Friday, July 04, 2008

Organ Trading

There are two weighty arguments against organ trading. They are:
  1. People might be coerced into trading their organs.
  2. Wealth becomes the sole deciding factor of whether someone gets an organ.
I do not believe that the first argument is totally valid. Firstly, the problem lies with coercion, and not with the trade of organs. To clarify, coercion is an external circumstance, and hence it is not indicative of any intrinsic ethical flaw in organ trading.

In other words, stop coercion, and there would be no problems. While my statement might sound foolish, it is not unfounded. People can be coerced into many things- into selling their apartment for pennies, into forced sex, into committing murder or suicide. The key issue here is not to prevent organ trades, but to ensure that coercion is prevented. Admittedly, this is in practice extremely difficult, but it is not something to dismiss as impossible.

The second concern is less obvious, but is of greater validity. To illustrate, consider the case of a patient A, who is of average wealth but due to die in a month if no organs were available. Patient B has a year to live, but has enormous resources. Under a free-market system, if both were to buy organs, and if supply was insufficient, clearly B would get the organ, although he might be considered as being less deserving. Hence, the key problem with organ trading (under a free market framework) is that wealth becomes the key deciding factor in organ allocation, which is ethically unjustified.

I would argue that this is a valid problem, but one which only exists if we were to adopt a free-market approach for the organ trade. Some, such as Mr Wang, have proposed an alternative trading framework for the organ trade. In such a framework, organs can only be sold to a central agency, who (on the list of patients on the buying list) to allocate the organs to, based on its own priority queuing system. Hence, organs would not be prioritized to the wealthy, but rather to whoever has the highest priority. Of course, to prevent abuse, the priority system would have to be transparent and publicly disclosed, and the priority system could possibly include factors such as urgency of transplant, potential usefulness of the organ to the patient, or even desert(as I have previously suggested in an ethics paper).

By breaking the direct link between buyer and seller, the system also effectively eliminates cases of coercion, as one would not be the direct and immediate recipient of the organs sold (barring the grim case of mass coercion, where one coerces many people to sell their organs). Also, as the central agency has direct participation in the trading process, abuses of the system are likely to noticed more quickly.

However, while the proposed trading system does plug many important gaps existing in the free market organ trading system, there are still some practical and ethical items to address. The most obvious would be the authority of the agency. Life is precious, and hence such a central trading agency must be held to the highest of standards, otherwise it would be worse than not having it. On the ethical side, arguments on the exploitation of the poor, or of using the poor as organ repositories, would also merit attention.

In short, the issue needs to be revisited at greater depth.

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