The current kidney donor shortage in relation to the number of patients suffering from renal failure creates responsibilities for transplant professionals to seek new methods to increase kidney donation. Although this is a dire effort to help save the lives of many who rely on it, unfortunately many die as they wait for a match. According to the United Network for Organ Sharing around 31,000 potential recipients are on the waiting list for organ transplantation. Only around one third get the transplant while many others die in the interim (Nelson). There were many efforts to try to establish a financial incentive for kidney donation, especially with live donors, which in most cases, is non-maleficence for the donor. However, under the National Organ Transplant Act, it is illegal to exchange an organ for money but there have been efforts that are statistically supporting such an exchange. That would facilitate the decrease in insurance expenses and increase in the number of living patients (Koren). The perspective of kidney donation is two-fold; with one party thinking that the financial incentive for a living kidney donor meets ethical bases if it preserves the donor’s autonomy, be non-maleficent for the donor, and help in saving lives; however, the other party views this process unethically where it decreases the sacredness of the human body by turning it into a commodity assessed by the donor’s financial need leading to unjust inducement, undue inducement, and even a decrease of altruistic donation (Allen, Peter). Therefore, the moral dilemma is: Should we allow people to donate kidneys in exchange for money or prohibit financial exchange for donation and risk the death of more patients with renal failure?
Virtue ethics is another form of approach in the analysis of medical dilemmas that don’t only depend on reason but also on the importance of emotion. Those against the financial incentive emphasize that there will be an emotional disrespect of life in general, the human body in particular, and a loss of human connection during the donation process. Moreover, the financial incentive will intimidate the needy people into accepting risks that might be unacceptable in the absence of financial rewards leading to “undue inducement.” For instance, donors who possess certain diseases, such as coronary vascular disease or diabetes, might ignore the risks of being operated on, as they are compelled to accept for the sake of the financial reward. This will also lead to “unjust inducement” as only the poor may feel guilty if they do not sell their kidney to satisfy their family’s financial needs (Allen, Peter). This will lead donors to violate the moral principle of beneficence by increasing harm on them despite potentially relieving harm on patients. However, a discerned physician should be able to determine if donors are competent, from a health standpoint, to make such a decision. A doctor with integrity has an essential responsibility to assess the calculated risks and determine the need for transplantation that would better the quality of life for both the patient and donor.
More questions need to be answered before a decision is made on this moral dilemma. Who would incur the responsibility for the financial reward, insurance company or recipient’s family? If the insurance company is held responsible then only the insured will benefit from such a program and if the recipient’s family are to bear the cost, then only patients who come from a particular socioeconomic status will survive as there will be a decrease in altruistic donation after the introduction of financial incentives. Therefore, patients are being discriminated based on their ability to pay or their respective insurance coverage. This dilemma appears to be more of a business negotiation as opposed to an ethical issue.
I think that, based on the aforementioned, kidney donation, under financial incentives, will encourage more donors to step forward and help in saving more lives despite the risks donors may endure throughout the procedural process. However, I disagree with the whole concept of financially benefiting from such a humanistic act of courage and altruism for the greater good of those in a terminal position. The whole concept of human relationship, the sacredness of human body, the decrease of altruistic donation and discrimination among patients, will alter the process of donation from being a moral act to being a business transaction.
Works Cited
Allen, Matthew B., and Peter P. Reese. “Financial Incentives for Living Kidney Donation: Ethics and Evidence.” Clinical Journal of the American Society of Nephrology : CJASN. American Society of Nephrology, 24 Oct. 2013. Web. 23 Jan. 2015.
Koren, Marina. “Would You Donate a Kidney for $10,000?” Www.nationaljournal.com. National Journal, 28 Oct. 2013. Web. 23 Jan. 2015.
Nelson, Edward W. “Organ Procurement and Transplantation Network.” Ethics. Health Resources and Administration Services, 20 June 1993. Web. 23 Jan. 2015.
When I read this post, I immediately thought about the black market in China in which kidneys are being sold, sometimes for nearly a quarter of a million dollars (“Illegal…”). Also, a couple of years ago, a teenager in China went behind his parents’ back and sold a kidney to purchase electronics. Soon afterwards, he began to experience some health issues (Goh). If financial benefits of selling organs were to be legalized, no doubt more of these situations would arise where people would exploit victims in order to harvest their organs or people would make rash decisions. You mention autonomy and non-maleficence as possible arguments for contingencies where the donation should be supported, but as you also mentioned, people who were in great need of money might be likely to rush into donation without considering possible consequences. Furthermore, that people might feel obligated to assume the risks and go with the paid donation would violate their autonomy, as the action would not be done completely out of voluntary altruism, but rather under compulsion. I agree with what you say about legalized organ donation being like a business; Iran, where paid donation has been legalized, is a good example of this: (Dehghan). Although many lives could potentially be saved if the donor pool were increased by legalizing paid organ donation, these lives would be saved at the cost of putting other people through unpleasant procedures that they could be inclined to assent to out of desperation.
Sources:
Dehghan, Saeed K. “Kidneys for Sale: Poor Iranians Compete to Sell Their Organs.” The Guardian. Guardian News, 27 May 2012. Web. 2 Feb. 2015. .
Goh, Melisa. “Chinese Teen Sells Kidney For IPad And IPhone.” NPR. NPR, 07 Apr. 2012. Web. 02 Feb. 2015. .
“Illegal Kidney Trade Booms as New Organ Is ‘sold Every Hour'” The Guardian. Guardian News, 31 May 2012. Web. 2 Feb. 2015. .
I agree with your assertions and I particularly like the point you made about who will incur the financial rewards and costs from the organs. If a donor is getting paid for their kidney, that also implies that someone has to pay them. This may not necessarily just be the person who is receiving the kidney. It could be the insurance companies who foot the bill. However, if the insurance companies pay for the kidney, that can lead to a slew of ethical dilemmas as the insurance companies choose to cover certain people with pre-existing health conditions over others. As a result, if people get paid to donate a kidney, some people who need the life saving surgery will not be able to have the transplant because they can’t afford to get the kidney, while more affluent peoples will be able to afford it. This would result in a ranking list for receivers of organs that is not based on need, but instead based on funding.
In addition, we have to think of those who are selling their kidneys in the first place. Most likely they would be the ones who are in a desperate place financially. This may become an issue of people just wanting to make ends meet, desperately resorting to selling their internal organs.