Let’s pretend, for just a moment, that I’m an entirely healthy young woman who wants to get a head start on life by selling her kidney for a few thousand bucks and running away to Canada. We’ll pretend this because, deep down, that’s what all healthy young women wanting to get a head start want to do, right? Well, right? OK, maybe not. So why is it that I can’t sell my kidney?
Most first-world countries and doctors and medical ethics experts consider selling one’s own organs to be a big no-no. The reason being because the thought of selling a body part out of desperation is essentially kinda sad and we don’t want people manipulating others out of body parts, do we? On the other hand, allowing the selling of organs and tissues could reduce waiting lists for those organs and it could very well save a lot of lives. In the mind of a young adventurer heading to Canada to do whatever they do in Canada, its a win-win situation.
That brings me to the real point of this whole article, the Scott sisters. You may have already heard of this duo, who were convicted of an armed robbery in 1994. What you may not have heard is, some people say they didn’t do it. Without having more information, I can’t tell you if they did or didn’t. What I can tell you is that they were given a hippopotomonstrogiganormous sentence that doesn’t really fit what may or may not have happened. Each sister got a life sentence for allegedly luring a couple guys into a trap where other people stole their wallets at gun point. Let’s repeat this, so it is completely understood, they got a life sentence for being decoys.
If you read the first article I linked to, though, you’d find that one is going to be released from prison because she is on dialysis. The other one might be released with her, if she gives her sister her kidney. Jamie Scott has a medical condition that is justifiably kept under wraps which has made her sick enough that the prison can’t take care of her very well. Thus, Gov. Haley Barbour, a governor who is known for clumsy comments about race issues and history has stated she could be released. Gladys, Jamie’s sister, has offered to donate her kidney to Jamie and so the same governor says that she may be released under the condition that she gives her sister her kidney in less than a year.
This case now provoked much weeping and wailing and gnashing of teeth in the media and spattered all over the interblogs. The concerns that people have happen to be about coercion and the fate of the sisters if Gladys is unable to give her sister her kidney.
But I don’t think selling a kidney is unethical and, if I were Gladys, I’d think that one kidney is a small price to pay for my freedom. But, as many people have argued, The prison term was already a problem and the illness that Jamie has is a problem, but they are problems that should each be resolved separately. The feeling is that this arrangement does not address the wrongdoing that once occurred when the girls were given unreasonable sentences and that this arrangement could lead Gladys into doing something she otherwise would not have done.
I agree with those complaints, but, I also approve of Gov. Barbour’s decision. While I couldn’t find anything that outright stated what Jamie’s medical condition is, just needing dialysis so much is a good indication that she needs a kidney now. Health conditions don’t wait for you to jump through various legal hurdles and heartache for ages before they progress. If making an agreement with someone to go on parole under the condition of a kidney donation will get Jamie a kidney sooner, then I’m all for it.
Even if that weren’t the case and Jamie’s condition weren’t so serious, I still think I would agree with it, if that was the best option they had. I don’t think selling a kidney should be illegal, for some of the reasons cited above. I acknowledge, though, that there could be something that I’m not getting. Thus, I ask that people give me their opinion on this topic: Is it ethical to allow people to sell their kidneys? Is a kidney worth your freedom?
Of course they don’t want to do the transplant now, transplants cost a lot of money. That would defeat the whole purpose of releasing the woman on dialysis (to save money). If they do the transplant now, the prison would have to pick up the tab (it being needed medical treatment).
The only reason they are willing to release the two women is because they are planning to move out of state, to Florida. I wouldn’t be surprised if they put a “move out of Mississippi” clause in the parole requirement too.
The problem isn’t with selling kidneys, the problem is that rich people will exploit poor people. Rich people who need kidneys will cause poor people who have an “extra” kidney to be so desperately poor that the only way the poor person can survive is to “sell” their kidney in the “free” market. Of course the market isn’t free because the rich control it.
The exploitation of poor people isn’t limited to kidneys. In a monopoly, the “cost” of things bears no relationship to how much it costs to provide the goods or services. That is why the rich are doing their best to maintain their monopoly on wealth, and on justice.
daedalus,
Given that both girls are freshly released from prison, they don’t have many resources. As a result, odds are high that the state will still pick up the tab for the transplant. The reason for the release is that the girl on dialysis could not be properly cared for by the prison.
The parole conditions seem to be more concerned for the well-being of the woman who is sick, so I don’t think this is a wanting-to-kick-someone-out kind of parole.
Are you implying that rich people will make poor people more poor to get a kidney? That doesn’t make sense. Also, while we don’t actually live in a free market, I don’t think the rich necessarily control it.
I wonder if the ethics of selling organs overlap at all with the ethics of paid surrogacy?
Some of them, yes, AU. They are both use of another’s body that could affect them medically in the immediate future.
I see the ethics of selling organs as a problem because it commodifies the human body. Once you have that then there are two problems – pressure on poor people to use it as a resource, and a regulatory problem to ensure that the organs are being sold voluntarily. This is exactly why blood and egg donations aren’t paid for (in Australia).
Currently there are people leaving their own countries and working in appalling conditions in order to support their families at home. It could certainly be argued that selling a kidney isn’t worse than that, but I would need to have a lot of questions answered to really judge it.
– Exactly what are the risks of only having one kidney? I’ve usually heard it framed as ‘if something goes wrong you won’t have a spare’ but is that accurate or are there other health concerns?
– We’re talking major surgery with all its risks, who picks up the tab if something goes wrong, both for the young student and the eldest sister with a family to feed?
– What organs are we talking about here? Once the genie is out of the bottle will corneas be on the table because you only need one eye? How about bone marrow and skin, they are even better because you can regenerate them and keep donating whenever you need some cash.
– It’s acceptable for someone to be brought up in the knowledge that their role is to work hard and support their family, is knowing that you are expected to support them through selling a kidney, (or a cornea or recurring skin and bone marrow grafts) psychologically the same or qualitatively different?
Then you have the regulatory issues – what will stop the middlemen and the blackmarket? How much money will actually go to the person selling the organ? How will you ensure that the operation is carried out under the best possible conditions rather than backyard operators? What about when undeveloped countries start offering ‘kidney transplant tourism?’ Look at the situation with IVF in the US, with extremely inflated prices and people who are willing to cut corners and do unethical and medically risky things. The pressures would be even higher in the case of life saving treatment, so how many octomum equivalents are acceptable, or how would you stop it?
Deb, Thanks for responding! Here are my thoughts:
Many blood banks in the United States pay for donations of blood/plasma. This has motivated people to donate and has increased the supply available to people in life threatening situations. I think the key to donation systems like this is to address each ‘commodity’ based on what it is. With blood, it isn’t a permanent loss. Instead, people recover from those donations quickly.
With organs, I would hope that certain steps would be put into place to help both the recipient and the donor through the process. Iran allows people to sell their kidneys and the programs have eliminated the kidney shortages in their country. The down side is that some people do have side-effects, even though side effects are uncommon. Also, the conditions people live in who donate in Iran are very different from conditions you find in the United States, so it is tough to use Iran as any kind of comparison as to how things would go in the U. S. if selling an organ were legal.
Side effects of donating an organ are the same as for any related major surgery, so the risks are the same. Kidney donors typically have very little change in health as compared to people with both kidneys. Their life span is the same as well as their health. A very small percentage report abdominal or pelvic pain and other complications. I think if organ donation were to be made legal, the concerns regarding side effects and consequences of the donation should be addressed by ensuring that all donors receive medical treatment, care and compensation for anything related to the donation. I also think it should be a priority that all donors know exactly what the consequences of their donation might be. If they are 100% informed, not making the decision in conditions that show a mentally unhealthy situation and are certain, then I don’t see any reason why we should prevent them from making that decision themselves.
I don’t think that allowing kidney donations to be paid for that it will cause a slippery slope into donating other things that might be more important for someone’s well being. Also, losing an eye isn’t the same as losing a kidney. Your body can compensate for losing a kidney, you can’t have binocular vision ever again if you give up a cornea. Bone marrow and skin seem like perfectly reasonable things for people to donate for money and I would have no problem with it.
I don’t think that making it legal to sell one’s kidney will lead to people expecting others to sell theirs if they need money. Just because it is legal to work at McDonald’s doesn’t mean that we expect everyone to take an extra job there.
Most of the time, when a product is on the black market and is then made available, legally, the sale of that product on the black market is significantly reduced. It is very likely that making it legal to sell one’s kidney will reduce the amount sold on the black market. That being said, the black market for body parts is over-exaggerated in the media. Given how picky the recipient’s body is about organ donations, the necessary treatment of an organ being transferred from one body to another and the types of tools needed in order to perform such an operation, the black market for organs is nothing like what you see in the media and it is pretty small. Medical tourism is much more common because it can put a compatible donor next to the recipient much more safely and faster, with the proper medical tools available.
I would expect that medical tourism to other countries would be reduced if we ever legalized the sell of one’s kidney and that we’d see more affluent people from other countries coming to the United States to acquire kidneys that they need. I don’t really see that as necessarily good or bad, overall.
I think that, much like other economic trends, the amount that an individual receives for their kidney is going to regulate the market for us. If they get a greater amount, we will see more kidneys being sold. If it is a smaller amount, we’d see less.
I don’t really think that IVF is a good comparison for transplants because this isn’t about one person risking their life to create more people. Instead, this is more about the preservation of one life with the selling of an organ for another.
I am hopeful that thing proceed with these two women quickly. It sounds like they are quite fortunate in the fact that they have a strong family support system. I wish them well, and good health as soon as possible.
Interesting, I think we’re coming from different cultural perspectives. Plus you are talking about selling organs, while I’m talking about being able to buy them – I wonder if that is a result of our perceptions or shapes them? In Australia blood or eggs cannot be sold at all, I’m not sure about sperm donation. Not even breastmilk can be sold although like the others it can be donated.
We also have a lot of people who are here from other countries working to support their families back home, many of them illegally in near slavery conditions. So that’s the type of scenario I’m thinking about, a future operation by the same types of people smugglers who are currently bringing in workers to bring in donors. I agree that current organ black markets are tiny if they even exist here.
I agree that the average Australian won’t feel pressured to sell organs, with our welfare system many don’t feel pressured to work! But our neighbouring countries in Asia have very different attitudes to family responsibility. If our laws were to change to make buying organs legal, there would be people volunteering to come here and sell them. I don’t know whether that would work in reality given the matching and surgery needed – I don’t believe you can harvest kidneys in a bathroom! – but there would be people trying if the price was right.
With my IVF example I was not talking about the patients, rather the clinics. My point is that the urge for a child, then the desire to keep that child alive are both extremely strong. If a small number of health professionals faced with the first are willing to do medically risky, unethical procedures, then when parents with money who are allowed to buy the organ they need are faced with a dying child some will find someone willing to procure it and do the transplant, even if it is unethical or risky. I’m sure this situation would not be common, it would probably be at least as rare as octomum. But the political tradition in Australia leans towards safety nets.
Perhaps a high profile case would change or start the public debate, but from what I have seen here the perception of risk of donor abuse is stronger than the perception that more lives might be saved.
Deb,
It does seem to be the place that different cultural backgrounds have at least some influence on our perspectives. I can’t say that one perspective is necessarily better than the other, either, because clearly we have different priorities and neither priority is entirely maladaptive. Both have flaws.
I still favor my stance, but mostly because of how I feel about consent. If we can’t trust people to be capable of informed consent when under the stresses you describe, such as poverty, then who can we trust to make their decisions? So, while it may create and environment where people act out of desperation, I don’t really feel it is the government’s place to regulate them when they do as long as they’re not doing harm to others.
Since both the United States and Australia have trouble dealing with people being smuggled into the country for economic reasons, I can understand that being a concern. Though, I think the flaw is not in why they’re coming to our countries. They come to our countries because of what they see as a desired economic and/or social decision. I actually see the flaw for the United States as being how we handle immigration issues. The United States has become horribly ethnocentric and has created laws accordingly. This isn’t a great context for discussing that, though. In short, if organ selling were legal, I don’t think it is reasonable to blame it on people smuggling, even if it being legal led to people sneaking into the country.
It is interesting how our backgrounds seem to have shaped our thoughts on this, but I can understand your point of view. I’m not sure that the safety nets lean is entirely adaptive, though. I’ll have to think about that more.
I agree, I don’t think the safety net mentality is really all that healthy in this case, it is simplistic and only looks at one side of the equation. It’s actually a very delicate balancing act between the risks of potential pressures on donors and the risks to people waiting for organs. I don’t know enough about organ donor lists in Australia to know if it would make a difference, but that mentality is deeply entrenched in Australian thinking and any public debate is going to start from that position.
It’s not that I’m saying people in extreme poverty would not be able to give informed consent, just that I would like to make sure they get the benefit of it. That’s going to come down to the regulations that go along with being able to sell organs – a temporary visa to allow people to come here for the surgery and clear rules on how expenses are shared would do it, but somehow I can’t see it happening that simply.
I’m also interested as a psychological question – if you are brought up to know that when you reach 18 you can sell an organ to support your family would that be a good thing, bad thing, or exactly the same as knowing you can go overseas and work? A very theoretical question!