Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative (Live Questions in Ethics and Moral Philosophy)

There are many who hold the view that there can be no such thing as "ethical organ trading"; that is to declare that any trading of any human organ is immoral. Yet there are countless people in the world who need an organ transplantation to survive but are either unable to find a donor, or are unable to afford one. The medical fact is that organ transplantation can be carried out safely with a high chance of success; that is to say, with donor and donee surviving. The social fact is that there are many people who are willing to donate their organs for a fee. Some of these people would rather not to if they weren't poor. Some might be quite happy to do so if the fee is high even though they are not poor. So why are there resistence to organ trading? James Stacey Taylor's book helps explain the moral considerations of organ transplantation, in particular, the trading of kidneys. People who are against organ trading almost invariably claim that organ trading leads to, or, in any case, is exploitation of the donor. They cannot, however, explain what exactly is the objection based on exploitation. Taylor anticipates these objections and provides rational answers to the concerns. Fear and superstition are the perpetual enemies of science. In many cases, fear and superstition disappear when they can be explained. Taylor has given a clear explanation of the market in kidney trading, and why it is not immoral to have an organ trading market, but that such an organ trading market is morally necessary. It addresses the point that if live organ transplantation is not morally objectionable, the only indicia of exploitation in the case of an organ purchase would be the infringement of personal autonomy and human well-being. These can easily be ensured in a well-regulated market. Furthermore, in the case of donating for a fee, the only issues are whether there was informed consent, and whether the fee was adequate. He makes the point that "it is surely wrong to hold that one can protect the autonomy of destitute people by removing from them the opportunity to escape their poverty". Ensuring autonomy and preventing unfair payment are not insurmountable problems. So, what remains is the small matter of the superstitious belief that the human body belongs to an unknown, undefined thing generally referred to as "god" and only that being can dispose of the body or its parts. This book will help the reader understand all the major issues in human organ trading. It may not convince religious objectors; but that may not be the object of this book.

This book contains a nice set of arguments in favor of regulated markets for kidneys. I was, more or less, convinced....altruism is not enough to ensure the availability of kidneys for those who need them. Taylor's primary argument rests on personal autonomy and respect for persons. Being free to buy or sell kidneys in a regulated market treats participants with the appropriate level of moral respect... Overall, I found Taylor's book to be clear, well reasoned, and a welcome contribution to the current debate

According to Taylor, the best interests of the kidney vendor and the patient morallyjustify a current market. But for some, selling a kidney by a live donor is not morally justifiedbecause the action is not considered worthwhile due to the dangers that it may present. In hisbook, Taylor compares the job of a vendor to other jobs that are just as life threatening. First,Taylor argues that if a current market is legalized, there would be proper, stringent rules toensure the best interests of both parties involved. Second, he states that if the reason for theprohibition is because vendors would be risking their livelihood, then it would also be true thatpeople should not be allowed to join the armed forces, or engage in other hazardous occupations.Taylor wants the reader to realize that there is no difference between a firefighter who ispaid to risk his or her life to save a person or a vendor who is paid to have a nephrotomy (kidneyremoval). Both types of actions therefore should be morally permissible. Taylor bolsters hisargument with reference to studies finding no evidence that persons with only one kidney havean increased mortality rate. Similarly, Taylor compares the 0.03 percent chance of dying withinthe 48 hours following a nephrotomy, with the 0.103 percent mortality rate of British commercialfisherman, or 0.0516 percent mortality rate of a merchant marine. The mortality rates forboth occupations are much higher than for those who will undergo a nephrotomy, yet bothoccupations are permissible.Opponents, however, may claim that there is a distinct difference between selling a vitalorgan and selling labor--that an individual can take back labor, but cannot take back an organ.Taylor, however, disagrees and adds that:There are many acts whose consequences are irrevocable (such as for example,undergoing elective surgery, or scattering the ashes of a cremated relative rather thanestablishing a permanent memorial) but whose performance is morally justified by bothrespect for autonomy and concern for well-being (p. 136).Also if the opponents' reasoning held true, then altruistic donation of kidneys should not bepermitted either, since an individual would not be able to take it back.Although selling a kidney is not the same as selling labor, it is still an action that shouldbe considered worthwhile, in spite of any discomfort the vendor may experience. Discomfort orminiscule danger is not a reason why current markets should be prohibited. It is a weakargument that does not make sense. As Taylor had mentioned, a person who altruisticallydonated a kidney cannot take it back, yet it is still permissible. Because there is money beingexchanged, it does not mean that people would have a greater chance of wanting their kidneyback, especially since an individual can survive with one working kidney.Taylor also responds to the allegation that a current market will result in thecommodification of goods and therefore decrease altruistic behavior.. Taylor concedes that theamount of kidneys that are altruistically procured would be greatly diminished; however, hecontends that the total amount circulating kidneys would increase. The diminished altruisticdonations would be more than replaced by kidneys from individuals that have been financiallycompensated.Many people argue that organ harvest through free donation is more morally acceptablethan donations by people who are financially compensated. Currently, even if the vendor ismotivated by altruistic reasons, the law states that no individual can be paid for the organs to betransplanted because organs are priceless. Proponents for altruism-only donation claim that the"introduction of a commercial system of organ procurement would result in persons being lessfree than they were prior to this, insofar as they can no longer give `priceless' (uncommodifiable)kidneys" (p. 168). The argument continues that, because a donor's right to autonomy wouldthereby be compromised, a prohibition of commercialization is necessary. Taylor countersby arguing that the market would offer another choice, not a prohibition of altruistic donation.Taylor states that adding a current market would allow "more individuals to exercise theirautonomy as they seem fit than would this market's prohibition" (p. 171). Taylor believesthe commodification of kidneys would provide more choices to individuals; therefore, moreautonomy could be practiced. Prohibiting a market would essentially decrease autonomy.Besides more autonomy, commodification of this once-uncommodifiable organ wouldgeneratemore interest in kidney donation.It is hard to grasp why opponents are so concerned with the notion that commodificationwould decrease altruistic donation. The decrease in altruistic donation will be more thanreplaced by kidneys from those motivated by monetary incentives. Although it is good to striveto be a charitable person, the main concern should be finding an answer to the shortage of organsfor donation. However, a more serious problem that Taylor does not address is thatcommodification of kidneys could lead to increased stratification between classes and ethnicities.Commodification could lead to unequal pricing of the organs of certain ethnic groups overothers. If the current market could be anonymous, then perhaps stratification and unequal pricesfor organs could be averted.

This is a GREAT book! I was really skeptical of the claim Stacey Taylor argues for--that markets for human body parts, especially kidneys, are morally imperative--but after I was done with this he'd convinced me. The writing can be a bit tough to follow at times, but for the most part it's really clear and readable--and there are some pretty good jokes, too. (Stacey Taylor claims that philosophical arguments, "like the course of true love" rarely run smoothly!) Plus, there's a lot of factual data included, too--like about how the market for kidneys in Iran works, and about the risks involved in selling a kidney versus dangerous employment. So this is by no means some abstract philosophy book unconnected with the real world.DEFINITELY recommended!!