibited.
This is the conclusion of the argument presented by SPP Assistant Professor Simon Rippon in his "Editor's Choice" article in the new issue of the Journal of Medical Ethics entitled "Imposing Options on People in Poverty: The Harm of a Live Donor Organ Market." Rippon rejects the free-market argument that prohibiting people from selling their organs for cash is paternalistic, and can only make things worse for people in poverty by taking away what they would themselves regard as their best option.
Rippon quotes opponents like University of Oxford professor of bioethics Julian Savulescu: “To prevent [people] making decisions is to judge that they are unable to make a decision about what is best for their own lives. It is paternalism in its worst form,” and Janet Radcliffe Richards: “Trying to end exploitation by prohibition is rather like ending slum dwelling by bulldozing slums: it ends the evil in that form, but only makes things worse for the victims.”
Rippon argues that these opponents make the false assumption that giving someone an option can only possibly harm that person if he would be making a mistake in choosing to take it. But Rippon highlights many exceptions to this assumption. For example, sometimes people have strategic reasons for preferring not to have certain options: "a union leader who can truthfully assert that the members simply will not vote for the deal on the table may be in a far better negotiating position than he would if he instead had the option to persuade the members to accept the deal."
Rippon argues that live donor organ markets would also provide options that people in poverty might reasonably prefer not to have, and that this provides the basis for a non-paternalistic argument for prohibiting them. As Rippon explains, "if organs can be easily exchanged for cash they will then become commodified, and naturally subject to the kinds of social and legal demands and responsibilities that govern our other transactions in the marketplace." The mere option to sell organs can easily be turned into a demand to sell organs, backed up by the kind of social and legal pressure to earn income that poverty brings. What is to stop a landlord demanding that you sell an organ to pay a high rent, or a loan shark demanding an organ as collateral?
In addition, citing evidence from the economics literature that markets tend to "crowd out" altruistic donors, Rippon argues that the effectiveness of organ markets in increasing the number of organs available is entirely dependent on their exerting social and legal pressures like this on people in poverty: "Those who want to sell their organs are not generally motivated by the promise of obtaining luxury goods such as holidays, recreational flying lessons or cases of fine wine". But Rippon sees an impermissible form of exploitation in the idea of rich transplant patients indirectly pressuring those in poverty to give up their organs.
By carefully explaining the rational basis of the discomfort many people feel about markets in human organs, Rippon hopes to influence the public policy debate on the issue, which he believes often fails to acknowledge the broader framework within which individual transactions take place in a free market. “It is easy to assume ... that in order to determine whether a market should be permitted, we need only consider the potential costs and benefits to individuals of particular transactions within the market," Rippon concludes, "But those making this assumption take too narrow a view, failing to see that while participants in a voluntary market choose for themselves whether or not to buy or sell, they do not thereby choose or approve of the option space within which they make their choices. And they fail to see that people in poverty might well have decisive reasons for preferring not to have the legal options that others seek to foist upon them."
Read the full text of Rippon's article here.
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