Organ Transplantation

Organs and obligations

Simon Rippon has recently argued here that markets in organs lead to harms, harms which may be outweighed by benefits, but which must nevertheless be taken into account in deciding whether such markets should be legal. He has argued that there are harms to specific third parties and harms to society at large. I’m not persuaded by his arguments that these harms arise. 

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The Cost of Non-Cash Incentives for Organs

The Times newspaper featured an editorial proposing changes in the organ procurement system last week by Sally Satel, a scholar from the American Enterprise Institute, a conservative think tank. I thought the first few lines were especially revealing about Satel’s attitude to market transactions – she reports that she desperately needed a kidney herself, but dreaded “the constricting obligation that would surely come with accepting” an altruistic donation. She therefore “wished [she] could buy a kidney just to avert the emotional debt.”

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Organ Donation Euthanasia

by Dominic Wilkinson and Julian Savulescu

There are 8000 patients on transplant waiting lists in the UK. Every year 400 patients die while waiting for an organ to come available.
We are all far more likely to be in need of an organ transplant than to be a donor. Most of us expect that if we needed a transplant that someone would donate one. On the basis of the ethical golden rule – do unto others as you would want them to do for you, we should all think seriously about whether and how we could donate our organs if we no longer need them.

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For Sale: Body Parts?

The Nuffield Council on Bioethics has recently published a consultation paper entitled Give and Take? Human Bodies in Medicine and Research: https://consultation.nuffieldbioethics.org/fileLibrary/pdf/Human_bodies_in_medicine_and_research_consultation_paper.pdf

The paper seeks responses from individuals or groups on a wide range of issues relating to the use of human bodies or body parts in medical treatment and research. Section 6 is on ‘Ownership and Control’, and one of the questions asked is: Should the laws in the UK permit a person to sell their bodily material for all or any purposes?

Why should the law forbid any sale of bodily material  by any competent adult, whether for medical treatment or research or for any other purpose? One immediate response comes from the gut: it’s just plain immoral. But immorality isn’t sufficient to justify legal prohibition. It is quite consistent to think that, say, gambling is morally reprehensible, but that it should nevertheless be permitted by law, or that there are certain areas of human life (such as personal relationships) in which, though people might treat one another pretty badly, the law has no place. For immorality to justify legal prohibition it has to be of a particular kind and of a particular order.

One common objection to the sale of body parts is that it will bring about or constitute the ‘commodification’ of the body. There certainly do seem to be good arguments for seeking to prevent market principles from dominating certain areas of human life – personal relationships are again a particularly clear example. We all need friends. Imagine a world in which any time with your acquaintances had to be bought at the market rate. Spontaneity, generosity, and love must be protected. But often there seems no real case against commodification. Consider people’s talents. Most of us think that anyone with a particular talent – for window-cleaning, accounting, or playing football – should be allowed to market the exercise of that talent as they wish (within the rules and regulations of their chosen occupation, of course, such as those concerning ‘transfer windows’ in the English football league). On the face of it, body parts seem much more like talents than friendship.

At this point, an appeal is often made to ‘human dignity’, as something to be respected and something that would be severely compromised by a legal market in body parts. For this appeal to have any weight, the value of dignity must be elucidated. Otherwise it amounts to no more than the ‘it’s just immoral’ gut reaction. Well, let’s assume that rational human beings do have some special value, demanding respect by others. Why should that dignity itself not consist partly in a right to control one’s own body? If anything, forbidding grown adults from doing what they wish with their own bodies is to treat them and their autonomous wishes in an undignified way.

In his classic work of liberalism On Liberty, John Stuart Mill claimed that the state’s only justification for interfering with an individual’s freedom is to prevent harm to others. So even if the individual herself, perhaps through sacrificing her dignity or in other ways, is harming herself, the state can do no more than inform her of the facts about, and in particular the risks of, the activity in question. (Slavery is perhaps a special case, and Mill certainly thought it was. But selling an organ or other body part is not to sell yourself, into slavery or in any other way.)

It cannot be denied, however, that there would be the most appalling risks were an unregulated market in body parts permitted to develop. The opportunities for both buyers and sellers to mislead or to misrepresent, for example, would be widespread and tempting. As in other areas of civil life, then, the market in human organs should be regulated, with an immediate view to the avoidance of harm to those involved in the market itself or otherwise affected by it.

One further question is whether the state – in the UK, through the NHS – should itself enter the market. I see no strong reason why it shouldn’t. A weightier question is whether state regulation should involve price-setting or restrictions on sales designed to make the most effective use of available body parts. I’m inclined myself to think that it should, since the state should always be seeking to produce the best and justest outcomes for its citizens as a whole. Mill himself says clearly in On Liberty that his liberal principle is justified through its promotion of the good of all, and that is equally true of market principles governing the sale of body parts or indeed anything else.

The real scandals in organ donation consent

Headlines in a number of newspapers in the last day or two have claimed scandalous failures in organ donation consent in the UK. According to ‘Sky News’, organs were “taken without consent”, while the Sun claims that “NHS doctors took the wrong organs from the bodies of donors”. But it is important to put these claims in context. There are some bigger and more serious scandals when it comes to organ donation consent.

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I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs

Is it true that “everyone’s a winner”, as Julian Savulescu suggested recently on this blog , if we price life and body parts? Let’s accept that if there is a valid objection to buying and selling body parts, it must be grounded in the recognition of a harm that would come to some person or group of people. Consider, then, Savulescu’s suggestion that we should price body parts, and engage in buying and selling of them. We could categorize the potential harms that it might generate under the following headings:

(1) Harm to the participants in the transactions: donors, recipients, or facilitators

(2) Harm to specific third parties

(3) Harm to society at large

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Second-hand and second-class organs. Should the patient know?

In a urology journal this month American
surgeons describe transplanting kidneys that would previously have been
rejected as unsuitable. In each case the donor kidneys had been found to
contain a solitary mass during the transplant work-up that was potentially
cancerous. Rather than cancelling the donation the surgeons removed the kidney,
cut out the tumour, and then transplanted the tumour-free organ. This follows
reports from a couple of weeks ago that surgeons are increasingly using ‘risky’
organs from donors who are elderly or who have other serious illnesses.

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Feetility – should we pay egg and sperm donors?

Lisa Jardine, the head of the UK Human Fertilisation and Embryology Authority, has called for public debate about paying egg or sperm donors. Currently donors are given a maximum of £250 in reimbursement for expenses. But donation rates have fallen in recent years, at least in part related to changes in rules in 2005 preventing donor anonymity. As a consequence a significant number of patients seeking donor egg or sperm for in-vitro fertilisation have been forced to travel overseas. In essence Jardine suggests that a regulated local market in donor eggs and sperm may be better than unregulated fertility tourism.

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Umbilical cord blood donation: opt out or work on Sundays?

Umbilical
cord blood (UCB) contains haematopoietic stem cells, which can be used for the
treatment of several
lethal disorders, including leukaemia
and several types of anaemia.
Other sources of haematopoietic stem cells are bone marrow and ordinary peripheral
blood. Unlike bone marrow donation, which requires general anaesthesia, UCB
donation does not cause any inconvenience or significant risks for the donor. Peripheral
blood contains very few stem cells. Another major advantage of using UCB stem
cells is that less genetic similarity is required between donor and recipient.
This increases the chance of finding a ‘match’ and thus of the transplantation
being successful.

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The Future of Making Organs for Self-Transplantation

Scientists have been able to create a new windpipe using stem cells. They took a windpipe from a dead patient, removed all the cells, and placed stem cells from a patient onto the remaining scaffolding to create what was in effect a new windpipe, with the patient’s own cells. The patient had an irreparably damaged her windpipe from TB.

The significance of this is that it opens the door to creating whole organs, like kidneys, livers and perhaps even hearts and lungs. This is a radical advance because up until now, stem cells have only really been useful to replace tissue, or bits of the body without a complex organized structure. But this means we could potentially replace any part of the body with a person’s own stem cells. New livers for people with liver failure, new kidneys from those with kidney failure – and because the cells would come from the patient, there would be no rejection. Indeed, this patient has shown no signs of rejection.

Does this raise any ethical issues?

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