From the ethical perspective of Utilitarianism, one must act in a manner consistent with the overall happiness of all sentient beings (Tong, 10). To sell a kidney (and it is wise to limit the discussion of buying and selling organs to that of kidneys; this is not only the most widespread transplant-for-pay procedure, it has also become fairly common knowledge that the kidneys are redundant organs and one can live a continued healthy life after losing a single kidney) is a major surgery. It is not a far logical jump to assume that one would not volunteer for major surgery and its associated risks without a profound need for the cash. When a member of a wealthy class (or caste, or State) pays a poorer individual
for the removal of a body part, this affects the dignity of the donor’s entire community (Kim, 148). The notion of The Rich ‘slicing up’ The Poor to ease their medical woes is disgusting and horrifying.
Ethicists who draw specifically from either the ‘Act Utilitarian’ or ‘Rule Utilitarian’ framework may pay closer attention to the specifics of a single surgery rather than the shaming of an entire group of people. The Act Utilitarian would view the removal of an organ from an otherwise healthy person as an immoral act. Unnecessary surgery performed on an individual – willing or unwilling – violates the ethic of non-maleficence, or ‘first do no harm,’ familiar to medical students around the globe. The strict Rule Utilitarian would likely be more conflicted on this issue. Again we might consider the case of a person dying from renal failure offering to pay for another (healthy) person’s kidney. Although this procedure would likely end with two living individuals, rather than one, it is the general rules of action that must be considered (Tong, 11). What is the price of a kidney? Must it be paid up front? What, if any, are the guarantees of this transaction? Who may have objections, and whose objections are valid? What are the contracts and/or timeframes involved? There simply are no rules of action by which a strict Rule Utilitarian can approve of this type of circumstance. Kidney sales are largely under-the-table, international, non-regulated procedures (Zurani, 273).
Deontology, duty-based ethics, would implore an individual to maintain a complete anatomy, out of duty to one’s own health, and, perhaps the peace of mind of one’s family or dependents. One individual should not be treated or volunteered as merely a means to another person’s happiness (Tong, 13). To make the sacrifice of, say, a single lung or kidney might seem a reasonable thing to do in order to obtain funding for food, clothing, shelter, etc. but this ultimately amounts to exploitation of the poor by the rich. One’s duty is to build his happiness – and that of others – by any reasonable means. It would never be considered one’s ‘duty’ to undergo major surgery to save another life, or to supplement family income.
Aristotle’s Virtue-based Ethical framework focuses on the overall virtue of a person – the goodness or badness of his character rather the rightness or wrongness of his actions (Tong, 17). This philosophy conveniently circumvents the details of surgery and payment, and asks, ‘is the selling of my kidney part of my overall character, and what does it say about me?’ Of course it is virtuous to save a life, or to simply ease the suffering of others. But to do so for money and/or acclaim is not virtuous at all. Charity, a virtuous facet of many religions, implies giving what you can and expecting nothing in return. The Virtue-based Ethicist would condemn the act of selling an organ for financial gain.
Cicero’s Natural-law based ethics, with its emphasis on preferring and maintaining what is ‘natural’ rather than ‘articifical’ (Tong, 19), is another philosophy by which we can see that people should not be allowed to buy and sell organs for ethical purposes. The risks involved with the surgical removal of an organ, however low, are always present, and one should not submit one’s self to this dangerous, ‘unnatural’ procedure. Natural-law based ethics condemns everything from cannibalism to cosmetic surgery (Tong, 20), and while kidney donation clearly falls somewhere in between these two extremes, it is still an alteration to the natural course of life. The natural course of life does, after all, include death – and trying to prevent or delay the death of a loved one or a stranger through modern medicines and technologies can be seen as veering off this natural course.
In the end it is perhaps easiest to simply say, “It is illegal to buy or sell human organs,” and that is enough of a case against the practice. Further arguments can be made which focus on political correctness, social engineering, individual rights, and the possibilities of murder and/or fraud, in addition to the medical ethical arguments presented here. It is important to note that the prohibition of organ sales, while unjust from so many viewpoints, should not besmear the advancements being made in organ transplant science. There are still scenarios where the fair, equitable transplants of healthy human organs are saving lives, sometimes near- miraculously.
WORKS CITED:
Cohen, L. 2001. The Other Kidney: Biopolitics Beyond Recognition. Body & Society. Volume 7 (2-3): pp. 9-29.
Ertin, H., Harmanci, A., & Mahmutoglu, F. 2010. Nurse-focused Ethical Solutions to Problems in Organ Transplantation. Nursing Ethics 17 (6): pp. 705-714.
Kim, J., Elliot, D., & Hyde, C. 2004. The Influence of Sociocultural Factors on Organ Donation and Transplantation in Korea: Findings from Key Informant Interviews. Journal of Transcultural Nursing, Volume 15 #2: pp.147-154.
Tong, R. 2007. New Perspectives in Health Care Ethics: An Interdisciplinary and Crosscultural Approach. Upper Saddle River, NJ: Pearson Education.
Zurani, N. et al. 2010. Organ Transplants: Ethical, Social and Religious Issues in a Multicultural Society. Asia-Pacific Journal of Public Health. Volume 22 #3: pp. 271-278.