A Market for Human Organs?

(I’ve just started reading the literature on this topic in preparation for the Fall, and thought I’d share some first impressions and reactions.)

The debate seems to focus to a large degree on kidneys, and the question of whether people (usually qualified as a healthy adults in full possession of their faculties and with informed consent) should be allowed to sell one of their kidneys. I wonder why there seems to be much less discussion about someone (again, a healthy adult etc.) who wants to donate his heart? It seems to me that any justification of a free market in kidneys ought to be able to show why selling a kidney is OK while selling a heart is wrong (if it is) or right (if it is). Not that someone arguing for the rightness of a market for kidneys is committed to the rightness of selling one’s heart, but anyone arguing for a free market in kidneys is obligated to take a position on a free market for hearts.

Having said that, I have to admit that the whole idea of a free market in human organs, even kidneys, is deeply disturbing to me. This is an emotional reaction, and not a result of thinking it through so as I think it through my reaction my change. Right now, my hunch is that whatever the arguments from economics or political theory might be, in practice any market in human organs will play out in ways that will cause serious injustices and make the lives of many people very miserable. Heck, we can’t even get the market for mortgages right! Markets are so complicated, unpredictable and set such powerful forces in motion that I suspect no arguments from theory can possibly anticipate the harms.

Let me just mention one thing that has already set off some alarm bells for me: Janet Radcliffe Richards, one of the most well-known and long-standing proponents of allowing people to sell their kidneys, begins one of her (co-authored) papers as follows:

“When the practice of buying kidneys from live vendors first came to light some years ago, it aroused such horror that all professional associations denounced it and nearly all countries have now made it illegal” (“The Case for Allowing Kidney Sales,” Lancet, June 27, 1998)

More recently:

“Some years ago, when news of kidney selling by live vendors first broke in the West, politicians from all points of the political compass rushed to declare it illegal, and medical organizations were equally quick to pronounce their professional anathema” (“Consent with Inducements: The Case of Body Parts and Services” in The Ethics of Consent, ed. by Franklin Miller, et al, 2009).

Vendors? Vendors?? The people who’d part with a bodily organ to help save another person’s life are vendors? I haven’t read enough of the literature to know whether others use this terminology, or whether Radcliffe Richards has been criticized for it (she’s used it consistently for a decade). But if the advocates for a market in human organs cannot themselves face the fact that they are talking about people, other human beings, and need to seek the psychological/emotional safety of thinking of them as “vendors,” isn’t it a fair supposition on my part that in one way or another they themselves find the whole idea horrifying (even as they advocate it)?

I can just picture the Orwellian language — and accompanying bureaucratic processes — of “vendors” and “sales” and “transactions” and “order fulfillment” that is bound to take over any such “market.” Getting back to mortgages, thousands of people’s lives have been wrecked by the collapse in the housing market, caused in large part by a market for mortgages (mortgage-backed securities, CDOs, CDSs, SIVs, etc. etc.) that got out of control. And that won’t happen with a free market for kidneys? (There has already been ample speculation in the literature about a futures market for kidneys!)

Just some first reactions. As I work through the issues I’ll post more. But I will keep an open mind. Give me good arguments, and I’ll accept the conclusions, despite my initial emotional reaction.