From research in the literature review, it appears that the donor in a kidney transplant actually suffers very little from the operation. They receive compensation for any transport and missed work, and there is a very low risk of complication or a lower life expectancy because of it. This means that the only real factor that makes the system unfair for the donor is the emotional effects of giving up a body part, but not the physical effects of this. Added to this, while the recipient often benefits from an extended life, they normally still have a shorter life expectancy, some complications with the procedure at some point, and have to remain on immunosuppressant drugs for the rest of their lives, so they do go through a significant amount of suffering too. Weighed up against each other from a relativist point of view, the donor does not really suffer while the recipient benefits, so the system seems quite fair as it is, without donors receiving a large payment for their actions in addition.
Under the rights and duties ethical framework, everyone has a duty to donate a kidney if they have one available, if they expect the right to receive one freely, and an increase in materialism in the donation system would undermine these underlying ethics, because people would no longer feel they are under an obligation to donate organs, since they are paid for doing so. This would not just affect the kidney donation system, but other systems, such as blood donation, because people would no longer feel obliged to donate without a payment.
To strengthen my argument against paid organ donation, there are many other negative effects that could be created from such a system. To start with, a paid system could encourage exploitation of less affluent people in the UK, because they would feel pressured into donating a kidney for the money, even though it would not necessarily be the best decision for their long-term interests. As I was informed by Judith Stewart, the donors cannot be discriminated against if they are not physically fit to lose a kidney, for example, if they lead a lifestyle that puts them at more risk of suffering without a kidney, so they must still be used even if they are putting themselves at more risk. It would also mean that there would be another avenue for them to turn down to get money, when what they really need to get out of their difficult situation is government advice and support about how to sustain a better life; paid organ donation would dissuade the government from providing more support for these people in need.
Since it has been established that only less affluent people are likely to sell their kidneys, other people would look down on those who sell their organs and more of a social divide between these two ‘classes’ would be created in Britain. Payment also encourages people to donate organs purely for the money, so the system would become much more materialistic. As suggested by Richard Titmuss, this would result in hospitals taking less care of the donor, because they are paid, so medics feel under less of an obligation to treat them well. Whilst this would probably not affect the health of the donor, a lack of care and respect may have an impact on their mental wellbeing after the procedure, because they do not receive as much attention or support for their actions.
If paid donation was introduced, it may also encourage people to believe that they do not need their kidneys and they can treat their bodies how they like, drinking, excessive eating, solvent abusing, without much consequence to their health. The NHS would be left with the effects of a less healthy society, and this would lead to an even more strained healthcare system and overall a worse situation than before a paid donation system was introduced. Relating to ethical frameworks, it would make a good person to donate a kidney altruistically, so according to virtue ethics, the donor should not be paid because this would be unethical.
Moreover, if a paid system was introduced, it is probable that more unsuitable candidates would come forward for donation – those who are less affluent and perhaps are in bad condition from drinking, drugs or solvent abuse or just in poor health – and all the organs that are offered must be screened. The tests for organs that are unsuitable for donation would waste a lot of money for the NHS, so less could be available for other causes.
Of course, many people argue that payment for organs in the UK would reduce the amount of worldwide illegal organ trading that occurs, because more available kidneys would mean fewer British patients would be travelling abroad to buy kidneys elsewhere, where the illegal trade is uncontrolled and causes exploitation and death. Exploitation in the UK would be unlikely to happen, because the donation system would be nationally run by the NHS, and the UK doctors would carry out the procedure under good conditions with minimal risk to the donor or recipient, compared to risky procedures abroad. However, these benefits are limited by whether the number of people staying in the UK was increased as a result of more organs becoming available for transplantation. As already discussed, there would probably not be a great increase in organs available, so there would still be people desperate enough for an organ to travel abroad and encourage the illegal transplant trade, meaning these advantages of a paid system would not arise.
According to some religious beliefs, human bodies are sacred, so it is not only impossible, but insulting their God, to value an organ; in Christianity, the dominating religion in the UK, it is believed that man was made in the image of God, so to sell part of man would be sacrilegious. One philosophical method of analysing arguments would be Karl Popper’s falsificationism. If you cannot disprove (‘falsify’) a theory then it can never be proven because it is not science. It is not possible to falsify that there is God or ‘higher being’, or that we, as humans, are made in the image of, or by a ‘God’, therefore we cannot ever prove against these religious theories about valuing an organ being wrong, so they cannot be ignored.
These factors would make it impossible to be able to value an organ without creating protest and controversy. Many religions would protest, as would ethicists and philosophers, until there became a unifying agreement about how valuable body parts are, and this will not happen because we cannot prove or disprove these religious theories about valuing organs.
There are some religions with views against general organ transplantation. Jehovah’s Witnesses and Gypsies in particular are against organ transplantation, with Gypsies believing that in their after-life, their soul maintains a physical shape which must remain in tact. Jehovah’s Witnesses do not agree with blood transfusion, having interpreted “keep abstaining from blood” in the Bible to mean that blood transfusion between humans is wrong. If some religions mean particular people cannot participate in organ transplants, it would be unfair to offer the option of this money to some of society and not others for a religious belief that they hold. Many absolutists would be in the same situation, as they are either morally against organ transplantation or payment for organs, so they would also be unfairly excluded from this system of earning money. This is another reason why the UK should not introduce a paid organ donation system.
Another aspect to be considered with the introduction of paid organ donation would be cost. It turns out that if the system worked, it would be more cost-effective than our current system, with a transplant costing around £20,000 in total compared to dialysis costing around £250,000 for ten years for a patient. So by a utilitarian approach, this would mean the paid system would be better because more savings for the NHS means more people can be treated for other things and more happiness is created among more people. However, we must take into account the limitations of the argument and the other circumstances; therefore, an absolutist, utilitarian or relativist could argue that there would be little difference in costs because so few people would come forward to donate an organ anyway, and other negative effects of the paid system would create a worse situation than without the system.
Philosophical aspects of the argument must also be considered; I have already said that the religious ideas of opposition to organ donation cannot be falsified, because they are not scientific, so we can never know that organ donation is right or wrong, and therefore, it would be unfair to disallow certain religious groups the option of earning money from selling organs.
An underlying problem with a paid organ donation system would be how to actually put a value on an organ. It would seem impossible to put a value on a body part, because every person would have a different point of view on whether you could do so, and how much it would be worth; many would argue that a kidney is priceless, so one cannot pay someone for it. It is very hard to equivocate the benefits of receiving a kidney to receiving money for the donation of this kidney, because the two things are so different – who can say that a certain amount of money would be just compensation for a body part?
We cannot deduct the value of an organ, as its value is subjective according to how much someone is willing to pay for it. It would be difficult enough to accurately work out how much it costs to raise a person and transplant their organ, in order to value the organ using just physical expenses involved in the growing of this organ, let alone if we consider that some regard organs as sacred and therefore priceless. We do not know whether this is the case because we cannot prove whether these religious teachings are correct!
Lastly, we cannot prove whether it is possible or not to value an organ by induction; unless you looked at what people in the illegal trade are willing to pay or accept for an organ, you cannot base a value for a kidney in the UK on the current transplant trade. It would be extremely hard to base a decent organ value on this existing trade because it is uncensored, so people may lie about the costs involved, many cases would never be discovered, and most prices paid are probably unfair anyway, due to exploitation of the poor. Therefore one cannot get an accurate idea of the current value of organs by this method of enumerative induction.
Using these philosophical methods of proof, it would not be possible to value an organ, and without this ability, the UK cannot introduce a fair system of paid organ transplant that will not cause controversy or be universally accepted as reasonable. Altogether, I feel that the falsification method of philosophy offers strong proof that the UK should not adopt a paid organ donor system, because it shows one cannot properly value an organ or ignore religious beliefs against paid organ donation, both being important aspects in introducing such a system.
In order to solve the problem of a paid donation system creating materialism in society, and this, as a result, leading to further problems, it could be a possibility to find a form of compensation other than money. For example, something that would benefit somebody more in the long term. A good idea would be free laser eye surgery, because this not only costs about the same amount of money to perform as a kidney transplant, but is equivalent in value to an organ (related to health and the body, rather than money), and would be a great attraction to many people who suffer from poor eyesight. Of course, a limitation of this argument would be that not everybody would benefit from laser eye surgery, so other options would have to be thought of that would be equivalent in value.
As well as society becoming more materialistic towards organ donation, a paid system could have negative consequences for the safety of the recipients. After some research, I found that a thorough amount of screening of the organs is undergone to prevent any unsuitable organs being used. However, people paid for donating a kidney are less likely to do so out of good intentions, so are less likely to tell the truth about their medical history, and greater risk could be created for the donor and perhaps even the recipient if the donor suffers from any underlying conditions that are not detected from the medical examination and history.
A final reason why paid organ donation would cause trouble would be about the actual tests that people have to go through to donate their organs. There would be more people coming forward to offer their kidneys, and, even if the organs were not suitable for donation, the tests can uproot problems. Sometimes the virus tests can show that the potential donor is HIV positive, which may make it worse for the donor than before they came forward. Blood testing can uproot family problems when, for example, someone finds they have a different blood group to their parents, revealing that they are adopted, when this information would be better never known. A utilitarian or a relativist would feel that these problems would often cause more unhappiness than if the tests if results were never discovered, so extra testing should be avoided and not encouraged by monetary payment.
As with most arguments, there are always limitations that would undermine the discussion if they arose. For example, if technology was developed so that stem cells could be grown into kidneys or mechanical kidneys could be created and used, then the UK would no longer need to consider methods of increasing organ availability, like paid donation. If there was no longer a need for more kidney donations then this argument would be invalid also, either from cures being found to kidney diseases so that kidney transplants are not needed, or from an alternative organ donation system being introduced so there are already enough available organs.
From ‘Why give to strangers?’ by Titmuss on organ transplants, from Bioethics: An Anthology edited by Helga Kuhse and Peter Singer.
The Bible, based on Acts 15:28, 29
