Organ Trafficking Ban

A joint committee from the UN and the COE (Council of Europe) recently called for an updated international treaty to ban organ trafficking.  Their report estimates that 10-15% of transplanted organs are trafficked, and cites “legal vacuums” that need to be filled to stop this kind of trafficking.

The international “trafficking” of organs for profit is an insidious sounding issue, and it is not hard to find politicians who support bans on the sale of organs.  But beneath the labels, the bio-ethical and political foundations of these kinds of bans are extremely weak.  The most basic premises are that body parts are not commodities, and the sale of organs should not be allowed for ethical reasons.

The ethical argument does not make sense in the context of other accepted approaches to bioethics.  Ban advocates like the joint committee of the UN and the COE argue that organ donation should be strictly based on voluntary altruism without financial benefit to the donor.  That sounds noble (it uses the word “altruism”), but there is no convincing argument for why the sale of body parts is unethical.

We already accept and allow several similar instances of body part sale.  Hair can be sold for wigs.  Donors receive money for donating plasma.  What is so special about internal organs that they could not be bought and sold?  What distinguishes them from the other body parts for which we allow sale and from other commodities?

Alastair Campbell, a professor of medical ethics, presents two arguments against allowing organ markets, attempting to show that they cannot be treated as goods:

Organ trading is wrong in principle because it presupposes that the body is a piece of property akin to our material possessions (house, car, etc). While a body part like a kidney is alienable, meaning it can be transferred to another, it is certainly not fungible (easily replaced by something similar) or commensurable (its value quantified and compared to another object). [emphasis added]

First, in a free society, the presumption lies with freedom and those seeking to ban something must bear the burden of justifying the ban.  Second, these requirements need not be met before the sale of something can be allowed.  Alienability, fungibility, and commensurability are typical traits of commodities, but they are not required before something can be bought or sold. Our society allows the sale of many goods that are obviously not fungible or commensurable (collectible items, artwork, unique services).

David Undis, the executive director of LifeSharers, discusses the need to incentivize organ donation:  “Incentives are missing in organ donation. That’s one of the reasons so many people are dying waiting for organ transplants.” Other economists, like the Freakonomics writers, have strongly advocated the need for incentives as well.

Last year, I wrote an article advocating reform for the current US organ donation system of voluntary opt-in.  An opt-out system would be politically feasible and medically helpful to the 100,000+ people on transplant waiting lists.  A more radical and more sensible (but politically impossible) solution is to enact “routine collection,” where every deceased person’s organs are available for donation upon death without exception.

At its core, opposition to organ markets is largely irrational.  It is based on outdated ethics and it puts vain tradition ahead of the valuable goal of saving lives.  “Organ trafficking” sounds evil and it is easy for politicians to fight against it.  But allowing incentives could actually bring significant benefits and deserves to be studied.