Have a Heart, but Pay for It
Matthews, Merrill, Jr., Insight on the News
The real question is not whether a market for human organs or other bodily tissue should exist; it already does. According to the United Network for Organ Sharing, in the United States alone more than 50,000 people needed a human organ in 1993. More than 2,885 people died before receiving one. In 1992, about 4,500 people donated organs and, although the average was about 3.5 organs per donor, that left the supply far short of the demand.
The problem is not restricted to the United States, however, because the shortage is worldwide. In response, several European countries have adopted "presumed consent" laws. These laws permit the authorities to presume you agree to having your organs "harvested" at death unless they can find a document stating otherwise. In Austria, the organs of deceased foreigners can be harvested.
Organ transplantation has become a lucrative venture, and more and more health care providers are entering the market. Thousands of dollars go to the doctors and hospitals performing the transplants and thousands more to nonprofit organizations that procure the organs. According to a 1993 article in the Journal of the American Medical Association, for example, organ procurement charges in 1988 ranged from $16,000 to $21,000 (1991 dollars). But all the donor or the donor's estate can receive is reimbursement for any actual expenses and lost time. No compensation or consideration of any kind legally can pass from the recipient to organ donors or their heirs -- regardless of how poor the donor might be.
That's because the National Organ Transplant Act of 1984 prohibits "any person to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration for use in human transplantation." As a result, the only legal reason for a person or a person's surrogates to donate one or more organs is altruism.
Because altruism is the only permissible motive, the shortage of organs is so chronic that international organized crime has become involved. But while altruism is a noble motive, it seldom is compelling. Economic theory clearly recognizes that when demand is high for a good or service, its price will increase until the supply and demand reach an equilibrium. If the price is prohibited from rising, a shortage will occur. To restore the balance so supply meets demand, price controls must be removed.
But, it is argued, wouldn't commercializing or "commodifying" human organs undermine the idealism of the system, enticing potential donors to think only of the monetary value and not of the moral value of their act? Perhaps, if one thinks that good can be achieved only if no compensation changes hands. For example, it would be kind of educators to donate their time to our children and beneficent for grocers to give away their food. Yet no one accuses teachers or grocers of undermining morals by accepting payment for their work and goods.
The fact that people usually receive compensation for their goods and services does not preclude them from being generous on occasion. When a major tragedy occurs, vendors often donate products--food, clothing, tools, etc.--and people often volunteer their time to help the victims. But these acts of generosity are the exceptions, not the rule--and it is precisely because they are exceptional that we find them praiseworthy.
In Christianity, for example, the imperative to benevolence is an individual imperative, and Christians thus are individually praiseworthy or blameworthy for their acts. The New Testament never implies that those who are compelled to do benevolent acts are worthy of praise.
Thus, in accordance with JudeoChristian teachings, the proper attitude with respect to organs and other bodily tissue is that while it would be considered a great humanitarian act for a person to donate an organ, there should be no ethical stigma attached to someone who desires compensation.
Those who want to donate their organs free of charge should keep that right, and they should continue to be honored for their generous acts. …