The Ethics of Organ Transplants: The Current Debate

By Arthur L. Caplan; Daniel H. Coelho | Go to book overview

22. The Case for
Allowing Kidney Sales

J. Radcliffe-Richards, A. S. Daar,
R. D. Guttmann, R. Hoffenberg, I. Kennedy,
M. Lock, R. A. Sells, and N. Tilney

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 1,2 and nearly all countries have now made it illegal. 3 Such political and professional unanimity may seem to leave no room for further debate, but we nevertheless think it important to reopen the discussion.

The well-known shortage of kidneys for transplantation causes much suffering and death. Dialysis is a wretched experience for most patients, and is anyway rationed in most places and simply unavailable to the majority of patients in most developing countries. 5 Since most potential kidney vendors will never become unpaid donors, either during life or posthumously, the prohibition of sales must be presumed to exclude kidneys that would otherwise be available. It is therefore essential to make sure that there is adequate justification for the resulting harm.

Most people will recognize in themselves the feelings of outrage and disgust that led to an outright ban on kidney sales, and such feelings typically have a force that seems to their possessors to need no further justification. Nevertheless, if we are to deny treatment to the suffering and dying we need better reasons than our own feelings of disgust.

In this paper we outline our reasons for thinking that the arguments commonly offered for prohibiting organ sales do not work, and therefore that the debate should be reopened. 6,7 Here we consider only the selling of kidneys by living vendors, but our arguments have wider implications.

The commonest objection to kidney selling is expressed on behalf of the vendors: the exploited poor, who need to be protected against the greedy rich.

____________________
Originally published in The Lancet 352 ( June 27, 1998): 1950-52. Reprinted by permission.

-224-

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