Neg Speeches

Offcase

1NC DA 1
Global norms against sales solidifying from Declaration of
Istanbulbut its reversible if the US legalizes sales
Capron 14 - University Professor and Scott H. Bice Chair in Healthcare Law,
Policy, and Ethics, University of Southern California (Alexander, SIX DECADES OF
ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A
MARKET SYSTEM WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY
PROBLEMS Vol. 77:25)

fifty countries that undertook to reform their practices

following the approval of WHOs original Guiding Principles. These
countries adopted laws in the early 1990s to institute the anticommercial
system recommended by WHO. Similarly, a number of countriesincluding
several that were centers for organ sales, such as Pakistan and the Philippines, and other
India was one of about

countries, such as Israel, that had sent large numbers of transplant tourists abroad to receive vended kidneys40

have adopted laws and regulations in the past few years that aim to put the
2010 WHO Guiding Principles into effect.41 These changes have been strongly supported by
other intergovernmental bodies such as the United Nations,42 the Council of Europe,43 and the UN Office on Drugs
and Crime,44 all of which have addressed the phenomena of organ trafficking45 and of people being trafficked for
the removal of the organs.46
Equally significant in driving ethical and legal reforms have been the advocacy efforts of leaders in transplantation
medicine. For example, the Transplantation Society (TTS) and the International Society of Nephrology organized a
global summit on organ trafficking and transplant tourism in Istanbul in late April 2008, where a statement of
professional opposition to organ markets, the Declaration of Istanbul, was adopted.47

The Declaration of

Istanbul has since been endorsed by more than 120 medical

organizations and governmental agencies.48 Realizing that the declaration would not be
selfimplementing, its creators formed the Declaration of Istanbul Custodian Group (DICG) in 2010 to encourage
adherence to its principles and proposals.49 The DICG and TTS have produced some notable results by calling on
government officials to adopt and enforce prohibitions, and by making clear to them the harm done to the standing
of medical professionals who work in locales where organ sales are widespread.50 Furthermore, the DICGs direct
interventions to change professional practices have been even more successful.51 For instance, academic
recognition has been withheld from physicians who have carried out transplants with organs from executed
prisoners by barring the physicians abstracts from inclusion in international medical congresses.52 Many medical
journals have announced that they expect adherence to the Declaration of Istanbul by their authors, just as they
have long insisted that research conducted with human beings must adhere to the Declaration of Helsinki, first
promulgated by the World Medical Association in 1964.53 In at least one instance, several articles were retracted
from an academic journal when it was discovered that the work discussed involved living donors who had been paid
to supply a kidney.54
C. Recent National Changes in Response to Global Norms
Bringing about thoroughgoing changes in transplant practices requires more than academic and professional

governments must also adopt and enforce bans on organ purchases

and transplant tourism. The latter has proven particularly difficult, not the least because of the built-in
opposition of the people who have profited from catering to transplant tourists. Accordingly, the hard-won
gains in this regard that have been achieved in the past five years are all the more
remarkable .
sanctions;

Some local proponents of organ-trade prohibitions have successfully used

global standards in their transformative efforts. This is illustrated by the experiences of
Pakistan where the Transplantation of Human Organs and Tissues Ordinance was adopted by presidential decree in
2007 before becoming a parliamentary act in 2010.55 Before the ordinance, an estimated 1500 patients from other
countriesprincipally in the Middle Eastas well as about 500 wealthy Pakistanis received vended kidneys each
year, mainly in private hospitals and clinics in Lahore and other Punjab cities.56 The efforts to bring that practice to
an end were lead by the professionals associated with the Sindh Institute of Urology and Transplantation (SIUT), a
medical center in Karachi that provides donation-driven kidney dialysis and transplantation to all patients without
charge. SIUT supplied the moral entrepreneurs: groups and individuals in civil society who are committed to the
elimination of trade they consider harmful and repugnant,57 who mobilized public opposition to commercial organ
donation. They urged the government to adopt the new law. Descriptions written by SIUT physicians of the
socioeconomic realities of the organ trade58 and of the resulting hazards to both donors and recipients59 led to
critical reporting of the practice in newspapers and on television.60
The media coverage took specific aim at the role of the government, whose failed poverty-alleviation programs left
individuals no choice but to sell their kidneys, and whose failure to enact a transplant law and later to enforce it

reports of Pakistans flourishing

kidney market had appeared in the international press, tarnishing the
countrys reputation.61
allowed the organ trade to thrive. It was also noted that

The owners of the private hospitals who profited greatly from transplant commercialism and who had strong
connections to high-level officials mounted fierce opposition to the transplant bill and sought to water down its
prohibitions on unrelated living donation.62 On the other side, SIUTs founder and director, Professor Adib Rizvi,
used his strong connections with international medical groups, particularly his membership in the DICG, to

transplant surgeons among the DICG leadership

came to Pakistan to convince government officials that organ sales were a
matter of international concern and needed to be curbed to rehabilitate
the reputation of Pakistani physicians.64 As Professor Asif Esrat concludes, For
government officials, the desire to conform to widely held international
norms and redeem the national reputation served as a motivation for
action.65 When the law was contested in a federal Shariat court as an interference with the Islamic duty to
counteract these powerful opponents.63 Prominent

save life, the existence of the international standards, as embodied in the WHO Guiding Principles (which Pakistan
had joined in endorsing at the World Health Assembly), weighed heavily enough that the court rejected the
challenge.66 When several transplant programs continued to carry out commercial transplants, including on
patients from abroad, Dr. Rizvi and his colleagues reported these violations to the authorities and prosecutions were
brought against the surgeons and hospitals that had attempted to profit by breaking the law.67
The current situation in the Philippines resembles that in Pakistan in some ways but differs in significant respects.
The country has been a well-known locale for organ purchases for the past several decades; indeed, it was one of
the first places where the anthropologists of Organs Watch, an independent research and medical-human-rights
project at the University of California, Berkeley, began their examination of the new body trade in which the
circulation of kidneys follows established routes of capital from South to North, from East to West, from poorer to
more affluent bodies, from black and brown bodies to white ones, and from female to male or from poor, low status
men to more affluent men.68
Although Internet sites have made the Philippines another important locus for the global organ trade, the initial
pattern of using vended kidneys there differed from what had occurred in Pakistan because the recipients were
mainly wealthy Filipinos, not foreigners. 358 of the 468 kidney transplants recorded in 2003 by the Renal Disease
Control Program of the Department of Health in the Philippines involved domestic patients (though the possibility of
incomplete reporting by private hospitals cannot be totally discounted).69 It was thus not surprising that elite
groups at that time supported a proposal under consideration by the government to institutionalize paid kidney
donation as well as to formally accept transplantation for foreign patients.70 As appealing as this idea may have
seemed to someone viewing it from a private hospital room in Quezon City, it was much less so for human-rights
advocates trying to protect potential organ sellers in a sewage-infested banguay (slum) in Manila.71 These
advocates used the attention that the World Health Organization was bringing to the issue at that time to halt the
movement toward legalizing compensation.
Over the following five years, international pressure on the government intensified, not only from intergovernmental
and medical bodies72 but from the Catholic hierarchy, particularly in light of press coverage about unscrupulous
organ brokers trolling in the slums for donors to meet the ever-increasing demand for kidneys coming from Manilas
transplant tourists.73 On April 30, 2008, a ministerial directive barred foreign recipients from getting kidneys from

Filipino living donors.74 The next year, the Inter-Agency Council Against Trafficking followed the international trend
and used the organ trafficking provisions of the Philippines Anti-Human Trafficking Law as the basis for
supplemental regulations outlawing all organ purchases, as well as other means of trafficking persons for organ
removal, including the use of force, fraud, and taking advantage of vulnerability.75
The fragility of these legal changes in the face of the determined opposition is indicated by the next swing of the
Filipino organ-policy pendulum. When Benigno Aquino III assumed office as President in June 2010, he nominated as
secretary of health Dr. Enrique T. Ona, a transplant surgeon who had previously expressed his opposition to the ban
on organ sales.76 The nomination was held up, however, when Ona announced his intention to allow organ donors
to be compensated by a $3200 gratuity package77 and joined several American regulated-market advocates in
sponsoring an international forum on Incentives for Donation in Manila that November.78 He was confirmed as
health minister, however, after providing assurances that he would not institute financial gratuities, but he did
sign the proposal for incentives that emerged from the international forum.79 In effect, the pendulum has swung
back, as the number of foreign transplant recipients, which had risen to 531 by 2007 before the ban, fell to two by
2011, even as a threefold increase occurred in deceased-donor transplants for Filipinos.80 Movement in the
opposite direction remains possible, however, as organ purchases by wealthy Filipinos have not completely
disappeared, with brokers helping potential kidney recipients persuade review committees to allow as emotionally
related donations what are in fact commercial transactions.81
Another variation on the theme of transplant tourism has taken place in Colombia, which was a major provider of
deceased-donor organs for wealthy foreigners during the first decade of this century,82 mainly for liver
transplantation.83 With strong international and regional backing, local medical leaders succeeded in redirecting
organs to recipients from Colombia and neighboring countries. The annual rate of transplantation to foreigners,
which stood at 200 in 2005 (16.5% of the national total), was reduced to 10 by 2011 (0.9% of the total, down from
1.45% the prior year).84

The situation in Colombia is indicative of the progress that has been made
across Latin America with the adoption by the Ibero-American Council of a set of principles and
objectives in a regional parallel to the Declaration of Istanbul, the Document of Aguascalientes,85 which was
encouraged through a strong alliance with the Spanish transplant program. The Document of Aguascalientes has
provided legal and ethical as well as technical guidance for countries across that region as they have created or
strengthened their own systems for organ donation, allocation, and transplantation that seek the support of the
public and medical professionals and that aim to meet the transplant needs of the domestic population and achieve
self-sufficiency nationally or through regional cooperation.86

Over the past five years, the most impressive examples of countries that
have responded to stronger global norms regarding the opposite side of selfsufficiency namely, not sending transplant tourists abroad as the means to
meet domestic demand for organsare in the Middle East. Israels enactment in
2008 of legislation halting insurance coverage for commercial transplants that violate local laws ended its reliance
on Turkey, South Africa, China, and the Philippines, among other countries, as sites where Israeli patients could go
to obtain vended kidneys.87 The law also stimulated the development of a robust system of deceased and livingrelated donation, which has been widely praised.88

A number of Arab countries have taken stepsthus far less sweeping in scope or impact
than the Israeli program but still effectiveto treat patients at home rather than sending
them abroad. The evolution of policy in Qatar provides a vivid example of the competing forces at work:
expediency, selfinterest, generosity, and concern about adhering to international norms. The local provider of
transplant services, the Hamad Medical Corporation (HMC), has concluded that it needs to go beyond the existing
Qatari program for honoring donors if it is to achieve self-sufficiency in organ transplantation.89 Consequently, the
HMC increased outreach within the expatriate community in Qatar (more than 85% of residents) to ensure that they
too have access to transplantation services.90 Additionally, the HMC has substantially increased deceased donation
by publicizing that brain death is acceptable under Islam91 and by having prominent persons, such as members
of the royal family, not only recognize the generosity of living donors and the families of deceased donors but also
enroll in the organ-donor registry.92
A central component of the new Qatari program is the Doha Donation Accord,93 which was formulated in November
2009 with assistance from the leaders of the DICG and the International Society for Organ Transplantation, and
which came into effect in 2010 following approval by the countrys Supreme Council of Health. The accord aimed to
combat organ commercialism, to create a deceased-donor program in which everyonewhether citizen or foreign
workerwould participate as both a potential donor and potential recipient, and to provide a path to self-sufficiency
in organ transplantation.94 The original accord departed from practices elsewhere in the region by not offering any

financial payment to the families of donors,95 but several of its promisesin particular, that a their family member
would be offered a free airplane ticket to accompany the deceaseds body from Qatar at the time of donationdo
not align with Guiding Principle 5 of the WHO Guiding Principles, which states that [c]ells, tissues and organs
should only be donated freely, without any monetary payment or other reward of monetary value.96 To the
accords framers, it would have been inconsistent with cultural norms of reciprocal gift-giving not to provide
something of value to those who agree to donate organs for transplantation. To outsiders, however, such a provision
seemed to exploit the vulnerable situation of the families of Qatars manual laborers and domestic workers from
India, Nepal, the Philippines, and other developing countries, who would otherwise find it difficult to repatriate their
loved ones remains.97
At a meeting in Doha in April 2013, held to mark the fifth anniversary of the Declaration of Istanbul, the leaders of
the HMC transplant program acknowledged the remaining shortcomings in the Doha Donation Accord and pledged
to make revisions satisfactory to the DICG.98 In particular, they pledged to ensure that any benefits provided to
donors families would be offered to the families of all potential donors, irrespective of whether they agree to
donate their deceased relatives organs for transplantation; further,
[A] social welfare program at HMC, in association with Qatar charities, provides assistance where required to
patients and their families. This assists in securing longterm medical care, supply of medications, and financial
support during residency in Qatar and sometimes following the return home of expatriates. For example, following a
formal socioeconomic evaluation, social services provide support to eligible families of all patients who die within
HMC hospitals, including families resident abroad. [W]hile the team at the Organ Donation Centre may directly refer
families of critically ill patients to welfare services for assistance as part of their routine care, such referrals and
provision of welfare benefits are unrelated to donation decisionsa point that is made clear to families.99
The forces at play in the movement of Qatar toward a more self-sufficient program of organ transplantation are the
same as those that have operated in the other countries described. In the countries that have provided transplants
to large numbers of transplant tourists, the forces favoring payments to living donors have largely been controlled
by those who directly profit from this business. But in Qatar, as in other countries that have sent most of their
potential kidney and liver recipients abroad for transplantation, those who had supported transplant tourism shifted
toward favoring payments to donors in Qatar, because they do not believe a domestic transplant program can be
built without such financial rewards.100 In a setting like Qatar where the population is sharply divided in both
socioeconomic and ethnic terms, as well as by residents degree of integration in, and identification with, the
country and its institutions, it is particularly easy to understand the view that those who are disadvantaged and
disenfranchised will only respond to a request for assistancein the form of a life-saving organwhen it is

forces on the other side have

been successfulas they have been in Pakistan and the Philippinesin
finding ways of overcoming the barriers to voluntary donation that do not
link benefits to an agreement to donate.101
accompanied by an offer to improve their condition materially. Nevertheless, the

the local medical and human rights advocates opposed to

giving material rewards for organ donation have been inspired by
professional and intergovernmental statements of principle and have
derived strength from the medical leaders and WHO officials who have
assisted them in persuading their governments to align national laws and
practices with international norms.
In all these settings,

IV BENEFITS, COSTS, AND INTERCONNECTIONS

National patterns of organ donation can be expected to be less diverse in

the future, thanks to changes of the sort detailed above, as countries move away from their
former roles as buyers or sellers in what has been called the global traffic in
human organs.102 But progress toward a world in which all countries where organ transplants are
performed103 rely on deceased and living-related donors, rather than paying living donors and the families of
cadaver donors, has been halting, and

changes

the outcome is far from assured . To a large extent, the

that have occurred have been heavily influenced by the WHO Guiding Principles and the Declaration

of Istanbul, which, in turn,

rest on the consistent practice of noncommercial organ

donation in the United States , Canada, and Western Europe for more than four decades. The
hands-on advocacy of WHO and DICG leaders has conveyed this vision to the responsible authorities in countries

that have previously relied on paid organ vendors, and it has reinforced the efforts of local medical leaders to
reform national laws and practices.

if systems that have so long embodied the ideal of voluntary, altruistic

solidarity as their basis for organ donation and that have thereby attained the highest rates
of donation were to move to a regulated market with financial inducements
for donation, the progress achieved in countries that have only recently come
into line with, or that have been moving in the direction of, the WHO
Guiding Principles and the Declaration of Istanbul would reverse course in short
But

order . The proponents of paying for organs in those countries whether they be
surgeons and brokers who stand to profit from transplant tourists or those who believe it is necessary to offer
material expressions of gratitude in order to build a functioning organ-transplant system104 would

seize
upon the change of policy in the West and say, Clearly, no principle is
offended by the sale and purchase of organs, for these enlightened countries allow
it; and if these countries, which are rich and medically well equipped, find payment necessary to generate an
adequate supply of organs, how can we succeed in any way other than by following their example?

Legal sales cause widespread suffering, economic ruin and

structural violence
Moniruzzaman, 14 - Department of Anthropology and Center for Ethics and
Humanities in Life Sciences, Michigan State University (Monir, Regulated Organ
Market: Reality Versus Rhetoric October, Volume 14, Number 10, 2014)

To make matters worse,

selling an organ does not alleviate the sellers poverty. In

my study, 81% of organ sellers did not receive the payment they were
promised. For example, Koliza, a liver seller, received 150,000 Taka (US$1,875), only half the amount the
broker had promised him. Proponents of the organ market therefore argue that a
regulated system could offer full payment for the sellers (though the Iranian
regulated market proves otherwise; Zargooshi 2001), yet these proponents fail
to explain how the payment (if it is paid in full) ensures income-generating
opportunities for impoverished populations. Here, Koplin aptly argues that
an organ market could not compensate for the extensive harms and
ensure long-term benefits for vendors overall well-being . My research cultivates
Koplins claim by capturing that Bangladeshi sellers mostly used their money to pay off their microloans; buy
material goods, such as a cell phone, a television, or gold jewelry; or arrange a dowry or medical treatment for their
family.

Once the money had nearly run out, most sellers had already lost

their jobs . Some managed to get new jobs, but their damaged bodies
impeded their abilities to continue to do physically demanding jobs, such as
rickshaw pulling, manual farm work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages
not only himself, but also his family, noting that three of my family members were depending on my income, and

some sellers have turned to organ brokering;

they prey on their families, neighbors, and villagers just to get by . My
research also finds that many sellers entered the organ market to pay off
their debts, but soon were back in debt (see Cohen 2003). For example, Koliza took out new
now I am done, and so are they. As a result,

microcredit loans to start a poultry farm a year after selling his liver lobe. With a chicken mortality rate as high as
50%, at the return of his microcredit debt Koliza remarked, I no longer have other parts to spare.

regulated organ market could not ensure the long-term economic benefits
of organ sellers, but rather might corrupt the overall situation . My recent
fieldwork reveals that moneylenders have pressured the poor to sell their
spare organs to repay loans. Husbands have tricked or forced their wives to sell their organs for
economic gain (in one case, a man married twice to profit from the sale of his wives kidneys, and in another case, a
man sold his wifes kidney after claiming to take her to the hospital for an appendectomy). A 6-year-old boy was
murdered by an organ trafficking racket and his body tossed in a pond after both kidneys were removed (The Daily
Star 2014). I also document that four members of one family (a father, two brothers, and a daughter-in-law) each
sold a kidney. Buyers regularly publish organ classifieds in major newspapers for soliciting organs, and brokers have
expanded their networks from local to national to international levels.

Such profound violence,

exploitation, and suffering would be rife in the regulated or rampant

commerce of organs.
after selling their vital organs, the health of sellers is compromised,
their economic situation has worsened, and their social status has
declined (Moniruzzaman 2012). The outcomes of organ selling are invasive,
harmful, and devastating. As seller Koliza said with regret, I donated my liver lobe to: i) live better, ii)
In sum,

save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of
poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.

a regulated organ market is not the solution, but

rather, the strict criminalization of the organ trade is ethically and
It can therefore be argued that

pragmatically essential . As Koplin notes, a regulated organ market would improve

vendors well-being or minimize their harms lack evidential warrant. Such a system does not speak to
the lives of the economic underclass, but rather seriously discriminates
against them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and
justice to organ sellers. We ought to oppose the organ market in order to curb this illicit practice.

The impact is widespread global exploitation and structural

violence
Moniruzzaman, 12 - Department of Anthropology and Center for Ethics and
Humanities in the Life Sciences Michigan State University (Monir, Living Cadavers
in Bangladesh: Bioviolence in the Human Organ Bazaar MEDICAL ANTHROPOLOGY
QUARTERLY, Vol. 26, Issue 1, pp. 6991, DOI: 10.1111/j.1548-1387.2011.01197.x)

The bioviolence, particularly for the extraction of organs, stems from the
growth of the transplant industry and is closely linked to the suppression
of the poor. It is not only widespread in the current practice of organ
commodification but also in every aspect of transplant technology. I will argue that the bioviolence
is seriously exploitative and highly unethical; however, it is deliberately
concealed for personal gains of vested interest groups. So far I have documented how
poor Bangladeshis are victims of bioviolence that turns them into kidney
sellers and causes extreme suffering . In the remainder of the article, I will discuss the
varieties of bioviolence, including physical, structural, and symbolic violence that dominate the lives of kidney
sellers.
In Bangladesh, about 35 million of its inhabitants (nearly one-quarter of the population) face the violence of
needless hungerwhat Amartya Sen calls a humanmade disaster (Hartman and Boyce 1998; Sen 1982). Inevitably,

77 percent of poor Bangladeshis lack the minimal requirements for a healthy human existence; about 50 percent of
women have anemia, and two million children are suffering from acute malnutrition (United Nations 2009). To make

socioenvironmental factors, such as arsenic poisoning, air

pollution, pesticide use, and smoking tobacco contribute to a high number
of organ maladies. Although the majority the economic underclassis at the
greatest risk of organ failure because of high exposure to these factors, they die
matters worse,

prematurely without receiving a transplant , let alone dialysis.

Kidney transplant is one of the most expensive medical procedures, starting at about 225,000 Taka ($3,200) for the
surgery and two weeks of postoperative care in a public hospital in Bangladesh. It is virtually impossible for most of
the poor, as well as many middle-class Bangladeshis, to save this amount of money in their lifetime. Nevertheless,
many of them strive for an organ transplant by literally begging for money in local newspapers, but in the end, they
experience serious drawbacks.9 For example, a brother of a recipient who died from kidney rejection just one month
after the transplantation told me, All of our family members tried our best to save my brothers life. We sold our
land and jewelry, and borrowed money from the bank to arrange the transplant. But we could not save my brother
and we are still paying off our debt. Moreover, the health care for organs in Bangladesh is concentrated in two
major cities; most poor people do not have access to organ care at all.
Evidently, transplantation does not proceed according to the principle of equity: The poor suffer from organ

The service of transplantation fulfills the needs

of fewer than 1 percent of the population the wealthy minority, while
maladies, but the wealthy receive care.

the majority of Bangladeshis die in silence , knowing they could have saved their lives
through this modern technology. Consequently, the current practice of organ transplant
constitutes a form of structural violence against the poor (see the detailed
discussion on structural violence in Galtung 1969; Farmer 2005), which is palpable in every aspect of the
transplant industry.

the poor deprived but also they are subject to physical violence as their
vital organs are viciously removed from their living bodies. As my ethnography
Not only are

explores, the wealthy buyers (both recipients and brokers) create a desire for the poor sellers, most of whom do not
understand the function of the kidney, but are tempted to donate because of the buyers fraudulent claim that

Once the sellers are induced, buyers

extract their organs through deception, manipulation, and without
consent, and then deprive them once the scar is permanent. The deception is so extensive here that not only
kidney donation is a safe, lucrative, and noble act.

brokers but also most recipients do not pay the total amount they had promised to the sellers. For example, seller
Monu received from his recipient as little as 40,000 Taka ($600)one-third of the promised amount. Some buyers
even use coercive force to extract organs from the sellers. For example, seller Mofiz was unable to attend the
funeral of his sister, who died of a heart attack after learning that her brother had left home to sell his kidney to
arrange her dowry. Mofiz was then held captive by three bodyguards at his recipients house and was tricked into
traveling to India a few days later. In the post-transplant period, bothMofiz and his wife were physically abused and
threatened with jail while he disputed the payment with his recipient (see also the above-mentioned case of seller

informed consent was completely flawed here, as buyers intentionally

because kidney
sellers cannot act competently and voluntarily (because of extensive
manipulation, not to mention the coercion of poverty); and because sellers gave
misinformed consent. These are means of the physical violence organ buyers use
to exploit their counterparts.
Sodrul). Furthermore,

provide misleading and inadequate information (e.g., the story of the sleeping kidney);

The bioviolence is both exploitative and unethical, as organs are

deliberately removed from the economic underclass to prolong the lives of
the affluent few. In this visceral violence, the wealthy recipients are beneficiaries, while the poor
sellers are mere suppliers of body parts, but at the severe cost of their

suffering.

This bioviolence constitutes an abuse of human rights (the 1948 Universal Declaration of Human

Rights adopted that health is a human right), as the poor deserve proper transplant care, rather than losing organs
from their underfed bodies. This bioviolence also violates the principle of social justice, as the poor have an equal
right to keep their organs inside their bodies.

survival;

They need their organs for their physical

the bioviolence against them is a serious crime.

Exploitation from organ sales justifies slavery and genocide by

viewing some people as less valuable than others
George, 1 - Southern Railway Hospital, Perambur, Chennai, 600 023, India
(Thomas, Issues in Medical Ethics, January-March, The case against kidney sales
PubMed)

I am one of those who, according to Radcliffe-Richards et al, oppose the practice of buying kidneys from live
vendors from a feeling of outrage and disgust. (1) These feelings are by no means irrational. They are based on a
bedrock of moral principle: that no human being should exploit another. The opponents and proponents of the trade
in human organs are divided by this (perhaps unbridgeable) chasm the one side is wedded to the belief that not
only are all human beings born free, but that they should stay free; the other is not so sure. The evolution of human
civilisation has witnessed several periods of gross exploitation of human beings .

Slavery, the
extermination of six million Jews, and today the transfer of body parts from
one living human being to another, for a financial consideration, are part of a
continuum of values which sees some human beings as less valuable than
others. It is this value system that those of us who oppose the sale of
kidneys, seek to change. All arguments in favour of the trade are attempts
to clothe, in the garb of reason, the concept that it is all right to remove a body
part from a poor person and put it into a rich one. But even these arguments will not
bear scrutiny and I will deal with them below.
First, the argument that the prohibition of organ sales worsens the position of the poor because it removes an
option in their already deprived lives: Here the authors (1) of the paper have cleverly stated the most potent
contrary argument themselves: the solution is the removal of poverty. They, however, appear to consider this a
distant possibility, and in the meantime advocate the selling of kidneys as one option available to the poor to better
their circumstances. It would have been useful if the authors had adduced material to show how and how long this

In the absence of any sustained means of livelihood, it is

quite probable that the money obtained by the sale of one organ will soon
be gone. What shall the seller do next? Sell another organ? An eye? A
lung? And when all the paired organs are gone?
so-called option works.

Let us accept that the risk involved in nephrectomy is not high. But is it not a fundamental tenet of medicine that
the risk must be in the medical interest of the patient? What medical advantage does the donor obtain?
Undoubtedly the risk is the same for those who sell and those living donors who do not sell but donate out of regard
for the recipient. Radcliffe -Richards et al move from this fact to the inference that therefore there should be no
difference between the two groups with surprising facility. What matters here is motive: the implicit coercion in the
case of the poor who sell out of financial compulsion. Radcliffe - Richards equating of the motives of the better off,
and comparing the risks of nephrectomy with the risks of dangerous sports can only be described as callous. No one

for us activists in the

Third World there are more pressing matters than looking after the well being of the jet- set. A profile of the sellers would be revealing. It will come as no surprise that they
all belong to the Third World. And it will also come as no surprise that besides the wealthy in the
Third World, the potential buyers will be from the rich, white, First World and from
the petroleum driven nouveau - riche! No wonder a veritable industry of philosophers
has risen in these countries to justify this horrible practice. And in the
prevents them from campaigning against these sports if they are so moved, but

honourable tradition of colonialism there will always be locals ready to aid

and abet the conquerors. He who pays the piper calls the tune!
Radcliffe-Richards et al (1) seem fixated on the belief that legalising and controlling
the trade in human organs will protect the exploited. The situation in other fields
shows that this is nave indeed. In Hamburg, legal commercial sex workers throng the glittering
Reeperbahn, while in the sad, sordid, shadowy bylanes the illegal commercial sex workers have no shortage of
clients. This in a country where social conditions ensure much closer adherence to the rule of law than is the case in
most developing countries, which are the main source of people willing to sell their organs. In India, child labour is a
reality. Poverty is the main reason for its existence. The efforts of numerous groups have succeeded in making it
illegal. Have they removed an option for the poor? After all, the poor consciously send these children to work.
Would it be a good idea to legalise the practice and control it on the theoretical basis that it would improve the lot

such trades will always be open to

exploitation. The most potent one is that the victims are poor and voiceless while the
beneficiaries are generally rich and powerful.
of these unfortunate children? There are many reasons why

The argument that organ selling is acceptable because some services are available to the rich, which are not
available to the poor, is extremely strange. Do the authors believe that the presence of undesirable practices
justifies adding a few more? What will the limit be? Who will decide how many more are to be allowed? No prizes for
getting it right. The answer is: the rich and powerful. Permit whatever is in their interest. They can always hire a
motley crew of philosophers and technicians to justify it and make it possible.

altruism necessary in organ donation? It is because it will ensure the absence of

exploitation. It is nobodys case that unless some useful action is altruistic it is better to forbid it altogether.
Altruism removes the profit - making element. It will help ensure that
organ transplantation is done in the best possible way and thereby achieve the best
Why is

possible medical result. It will also ensure that no vital organ is removed from a living person. On the other hand,

trade in kidneys definitely puts one on the slippery slope to selling vital
organs as documented elsewhere. (2) Here, the authors utilise the familiar stratagem of positing
and demolishing imaginary weak arguments against their stated position, while ignoring the real and powerful
argument.

1NC T 1
Topical affirmatives must legalize at both the federal and state
level- The United States is a collective term
American Civil Procedure: A Guide to Civil Adjudication in US Courts, Edited by John
Bilyeu Oakley, Professor of Law at the University of California, Davis, and Vikram D.
Amar, Professor of Law and Associate Dean for Academic Affairs of the School of
Law of the University of California at Davis, Kluwer Law International, 2009, page 19

Although it is commonplace today to refer to the United States as a

single entity and as the subject of statements that grammatically employ
singular verbs, it is important to remember that the United States
remains in many important ways a collective term . The enduring legal significance of
the fifty states that together constitute the United States, and their essential dominion over most legal matters
affecting day-to-day life within the United States, vastly complicates any attempt to summarize the civil procedures

Within the community of nations, the United States is a

geopolitical superpower that acts through a federal government granted
constitutionally specified and limited powers. The organizing principle of
the federal Constitution,1 however, is one of popular sovereignty, with
governmental powers distributed in the first instance to republican
institutions of government organized autonomously and uniquely in each
of the fifty states. Although there are substantial similarities in the organization of state governments,
within the United States.

idiosyncrasies abound.

VOTE NEG splitting it up topical actors makes thousands of

agents with different advantages. No way to predict.

1NC DA 2
TPA will pass has the votes. But Obamas capital is key
pushing now
THE HILL 2 19 15 [Pritzker expects fast-track to pass Congress,
http://thehill.com/policy/finance/233285-pritzker-expects-fast-track-to-passcongress]

Obama administration officials are acknowledging the challenge of passing trade

promotion authority (TPA) as they ramp up efforts to build broad support.
Pritzker said Thursday that getting a fast-track measure through
has always proven difficult and that this time around won't be any
different.
Commerce Secretary Penny
Congress

"These are never easy votes so lets not think its different or theres some circumstance now thats
different than before, she said in a call with reporters.
"Trade promotion legislation is a hard vote to get passed
what it is, she said.

because takes a lot of explanation as to

Pritzker is confident that a fast-track measure, despite widespread

opposition from Democrats in Congress, will pass, most likely by a small
margin.
Still,

Pritzer said she has been talking to Republicans and Democrats who were
involved in previous TPA battles and understands what is needed to get push a
measure through Congress.
The last TPA bill passed in 2002, only by a few votes in the House.
Earlier in the day, Agriculture Secretary Tom
according to press reports.

Vilsack said that a TPA vote is a close call,

Pritzker and Jeff Zients, director of the White House National Economic Council, said the
lobbying effort to convince lawmakers and Americans continues in earnest and
will succeed on TPA and the broader trade agenda.
Zients, who has led the White Houses campaign to get Cabinet members talking to
Democrats about gaining their support, reiterated President Obama's message that trade will
create more and better paying jobs while boosting the nations overall growth.
He argued that exports are essential to growing the U.S. economy and that "trade agreements like the Trans-Pacific
Partnership can boost wages and help protect American workers."
Obama administration officials used Minnesota as an example of how trade can work, especially for smaller
businesses.
The Commerce Department reported on Thursday that last year merchandise exports from the state hit a record
$21.4 billion, helping bring the U.S. total to a $2.35 trillion record for goods and services exports.

Pritzker, as well as other Cabinet officials, has been on the road hawking
the trade agenda to small- and medium-sized business. She recently zipped through the West Coast cities
of San Francisco, Seattle and Portland making the sell.

The plan is political suicide

Calandrillo 4 [Steve Calandrillo (Law ProfU of Washington); George Mason Law Review, Vol. 13, pp. 69133, 2004; Cash for Kidneys? Utilizing Incentives to End America's Organ Shortage]

REAL REFORMS: UTILIZING INCENTIVES TO END THE NATIONS ORGAN SHORTAGE

Despite the above analysis,

any form of legalized human organ market would be far

from a utopian solution: it would be political suicide

to propose,

entail significant

administrative costs to establish and monitor, and remain morally

distasteful to many Americans. While such markets havebeen debated without much progress in the
past, far less attention has been paid to dozens of other monetary and nonmonetary incentives that could be

an incentive-based approach would avoid imposing risk on

living donors, dramatically expand the pool of available organs, and shock
the conscience far less than allowing living-seller markets. 190
employed. Taking

Solves global trade collapse

Kati Suominen 14, Visiting Assistant Adjunct Professor at UCLA Anderson School
of Management, Adjunct Fellow at CSIS, Ph.D. Political Economy from UC San Diego,
Aug 4 2014, Coming Apart: WTO fiasco highlights urgency for the U.S. to lead the
global trading system, katisuominen.wordpress.com/2014/08/04/coming-apart
threats are
disintegration of the trading system
WTO is utterly dysfunctional: deals require unanimity
player
a veto.
Two

emerging. The first is

among 160 members,

cantankerous

like India

the
making any

. The core of the system until the mid-1990s,

Aligning interests has been impossible, turning all action in global trade policymaking to free trade agreements (FTAs), first kicked off by the North American Free

Trade Agreement (NAFTA) in 1994. By now, 400 FTAs are in place or under negotiation. FTAs have been good cholesterol for trade, but the overlapping deals and rules also complicate life for U.S. companies doing global business.

The U.S.-led
talks for mega-regional agreements
TTIP)
and
TPP), are the best solution yet to these problems . They free
One single deal among all countries would be much preferable to the spaghetti bowl of FTAs, but it is but a pie in the sky. So is deeper liberalization by protectionist countries like India.

with Europe and Asia-Pacific nations, the Trans-Atlantic Trade and Investment Partnership (

Trans-Pacific Partnership (

trade and create uniform rules among

economy

. Incidentally, they would create a million jobs in America. Yet

Capitol Hill to pass

Party line up in opposition.

countries making up

two-thirds of the world

both hang in balance thanks to inaction on

the Trade Promotion Authority (

TPA

), the key piece of legislation for approving the mega-deals, now stuck in a bitter political fight as several Democrats and Tea

TPA is key for the Obama administration to conclude TPP and

TTIP talks Europeans and Asians are unwilling to negotiate the thorniest
:

topics before they know TPA is in place

to constrain U.S. Congress to voting up or down on these deals, rather than amending freshly negotiated

texts. The second threat in world trade is the absence of common rules of the game for the 21st century global digital economy. As 3D printing, Internet of Things, and cross-border ecommerce, and other disruptive technologies
expand trade in digital goods and services, intellectual property will be fair game why couldnt a company around the world simply replicate 3D printable products and designs Made in the USA? Another problem is

protectionism

data

rules on access and transport of data across borders. Europeans are imposing limits on companies access to consumer data, complicating U.S. businesses customer service and

marketing; emerging markets such as Brazil and Vietnam are forcing foreign IT companies to locate servers and build data centers as a condition for market access, measure that costs companies millions in inefficiencies. A growing
number of countries claim limits on access to data on the grounds of national security and public safety, familiar code words for protectionism.

balkanizing the global virtual economy

Digital protectionism risks

just as tariffs siloed national markets in the 19th century when countries set out to collect revenue and

promote infant industries a self-defeating approach that took well over a century to undo, and is still alive and well in countries like India. The biggest losers of

digital

protectionism are American small businesses and

Trade policymakers
lag far behind
todays trade, which requires sophisticated rules
The mega-regionals, especially the TTIP, are a perfect to
start this
. Disintegration of trade policies risk disintegrating world
consumers leveraging their laptops, iPads and smart phones to buy and sell goods and services around the planet.

however

on IP, piracy, copyrights, patents and trademarks, ecommerce, data flows,

virtual currencies, and dispute settlement.

venue

process

markets
the global trading system rests in Americas hands

approval of TPA unshackles U.S. negotiators to finalize TPP and

TTIP
TPP and TTIP will be giant
magnetic docking stations to outsiders; China and Brazil
are
interested
the TTIP-TPP superdeal will cover 80 percent of worlds
output and approximate a multilateral agreement
. Just as after World War II,

needed.

The first is the

. Three things are

, which

. Most interesting for U.S. exporters, TPP and TTIP almost de facto merge into a superdeal: the United States and EU already have bilateral FTAs with several common partners belonging in TPP Peru, Colombia, Chile,

Australia, Singapore, Canada, and Mexico to name a few. Whats more, gatekeepers to markets with two-thirds of global spending power,

, aiming to revive sagging growth,

. Once this happens,

and have cutting-edge common trade rules that could never be agreed in

one Big Bang at the WTO.

Causes global hotspot escalation---trade solves

Miriam Sapiro 14, Visiting Fellow in the Global Economy and Development
program at Brookings, former Deputy US Trade Representative, former Director of
European Affairs at the National Security Council, Why Trade Matters, September
2014, http://www.brookings.edu/~/media/research/files/papers/2014/09/why
%20trade%20matters/trade%20global%20views_final.pdf
This policy brief explores the economic rationale and strategic imperative of an ambitious domestic and global trade agenda from the perspective of the United States. International
trade is often viewed through the relatively narrow prism of trade-offs that might be made among domestic sectors or between trading partners, but it is important to consider also the

With that context in mind, this paper assesses the implications of the
Asia-Pacific and European trade negotiations underway , including for countries that are not
impact that increased trade has on global growth, development and security.

participating but aspire to join. It outlines some of the challenges that stand in the way of completion and ways in which they can be addressed. It examines whether the focus on megaregional trade agreements comes at the expense of broader liberalization or acts as a catalyst to develop higher standards than might otherwise be possible. It concludes with policy
recommendations for action by governments, legislators and stakeholders to address concerns that have been raised and create greater domestic support. It is fair to ask whether we

dire developments are threatening the security

interests of the United States and its partners in the Middle East, Asia, Africa and Europe. In the Middle East, significant areas of Iraq
have been overrun by a toxic offshoot of Al-Qaeda, civil war in Syria rages with no end in sight, and the IsraeliPalestinian peace process is in tatters. Nuclear negotiations with Iran
have run into trouble, while Libya and Egypt face continuing instability and domestic challenges. In Asia, historic rivalries and
disputes over territory have heightened tensions across the region, most acutely by Chinas aggressive
should be concerned about the future of international trade policy when

moves in the S outh C hina S ea towards Vietnam, Japan and the Philippines. Nuclear-armed North
Korea remains isolated, reckless and unpredictable. In Africa, countries are struggling with rising terrorism, violence and corruption. In Europe,
Russia continues to foment instability and destruction in eastern Ukraine. And within the European Union, lagging
economic recovery and the surge in support for extremist parties have left people fearful of increasing violence against immigrants and minority groups and skeptical of further
integration. It is tempting to focus solely on these pressing problems and defer less urgent issuessuch as forging new disciplines for international tradeto another day, especially
when such issues pose challenges of their own. But that would be a mistake. A key motivation in building greater domestic and international consensus for

trade liberalization

now is precisely the role that greater economic integration can play in opening up new avenues of opportunity for promoting

development and increasing economic prosperity. Such initiatives

security

advancing

can help stabilize key regions and strengthen

of the United States and its partners. The last century provides a powerful example of how

can help reduce global tensions

and raise living standards.

the

expanding trade relations

Following World War II, building stronger economic

cooperation was a centerpiece of allied efforts to erase battle scars and embrace former enemies. In defeat, the economies of Germany, Italy and Japan faced ruin and people were on

A key element of the Marshall Plan, which established the

foundation for unprecedented growth and the level of European integration that exists today, was to revive trade by reducing tariffs.1 Russia, and the
the verge of starvation. The United States led efforts to rebuild Europe and to repair Japans economy.

eastern part of Europe that it controlled, refused to participate or receive such assistance. Decades later, as the Cold War ended, the United States and Western Europe sought to make
up for lost time by providing significant technical and financial assistance to help integrate central and eastern European countries with the rest of Europe and the global economy.
There have been subsequent calls for a Marshall Plan for other parts of the world,2 although the confluence of dedicated resources, coordinated support and existing capacity has been

difficult to replicate. Nonetheless, important lessons have been learned about the valuable role

economic development can play in

defusing tensions , and how opening markets can hasten growth. There is again a growing recognition that economic security and national security are two
sides of the same coin. General Carter Ham, who stepped down as head of U.S. Africa Command last year, observed the close connection between increasing prosperity and bolstering
stability. During his time in Africa he had seen that security and stability in many ways depends a lot more on economic growth and opportunity than it does on military strength.3
Where people have opportunities for themselves and their children, he found, the result was better governance, increased respect for human rights and lower levels of conflict. During
his confirmation hearing last year, Secretary John Kerry stressed the link between economic and national security in the context of the competitiveness of the United States but the point
also has broader application. Our nation cannot be strong abroad, he argued, if it is not strong at home, including by putting its own fiscal house in order. He assertedrightly sothat

Every day, he said, that

goes by where America is uncertain about engaging in that arena, or unwilling to put our best foot forward and win, unwilling to
more than ever foreign policy is economic policy, particularly in light of increasing competition for global resources and markets.

demonstrate our resolve to lead , is a day in which we weaken our nation itself.4
Strengthening Americas economic security by cementing
not simply an option, but an

its

economic alliances is

imperative . A strong nation needs a strong economy that can generate growth, spur innovation and create jobs. This is true, of course, not

only for the United States but also for its key partners and the rest of the global trading system. Much as the United States led the way in forging strong military alliances after World War
II to discourage a resurgence of militant nationalism in Europe or Asia, now is the time to place equal emphasis on shoring up our collective economic security. A

act now could undermine

international security and place

stability in key regions

failure to

in further jeopardy.

1NC DA 3
Plan wrecks doctor-patient trust collapses health care and
solvency
Caplan, 14 - Department of Medical Ethics and Director, Center for Bioethics,
University of Pennsylvania (Arthur, Contemporary Debates in Bioethics, ed: Caplan
and Arp,. Google books)
Second, Cherry argues that medicine is a business: "Medicine is a commodity: its goods and services are bought
and sold, valued over against other goods and services, are the subject of economic choices, and are given a
monetary equivalence. Hospitals, physicians, and other healthcare workers demand payment for services
rendered." Therefore, he concludes, we can have doctors paid and patients paid to undergo surgery to take out

Medicine is a business, but it is also a

professionone that relies on trust. If commercial concerns are seen as
overwhelming the protection of patient interests, then medicine will not
their organs for no reason other than profits.

long be able to function . If doctors do useless tests on patients solely to

make money, then patients come to distrust recommendations for tests . If
doctors will remove your kidney, cornea, lobe of liver, or limbs solely so that you and they may turn a buck,

patients soon will come to completely distrust their doctors.

Transplantation depends upon trust to obtain organs such as hearts and lungs, people
must believe their loved ones are truly dead before removal . Trust in that
the surgeon will not give you an inferior or infected organ just to get a
paycheck. Trust in that you cannot bribe your way to access to an organ
ahead of those in greater need. There is nothing that will destroy trust more in
transplant than showing that doctors are quite willing to harm their
patientsespecially those who are poor or vulnerable solely and only for
money.

Impact is bioterror
Jacobs, 5 MD; Boston University professor of medicine [Alice, director of Cardiac
Catheterization Laboratory and Interventional Cardiology, "Rebuilding an Enduring
Trust in Medicine," Circulation, 2005,
circ.ahajournals.org/content/111/25/3494.full#xref-ref-3-1, accessed 8-18-14]
To be sure, we will learn about the emerging science and clinical practice of cardiovascular disease over the next

there is an internal disease of the heart that confronts us as scientists, as

physicians, and as healthcare professionals. It is a threat to us allinsidious and pervasiveand one
that we unknowingly may spread. This threat is one of the most critical issues facing our
profession today. How we address this problem will shape the future of medical care. This issue is the
erosion of trust. Lack of trust is a barrier between our intellectual renewal and our
ability to deliver this new knowledge to our research labs, to our offices, to the bedside of our
patients, and to the public. Trust is a vital, unseen, and essential element in diagnosis,
treatment, and healing. So it is fundamental that we understand what it is, why its important in medicine,
four days. But

its recent decline, and what we can all do to rebuild trust in our profession. Trust is intrinsic to the relationship
between citizens around the world and the institutions that serve their needs: government, education, business,
religion, and, most certainly, medicine. Albert Einstein recognized the importance of trust when he said, Every
kind of peaceful cooperation among men is primarily based on mutual trust.1 In our time, trust has been broken,
abused, misplaced, and violated. The media have been replete with commentaries, citing stories of negligence,
corruption, and betrayal by individuals and groups in the public and private sectors, from governments to
corporations, from educational institutions to the Olympic Organizing Committee. These all are front-page news.

Perhaps the most extreme example is terrorism, in which strangers use acts of violence to shatter trust and splinter
society in an ongoing assault on our shared reverence for human life. Unfortunately, we are not immune in our own
sphere of cardiovascular medicine. The physician-investigator conflicts of interest concerning enrollment of patients
in clinical trials, the focus on medical and nursing errors, the high-profile medical malpractice cases, the mandate to
control the cost of health care in ways that may not be aligned with the best interest of the patientall of these
undermine trust in our profession. At this time, when more and more public and private institutions have fallen in
public esteem, restoring trust in the healthcare professions will require that we understand the importance of trust
and the implications of its absence. Trust is intuitive confidence and a sense of comfort that comes from the belief
that we can rely on an individual or organization to perform competently, responsibly, and in a manner considerate
of our interests.2 It is dynamic, it is fragile, and it is vulnerable. Trust can be damaged, but it can be repaired and
restored. It is praised where it is evident and acknowledged in every profession. Yet it is very difficult to define and
quantify. Trust is easier to understand than to measure. For us, trust may be particularly difficult to embrace
because it is not a science. Few instruments have been designed to allow us to evaluate it with any scientific rigor.

trust is inherent to our profession, precisely because patients turn to us in their most
vulnerable moments, for knowledge about their health and disease. We know trust
when we experience it: when we advise patients in need of highly technical procedures that
are associated with increased risk or when we return from being away to learn that our patient who
Yet,

became ill waited for us to make a decision and to discuss their concerns, despite being surrounded by competent

leaders in the medical field understand the

importance of trust.3 When asked whether the public health system could be
overrun by public panic over SARS and bioterrorism, C enters for D isease C ontrol and Prevention
Director Julie Gerberding replied, You can manage people if they trust you. Weve
put a great deal of effort into improving state and local communications and scaled up our own public
affairs capacitywere building credibility, competence and trust.4 Former H ealth and H uman
S ervices Secretary Donna Shalala also recognized the importance of trust when she said,
If we are to keep testing new med icine s and new approaches to curing disease , we
cannot compromise the trust and willingness of patients to participate in clinical
trials .5 These seemingly intuitive concepts of the importance of trust in 21st century medicine actually have
colleagues acting on our behalf. Many thought

little foundation in our medical heritage. In fact, a review of the early history of medicine is astonishingly devoid of
medical ethics. Even the Codes and Principles of Ethics of the American Medical Association, founded in 1847,
required patients to place total trust in their physicians judgment, to obey promptly, and to entertain a just and
enduring sense of value of the services rendered.6 Such a bold assertion of the authority of the physician and the
gratitude of the patient seems unimaginable today. It was not until the early 1920s that role models such as
Bostons Richard Cabot linked patient-centered medical ethics with the best that scientific medicine had to offer,6
and Frances Weld Peabody, the first Director of the Thorndike Memorial Laboratory at the Boston City Hospital,
crystallized the ethical obligation of the physician to his patient in his essay The Care of the Patient.7 In one
particularly insightful passage, Peabody captures the essence of the two elements of the physicians ethical
obligation: He must know his professional business and he must trouble to know the patient well enough to draw
conclusions, jointly with the patient, as to what actions are indeed in the patients best interest. He states: The

The care of the patient must be completely

personal. The significance of the intimate personal relationship between physician and patient
cannot be too strongly emphasized, for in an extraordinarily large number of cases
both diagnosis and treatment are directly dependent on it. Truly, as Peabody said, The
secret to the care of the patientis in caring for the patient.7 This concept that links the quality of
the physician-patient relationship to health outcomes has indeed stood the test of
time. Trust has been shown to be important in its own right. It is essential to patients, in
their willingness to seek care, their willingness to reveal sensitive information, their
willingness to submit to treatment, and their willingness to follow
treatment of a disease may be entirely impersonal:

recommendations . They must be willing for us to be able.

Extinction
Sandberg, 8 -- Oxford University Future of Humanity Institute research fellow
[Anders, PhD in computation neuroscience, and Milan Cirkovic, senior research

associate at the Astronomical Observatory of Belgrade, "How can we reduce the risk
of human extinction?" Bulletin of the Atomic Scientists, 9-9-2008,
thebulletin.org/how-can-we-reduce-risk-human-extinction, accessed 8-13-14]
The risks from anthropogenic hazards appear at present larger than those from natural ones. Although great progress has been
made in reducing the number of nuclear weapons in the world, humanity is still threatened by the possibility of a global

Advances in
synthetic biology might make it possible to engineer pathogens capable of
extinction-level pandemics. The knowledge, equipment, and materials needed to
engineer pathogens are more accessible than those needed to build nuclear
weapons. And unlike other weapons, pathogens are self-replicating , allowing a
small arsenal to become exponentially destructive. Pathogens have been implicated
in the extinctions of many wild species. Although most pandemics "fade out" by
reducing the density of susceptible populations, pathogens with wide host ranges in
multiple species can reach even isolated individuals. The intentional or unintentional release of
engineered pathogens with high transmissibility, latency, and lethality might be
capable of causing human extinction. While such an event seems unlikely today, the likelihood may increase as
thermonuclear war and a resulting nuclear winter. We may face even greater risks from emerging technologies.

biotechnologies continue to improve at a rate rivaling Moore's Law.

1NC CP 1
Text: The fifty states should, through the National Conference
of Commissioners on Uniform Law, amend the Uniform
Anatomical Gift Act to require routine recovery of cadaveric
organs in the event of brain death, allowing limited religious
opt-out.
Solves supply better and avoids exploitation DA
Spital, 7 - Department of Medicine, Mount Sinai School of Medicine, New York, New
York (Aaron, Routine Recovery of Cadaveric Organs for Transplantation: Consistent,
Fair, and Life-Saving CJASN March 2007 vol. 2 no. 2 300-303, doi: 10.2215/
CJN.03260906)
Transplant candidates and the people who care for them know only too well that there is a severe shortage of
acceptable organs. As a result, in the United States alone, approximately 19 people on the transplant waiting list die
every day (1). Compounding this tragedy is the fact that many potentially life-saving cadaverica organs are not

our organ procurement system fails to meet our needs.

Recognition of this failure has led to several radical proposals designed to increase the
number of organs that are recovered for transplantation, including legalization of organ sales (3)
and offering priority status to people who agree to posthumous organ recovery (4). But before reaching
for a new approach, we need to ask first, What is wrong with our current
cadaveric organ procurement system?
procured (2). Clearly,

The Need for Consent: Widely Accepted but Sometimes Deadly

the major problem with our present cadaveric organ procurement system is its
absolute requirement for consent. As such, the systems success depends on altruism and
We believe that

voluntarism. Unfortunately, this approach has proved to be inefficient. Despite tremendous efforts to increase public
commitment to posthumous organ donation, exemplified most recently by the US Department of Health and Human
Services sponsored Organ Donation Breakthrough Collaborative (5), many families who are asked for permission to
recover organs from a recently deceased relative still say no (2). The result is a tragic syllogism: nonconsent leads
to nonprocurement of potentially life-saving organs, and nonprocurement limits the number of people who could
have been saved through transplantation; therefore, nonconsent results in loss of life.
In an attempt to overcome this consent barrier while retaining personal control over the disposition of ones body
after death, several countries have enacted opting-out policies, sometimes referred to (erroneously, we believe)
as presumed consent (6). Under these plans, cadaveric organs can be procured for transplantation unless the
decedentor her family after her deathhad expressed an objection to organ recovery. Although there is evidence
that this approach increases recovery rates, perhaps by changing the default from nondonation to donation (7,8),
the recent Institute of Medicine (IOM) report on organ donation concluded that a presumed consent policy should
not be adopted in the United States at this time (8). One of the most important concerns noted by the IOM
committee is the results of a 2005 survey in which 30% of the respondents said that they would opt out under a
presumed consent law. The IOM report also pointed out that in the United States there seems to be a lack of public
support for this approach, that the organ donation rate in the United States currently exceeds that of many
countries with presumed consent policies, and that in most of these countries the family of the decedent is still
consulted (8). It should also be noted that even opting-out countries do not have enough organs to meet their
needs, and for people who remain unaware of the plan, presumed consent becomes routine recovery in disguise.
Given that some people do not want to donate, it is clear that whether we follow an opting-in or an opting-out
approach, life-saving organs are and will continue to be lost because of refusals. In other words, the requirement for
consent, whether explicit or presumed, is responsible for some deaths. But isnt this the price that we must pay to
show respect for people after they die? We believe that the answer is no.

The view that consent is an absolute requirement for cadaveric organ recovery has long been accepted as selfevident, and few experts in the field have seen the need to justify it. We agree that the premortem wishes of the
deceased regarding the postmortem disposition of his or her property should generally be respected. However, we
believe that the obligation to honor these (or the familys) wishes is prima facie, not absolute, and that it ceases to
exist when the cost is unnecessary loss of human life, which is often precisely what happens when permission for
organ recovery is denied. Therefore, given the current severe organ shortage and its implications for patients who

we propose that the requirement for consent for cadaveric

organ recovery be eliminated and that whenever a person dies with
transplantable organs, these be recovered routinely (911). Consent for such recovery
are on the waiting list,

should be neither required nor sought. In our opinion, the practical and ethical arguments for this proposal are
compelling.
Routine Removal: Consistency with Other Socially Desirable but Intrusive Programs
One of the major reasons for insisting on consent is to show respect for autonomy, a major principle of biomedical
ethics. However, Beauchamp and Childress (12) pointed out that as important as this principle is, it has only prima
facie standing and can be overridden by competing moral considerations. One such consideration occurs when
society is so invested in attaining a certain goal that is designed to promote the public good that it mandates its
citizens to behave in a manner that increases the probability of achieving that goal, even though many of them
would prefer not to act in this way. Silver (13) pointed out the legitimacy of this approach in his discussion of an
organ draft: The sense behind the coercive power of democratic governments is to move society forward by
public decree where individuals will not, by private volition, act in their own best interests. Examples of such
situations include a military draft during wartime, taxation, mandatory vaccination of children who attend public
school, jury duty, and, perhaps most relevant to routine removal of cadaveric organs, mandatory autopsy when foul
play is suspected. Although some people may not like the fact that they have no choice about these programs, the
vast majority of us accept their existence as necessary to promote the common good. Routine removal of cadaveric
organs would be consistent with this established approach, and it would save many lives at no more (and we
believe much less) cost than these other mandated programs. Furthermore, had we been born into a world where
cadaveric organ removal for transplantation were routine, it is likely that few if any people would question the
policy, just as few of us question mandatory autopsy today. And while most of us will never need a transplant,
nonrecipients would also benefit from the plan in the same way that people who never file a claim benefit from the
security of having insurance. It should also be noted here that, as discussed below, a persons autonomy is lost
after death.
Recovering Cadaveric Organs without Consent: Life-Saving and Fair
Few would argue against the view that routine removal of usable cadaveric organs would save many lives.

Under

such a program, recovery of transplantable organs should approach

100%.

It is unlikely that any program designed to increase consent rates could even come close. Although the

expected high efficiency of routine recovery is its major raison dtre, it also has several other advantages.

Routine recovery would be much simpler and cheaper to implement than

proposals designed to stimulate consent because there would be no need
for donor registries , no need to train requestors, no need for stringent
governmental regulation, no need to consider paying for organs , and no
need for permanent public education campaigns. The plan would eliminate the added
stress that is experienced by some families and staff who are forced to confront the often emotionally wrenching
question of consent for recovery. Delays in the removal of transplantable organs, which sometimes occur while
awaiting the familys decision and which can jeopardize organ quality, would also be eliminated.

routine posthumous organ recovery is that it is more equitable

than are systems that require consent. All people would be potential
contributors, and all would be potential beneficiaries. No longer could one say, Thank
you, when offered an organ but say, No, when asked to give one; such free riders would be eliminated. And
concern about exploitation of the poor, as sometimes arises during
A final advantage of

discussions of organ sales, is not an issue here .

Case

1NC Shortages
Plan crushes donationshurts overall supply
Sheila M. Rothman 6, Professor of Public Health in the Division of Sociomedical
Sciences the Joseph L. Mailman School of Public Health at Columbia University,
Assistant to the Deputy Director of the Center for the Study of Society and Medicine
at the Columbia College of Physicians & Surgeons at Columbia University, and David
J. Rothman, professor of Social Medicine at Columbia University College of
Physicians and Surgeons, President of the Institute on Medicine as a Profession, 13
Feb 2006, The Hidden Cost of Organ Sale, American Journal of Transplantation,
6(7); 1524-1529,
http://www.societyandmedicine.columbia.edu/organs_challenge.shtml
Advocates think it self-evident that market incentives will yield more
organs

for transplantation. People are more likely to do something if they are going to get paid for it (6).

And sellers will not drive

out donors. Whatever financial incentives exist, siblings and parents will continue to donate to loved ones. These expectations , however,
may be disappointed . Since the 1970s, a group of economists and social psychologists
have been analyzing the tensions between extrinsic incentives financial
compensation and monetary rewards, and intrinsic incentivesthe moral
commitment to do ones duty. They hypothesize that extrinsic incentives can crowd
out intrinsic incentives, that the introduction of cash payments will weaken
moral obligations . As Uri Gneezy, a professor of behavioral science at the
University of Chicago School of Business, observes: Extrinsic motivation
might change the perception of the activity and destroy the intrinsic
motivation to perform it when no

apparent

reward

Although the case for the hidden costs of rewards is certainly not indisputable, it does suggest that

altruistic donation and

apart from the activity itself

is expected

(712).

a market in organs might reduce

overall supply . Perhaps the most celebrated analysis of the tension between intrinsic and extrinsic incentives is Titmuss work in blood

donation. His book, The Gift Relationship (1971), argued that the commercialization of blood represses the expression of altruism (and) erodes the sense of community. Payment
undermined the altruistic motivations of would-be blood donors. Titmuss supported his hypothesis by comparing blood donation in the United States and the United Kingdom. Analyzing

where the sale of blood was prohibited, Titmuss found that the
percentage of the population who donated blood and the amount of blood
donated steadily increased . By comparison, in the United States, where the sale of blood was
data from England and Wales over the period 19461968,

allowed, donations declined . Because U.S. data were more fragmentary, Titmuss drew as best he could on a variety of sources, including
surveys, municipal statistics and comments by medical experts and blood bank officials. Nevertheless, he confidently concluded: The data, when analyzed in microscopic fashion, blood
bank by blood bank area by area, city by city, state by state, revealed a generally worsening situation (12).

Physician opposition crushes solvency

D.L. Segev 10, associate professor of surgery and epidemiology at the Johns
Hopkins University School of Medicine, and S.E. Gentry, Associate Professor,
Mathematics, US Naval Academy, Kidneys for Sale: Whose Attitudes Matter?
American Journal of Transplantation Volume 10, Issue 5, pages 11131114, May
2010, http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2010.03085.x/full

First,

nothing else is relevant until physicians support organ sales . And ,

right now, they dont . In a recent survey of the American Society of Transplant Surgeons, only 20% of
transplant surgeonsthose actually doing the transplantssupported cash payments for deceased or live
donation (2). Similar lack of support was found among physicians from other
societies as well (3). Clearly an organ market will not be much of a market with
so few willing to perform the transplants or refer the patients. And a rift in
the transplant community resulting from a marginally supported organ market
will likely be much more detrimental to organ transplantation in the United States than
any putative increase in donation from establishing financial incentives (4). As such,
those seeking to better understand the viability of organ markets should
focus first on the physicians .

Organ banks backlash

Gabriel Danovitch 8, M.D., Prof of Clinical Medicine and Nephrology at UCLA, and
Francis Delmonico, MD, Clinical Prof of Surgery at Massachusetts General Hospital,
The prohibition of kidney sales and organ markets should remain, Current Opinion
in Organ Transplantation Volume 13(4), August 2008, p 386394
Many organ banks will not willingly participate in a commercial system of organ
sales. An algorithm of alternatives arises by that decision. The regulated system could attempt to force organ banks to comply
by making this a requirement as a governmental condition of participation. The proponents of the market
system should anticipate a bitter and protracted legal battle in the unlikely event
that this was the government's decision.

Once several of the nearly 60 organ banks in the U nited

S tates refuse to participate, chaos is set into motion . What if the patients of Massachusetts
go to New York to be on the list and the patients on the New York list complain that they are being disadvantaged by patients of
Massachusetts swelling the ranks of the list?

Not all transplant centers will comply with organ

sales because not all transplant surgeons and physicians will participate
as enablers of the transaction . The government does not tell physicians
how to practice medicine. Subscribing to organ sales will not be a
condition of licensure. What happens next?

No shortage their impacts are exaggerated, donations

increasing
Segev, 10 -- Johns Hopkins professor of surgery
[Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins
School of Public Health, Department of Mathematics, United States Naval Academy,
"Terminology Influences Many Aspects of the Market/Incentives Debate," American
Journal of Transplantation, 2010, 10, 2375, ebsco, accessed 8-27-14]

Carefully
examining the kidney waiting list reveals that the 'tremendous organ shortage' is
In seeking more precise terminology, we wish to clarify two other terms critical to this debate.

widely distorted , with totals on the waiting list inflated by inactive candidates who are
not eligible for a transplant (approximately one-third of the list). For exam- ple, between 2002
and 2007, McCullough and colleagues showed that the active kidney waiting list grew by only 10%, indicating a
near steady-state of new eligible regis- trants and transplants for them, while the inactive kidney waiting list grew
by 282% (2). Furthermore, live donation rates are often said to have 'stalled' since 2004.

However, living donation rates tripled in the preceding 15 years (3). The level
donation rates since 2004 suggest sustainability of these historic highs in
donation. Some areas of living donation have seen exponential growth in the last
few years. Nondirected donation grew from 2 in 1998 to 56 in 2002 to 137 in 2009 (4,5). Paired donation grew
from 3 in 2000 to 39 in 2004 to 419 in 2009 (5,6). These donors do not comprise a large proportion of the living
donor pool at this early stage and so do not con- tribute to a visible overall rise in kidney donation. As they continue
to increase, however, these sources of donors will likely play a more obvious role in the future. In fact, the rise in
living donation between 2008 and 2009 is partly attributable to these novel modalities.

Tech solves
A. Xenotransplantation- new discoveries
Moline, 14 Truth Atlas editor
[Aaron, "Xenotransplantation Could Solve Organ Crisis," 5-23-14,
truthatlas.com/xenotransplantation-could-solve-organ-crisis/, accessed 8-28-14]

Xenotransplantation Could Solve Organ Crisis

Scientists are trying to resurrect a project, decades in development, that could potentially alleviate the dire
shortage of implantable organs in humans. Its called xenotransplantation, and it means altering the

organs of other animals into becoming functional in a human body, providing an

endlessly renewable source of hearts and other organs to those critically ill and still waiting for a
viable donor. It isnt exactly a new idea to use animal organs to replace damaged human ones. After all, we share a
common internal design with many different animals, and some are nearly identical to our own. Recently, the
discovery that human and pig skin are very similar has led to the use of animal-based skin grafts that have saved
the lives of burn victims worldwide. However, our powerful immune systems, which are poised to attack any foreign
object from any source, including human donors, remain an obstacle to using internal organs from these same
animals for xenotransplantation. Now, a new project has demonstrated that such an operation

is indeed possible by successfully implanting a pig heart within the body of a baboon.
While this may sound like mad science, it is the first step in developing a method to give these organs to the people
who need them most. Of course, this achievement could not have been accomplished without a substantial effort
from scientists at the US National Heart, Lung and Blood Institute in Bethesda, Maryland. They first observed the
method by which the primate body rejected the new organ. Two different sets of protections exists within our bodies
and those of the baboons to keep foreign organs out. The first is a system of detection, which the scientists fooled
by masking the organ, modifying its genome not to produce the molecule that signals the immune system. The
second is the weaponry with which the immune system attacks these invaders, which had to be shielded against
with the genetic introduction of a new protein that bolsters the organs defenses. The next step was to correct the
problems that arose over time when an animal lived with a mismatched heart. They noticed a tendency for blood
clots to form in both donated hearts and kidneys, both of which pose serious risks to the animal. A third genetic
modification was needed: the addition of a human anti-clotting substance called thrombomodulin to keep the organ
healthy over time.

The results have been an astounding increase in the efficacy of

xenotransplantation . Hearts that once gave out after 6 months now last 2 years, providing the
foundation of the technology that one day could provide the organs patients
desperately need. As the global population ages, the demand for these organs will only rise as the supply
ebbs. When that day arrives, we may need to rely on our porcine friends to give us a heart.

Plan kills the industry at its base

MORTENSEN 05 BA, MA, LLB, BCL, LLM at the Institute of
Comparative Law of McGill University [Melanie J. Mortensen, In the Shadow of Doctor
Moreau: A Contextual Reading of the Proposed Canadian Standard for Xenotransplantation, university of ottawa law
& technology journal]

It seems anomalous to provide the heading alternatives to xenotransplantation, since it would seem to imply that

human-organ
transplantation is the accepted practice, whereas xenotransplantation is
simply an alternative to this practice since the Canadian government has already committed to
increasing the levels of organ donation. The Ontario government recently proposed an
initiative with regard to better procurement requests on the part of doctors when dealing with
patients and the families of patients. These developments are encouraging. Nevertheless, it has
xenotransplantation is a foregone conclusion. Instead, I wish to emphasize the fact that

been argued that human donors will never provide enough transplantable organs to meet the demand, even if

better efforts
concentrated on improving access to human organs because they are currently the
procurement rates improve.121 It is tragic that there is an organ shortage, but there must be

more biologically sound choice. Indeed, as discussed above, even if organ-donation rates were to increase, there
would still likely be problems with hyperacute and chronic rejection of the organ, as well as with the reoccurrence of
the disease that caused the necessity for the organ transplant in the first place.122 The Canadian governments
initiatives toward reducing the need for organ transplants by focusing on the treatment of disease

represent

another positive step that could help to avoid the need for difficult
biotechnology products such as xenotransplants . There should be more stringent
controls on the development of xenotransplantation within Canada in light of the complications of this science and

the potential reduction of

organ shortages that might follow the improvement in the procurement of
organ donations, the reduction of both human-transplant rejection and the severity of diseases that give
in light of the unpromising outcome for patients at present in comparison to

rise to organ failure, as well as the development of more effective artificial replacements.

B. 3D printing- new tech is a quantum leap forward

Gilpin, 14 -- TechRepublic staff writer, citing Dr. Jay Hoying, the Division Chief of
Cardiovascular Therapeutics at the Cardiovascular Innovation Institute at Louisville
[Lyndsey, "New 3D bioprinter to reproduce human organs, change the face of
healthcare," Tech Republic, 8-1-14, www.techrepublic.com/article/new-3d-bioprinterto-reproduce-human-organs/, accessed 8-28-14]

New 3D bioprinter to reproduce human organs, change the face of healthcare

Researchers are only steps away from bioprinting tissues and organs to solve a myriad of injuries and
illnesses. TechRepublic has the inside story of the new product accelerating the process. If you want to understand how
close the medical community is to a quantum leap forward in 3D bioprinting, then you
need to look at the work that one intern is doing this summer at the University of Louisville. A team of doctors, researchers, technicians,
and students at the Cardiovascular Innovation Institute (CII) on Muhammad Ali Boulevard in Louisville, Kentucky swarm around the BioAssembly Tool (BAT),
a square black machine that's solid on the bottom and encased in glass on three sides on the top. There's a large stuffed animal bat sitting on the machine
and a computer monitor on the side, showing magnified images of the biomaterial that the machine is printing. This team stands at the forefront of

the team is also

pioneering breakthroughs in printing human stem cells -- a move that could
research in 3D bioprinting, as they methodically take steps toward printing a working human heart. As part of this work,

remove the raging ethical dilemmas associated with stem cells and potentially
take regenerative medicine to new heights. The combination of these stem cells and 3D bioprinting is going to help
repair or replace damaged human organs and tissues, improve surgeries, and ultimately give patients far better outcomes in dealing with a wide range of
illnesses and injuries. But, there are problems with BAT -- as advanced as it is from its surprising background as a military project. It's way too slow and
printing anything with it is a tortuously manual process. The printhead runs on a three-axis robot that doesn't handle curves very well. No one at the lab
knows the limitations and challenges of BAT better than a summer intern named Katie, an undergrad from Georgetown University. She's in Louisville as
part of a summer program for the Howard Hughes Medical Institute that exposes students to cutting edge research and lets them participate in
groundbreaking work. Katie's not sure what she wants to do when she finishes her bachelor's degree in mathematics but she has thrown herself into her
work at the CII with full intensity this summer. A big part of what Katie does is build intricate scripts to tell BAT what to print. It's similar to a computer
programmer writing in assembly language to give a computer system an exact set of instructions. It's an incredibly laborious process and it involves Katie
going back and forth with Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at CII and one of the leaders of the 3D bioprinting project.
"What's interesting is Katie's background in mathematics," said Hoying, "which is really essential here because it's basically a geometry problem." But

Hoying and his team are about to get a new 3D bioprinting solution that will
accelerate their work so significantly that what has taken Katie half the summer will soon take half a day, according to Hoying.
This new solution's hardware, BioAssemblyBot (BAB), runs as a six-axis robot that is far more precise than BAT. The real difference, however, is in the
software: Tissue Structure Information Modeling (TSIM), which is basically a CAD program for biology. It takes the manual coding out of the process and
replaces it with something that resembles desktop image editing software. It allows the medical researchers to scan and manipulate 3D models of organs
and tissues and then use those to make decisions in diagnosing patients. And then, use those same scans to model tissues (and eventually organs) to

It's a big step forward in the capability and technology of bioprinting

print using the BAB. "

,"
said Hoying, "but what someone like me is really excited about is now it enables me to do so much more." Hoying went back to the example of his highlycapable intern, Katie. "Katie has spent half the summer just understanding and scripting up and doing this," he said. "Now if Katie can do that in half a
day, I can do more biology, I can do more experiments. I can explore new cell combinations.... In that same half a summer I could have explored different
structures, different cell-[to]-cell combinations, experiment here growing them up, etc. Where she's taking half the summer to understand the geometry,
script it out, test it... with the BAB and the TSIM, I would have finished a handful of experiments." Bioprinting's new robot BAB and TSIM are an integrated
package built by Advanced Solutions, a private biotech company located in suburban Louisville. The new solution officially launches today -- Friday, August
1, 2014 -- and Hoying's CII is not the only lab ready to jump on it. In fact, Hoying is concerned that demand could be so strong that it could interfere with
his facility getting one as soon as he would hope, although that seems unlikely considering Hoying was an important collaborator and consultant for
Advanced Solutions in creating the product. While the lab where Katie and Dr. Hoying run their experiments is downtown next to the hospitals and cutting
edge medical facilities, the Advanced Solutions office is about 20 miles east, tucked away in a suburban office park that's also home to a tree care service,
a construction company, a dental association, a US Postal Service branch, and a handful of small healthcare companies. The building that houses
Advanced Solutions sits just down a hill off Nelson Miller Parkway, and less than 1000 feet from the I-265 interstate highway. From the outside, there's little
indication that the single story brick structure houses a team of 65 people who are working on a hardware and software solution that could revolutionize
modern medicine. Advanced Solutions has been around since 1987. During most of the time since then, it has been a software provider building solutions
on top of Autodesk for specific industries. But, in October 2010, Advanced Solutions CEO Michael Golway took an alumni tour of the CII -- since Golway is a
University of Louisville alum and the university is a key partner of the facility. Golway told TechRepublic, "At the end of the presentation, Dr. Stu Williams
passionately summarized the CII business model and I was not only impressed by the CII innovation, team of researchers and focus on cardiovascular
solutions but intrigued by the possibilities that Advanced Solutions engineering know-how could contribute in a positive and profound way to helping his
team. I followed back up with Dr. Williams one-on-one and we became fast friends." That began the journey that would lead to the integrated solution that
Golway and his team devised to meet the needs of Williams, Hoying, and researchers and hospitals throughout the world. "Over the course of 2.5 years we
would periodically meet and I learned about some of the technological workflow challenges that slowed his team from advancing the biology research to
achieve the Total Bioficial Heart," Golway said. "Dr. Williams and eventually Dr. Hoying also invested time in learning more about the Advanced Solutions
team and our capabilities. After 2.5 years of building a terrific working relationship, listening, learning and collaborating I brought forward an engineering
design concept for Dr. Williams and Dr. Hoying to consider that was intended to solve the tissue design technology problem." Hoying and Williams, who is
the division chief of the bioficial heart program at the CII, are both widely respected cell biologists who came to Louisville from Arizona to work together.
They were obviously impressed that Golway's solution could get them closer to their goal of creating that "Total Bioficial Heart." Golway continued, "In
March 2013, Advanced Solutions Life Sciences, LLC was formed as a wholly owned subsidiary of Advanced Solutions, Inc. to engineer, fabricate and
commercialize the technology in support of that initial concept design. Today the BioAssemblyBot and [the] TSIM software integrated solution are the work

this work as part of a larger trend of digitizing the

is destined to unleash other new advances as well

product from that endeavor." Beyond the launch of his company's product, Golway views

medical and biological space, which

. "What's been really
interesting to me is that we're on a trajectory here where we're really treating biology as more of an information technology," Golway said. "That's
incredibly exciting to us because IT grows exponentially -- instead of just the hardcore traditional discovery that biology has been tracking on, if we can
translate that into IT we can take that experimentation and rapidly start looking at optimization. How to combine cell types in a way to create cell types

The exponential curve is already there but this technology allows you to take
the next step."
and structures.

C. Organ cloning- tech exists now

Aronson, 13 -- Organ Transplant Initiative founder
[Bob, "Artificial and Bioengineered Organs Can End the Shortage," 2-10-13,
https://bobsnewheart.wordpress.com/category/ending-the-organ-shortagesolutions/, accessed 8-28-14]

In June 2011, an Eritrean man entered an operating theater with a cancer-ridden windpipe,
People had received windpipe transplants before, but this one was different. His was the first organ of its kind
to be completely grown in a lab using the patients own cells . The windpipe is one
of the latest successes in the ongoing quest to grow artificial organs in a lab. The

No-one
will have to wait on lengthy transplant lists for donor organs and no-one will have to
take powerful and debilitating drugs to prevent their immune systems from rejecting new
body parts. Scaffolds for Tissue Repair energy pulsar Researchers are making use of advances in knowledge of stem cells,
goal is deceptively simple: build bespoke organs for individual patients by sculpting them from living flesh on demand.

basic cells that can be transformed into types that are specific to tissues like liver or lung. They are learning more about what they
call scaffolds, compounds that act like mortar to hold cells in their proper place and that also play a major role in how cells are
recruited for tissue repair. Tissue engineers caution that the work they are doing is experimental and costly, and that the creation of
complex organs is still a long way off. But they are increasingly optimistic about the possibilities. Bioartificial Liver Boston company
HepaLife is working on a bioartificial liver using a proprietary line of liver stem cells. Once the patients blood is separated into
plasma and blood cells, a external bioreactor unit with those stem cells inside can reduce levels of toxic ammonia by 75% in less
than a day. Bioartificial Hand Smarenergy coming from a handtHand is a bioadaptive hand that can actually feel. Its 40 sensors
communicate back and forth directly with the brain using nerve endings in the arm. The hand sends its sensory input to the brain,
and the brain sends instructions for movement to the hand. The result? It can pick up a plastic water bottle without crushing it, or
pour a drink without spills. BioLung MC3 BioLung is a soda-can-shaped implantable device that uses the hearts pumping power to
move blood through its filters. Its designed to work alongside a natural lung, exchanging oxygen from the air with carbon dioxide
from the bloodstream. So far, its been tried on sheep, where six of the eight animals on the BioLung machine survived for five days.
Human trials are expected within the next couple of years. 3D Organ Printing Organ printing, or the process of engineering tissue via
3D printing, possesses revolutionary potential for organ transplants. The creation process of artificial tissue is a complex and
expensive process. In order to build 3D structures such as a kidney or lung, a printer is used to assemble cells into whichever shape
is wanted. For this to happen, the printer creates a sheet of bio-paper which is cell-friendly. Afterwards, it prints out the living cell
clusters onto the paper. After the clusters are placed close to one another, the cells naturally self-organize and morph into more
complex tissue structures. The whole process is then repeated to add multiple layers with each layer separated by a thin piece of

Using the patients own cells as

a catalyst, artificial organs may soon become mainstream practice among treatment centers
worldwide. As the health of the nation delves down to record negatives, organ printing may be the establishments answer to
a number of preventable conditions. The above alternatives to human organs are but the tip of
the iceberg. Medical science and technology are on the verge of incredible
breakhroughs that will extend life and, at some point, end the need for human organ
donation, anti-rejection drugs and maybe even invasive surgery.
bio-paper. Eventually, the bio-paper dissolves and all of the layers become one.

1NCTrafficking
Doesnt get rid of the black market
Michael Hentrich 12, 19 Mar 2012, Health Matters: Human Organ Donations,
Sales, and the Black Market, http://arxiv-web3.library.cornell.edu/pdf/1203.4289v1
Contemporary sociologists including Michele Goodwin in Black Markets: The Supply and Demand of
Body Parts (2006) have criticized the present system, pointing out that where there is a
gift-relationship procurement system, a thriving black market also exists. Goodwin also argues that
poor African American communities are especially ill-served by black markets. There are simply no
guarantees that either regulation or marketization would alleviate black
market use rates

and supply-side shortages. Consider that

a black market prospers

even in Iran where the government regulates kidney pricing; black

market use there (even for kidneys) has not been eliminated or even
substantially limited .

The plan is insufficient there is strong demand for organs

outside the U.S.
Shimazono 7 Yosuke, Assistant Professor in Medicine @ Osaka University, The
state of the international organ trade: a provisional picture based on integration of
available information http://www.who.int/bulletin/volumes/85/12/06-039370/en/
The organ-exporting countries
Other forms of international organ trade There are other forms of
international organ trade that demand attention. In some cases, live donors
have reportedly been brought from the Republic of Moldova to the United States of America, or from
Nepal to India.7,8 In other cases both recipients and donors from different
countries move to a third country. More than 100 illegal kidney transplants
were performed at St. Augustine Hospital in South Africa in 2001 and 2002; most
of the recipients came from Israel , while the donors were from eastern Europe
and Brazil. The police investigation in Brazil and South Africa revealed the existence
of an international organ trafficking syndicate.9 These cases may involve
human trafficking for the purpose of organ transplantation . Unlike cell tissues, no
confirmed report on transplant organs being trafficked after their removal was found in this survey.

A regulated market of organs cant solve the black market or

organized crime
Delmonico et al 2 Francis L., M.D. Massachusetts General Hospital, Robert
Arnold, M.D University of Pittsburgh, Nancy Scheper-Hughes, Ph.D. University of
California Berkeley, Laura A. Siminoff, Ph.D Case Western Reserve University
School of Medicine, Jeffrey Kahn, Ph.D, M.P.H., - University of Minnesota, Stuart J.
Youngner, M.D. Case Western Reserve University School of Medicine, ETHICAL

INCENTIVES NOT PAYMENT FOR ORGAN DONATION, N Engl J Med, Vol. 346, No.
25, http://eml.berkeley.edu/~webfac/held/delmonico.pdf
A REGULATED MARKET SYSTEM Since the current system of altruistic organ donation has not met
the demand for organs, some critics suggest that the way to resolve this problem is
to turn to a market approach that would permit the sale of human
organs.41'44 However, the ethical principle that one should not sell one's body applies whether the market is
regulated or left to the vicissitudes of capitalism.45 A system regulated by a government
agency (e.g., the Department of Health and Human Services) would probably not be the only
source of organs for sale . In fact, the futility of trying to reg- ulate payments
to donors is suggested by worldwide experience . In the current global
market, prices vary depending on the region and the social status and sex of the
donor. For example, in Bombay, India, the current price for a woman's kidney is said to be
S 1,000; in Manila, the Philippines, the price for a man's kidney may be closer to $2,000;
and in urban Latin America, a kidney can be sold for more than $10,000. Such are the
payments allegedly made to the vendor; payments to the broker are an
additional expense that can drive the cost of the organ even higher .
Payments have allegedly exceeded $200,000 for arrangements in which the
financial transaction occurred in another country and the transplantation
was performed in the U nited S tates.18 Brokering in the U nited S tates according
to market criteria of donor suitability would probably be no different. If the
current prohibition against the sale of organs were rescinded, there would be little
legal or ethical justification for preventing persons from bypassing the
regulated system and using other means to obtain a better price for an
organ from a more medically suitable donor . The Internet can be used to
secure the best price for any commodity. A federally regulated system would have to outlaw
Internet bidding and set a controlled price for certain types of donors or continuously modify the price.

Beard is entirely wrong we cite him.

-squo system is working
-crowd out

Capron, 14 this evidence is responding directly to Beard who is cited in

the footnotes - University Professor and Scott H. Bice Chair in Healthcare Law,
Policy, and Ethics, University of Southern California (Alexander, SIX DECADES OF
ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A
MARKET SYSTEM WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY
PROBLEMS Vol. 77:25)

Free-market economists are quick to pronounce that the organ

transplantation policies based on the noncommercial model followed by most
countries over the past three decades have failed. 153 This seems a rather blinkered
assessment of a system that has extended and improved millions of lives

while also providing a dramatic affirmation of human generosity and solidarity. There is no question that more

were all countries to adopt the best practices used by

the organ-procurement programs with the highest rates of donation, a
huge increase in transplantation would be possible without resort to
organs are needed, but

paying for organs . Indeed, during the first decade of this century, a concerted effort by the Department
of Health and Human Services led to an increase of more than twenty-five percent in the rate of donation in the

if only a small fraction of the amount that would need

to be spent to purchase organs in a regulated market were instead used
to improve the present system, further substantial increases in the rate of
donation would be possible. But what of the claim that it is self-evident that paying
for organs would increase the net rate of donation? 155 The extensive
United States.154 Moreover,

literature on crowding out suggests that many people who are willing
to donate in a voluntary, unpaid system would cease doing so once paid
donation became an accepted practice.156 It is not simply that one does not want to be played for a
fool (by giving away what others are paid for), but that the nature of the act changes when it
is not experienced by the donor, and seen immediately and universally by others, as
something that is generous and ennobling. This change would be
especially pronounced if, as is likely to be the case, most organ vendors
were understood to be acting out of financial desperation. Although todays most
highly motivated donorsthose who are giving a kidney to a close relativemight be expected to be immune to
such a change, this has been found not to be the case. [R]ecently,

when the U.S. rules for

allocating deceased donor kidneys were changed to give children on the
waiting list greater access to deceased adult donors kidneys, parental
donations fell by a larger amount, so that overall fewer pediatric kidney
transplants are being done while some potential adult recipients have been deprived of a kidney that
went to a child instead.157 Likewise, the ready availability of vended kidneys and liver
lobes would leave most potential recipients disinclined to ask a relative or
friend to donate. Who would want to ask for such a gift from a loved one when his or her need for an organ
can be met without imposing any burden on that person and without enmeshing oneself in all the psychological and
moral complexities that arise in the gift relationship?158 Summarizing observational and experimental research
over many decades by economists and social psychologists, Sheila and David Rothman conclude that although the
case for the hidden costs of rewards is certainly not indisputable, it does suggest that a market in organs might
reduce altruistic donation and overall supply.159

(Footnote 153)
153. T. RANDOLPH

BEARD , DAVID L. KASERMAN & RIGMAR OSTERKAMP, THE GLOBAL ORGAN SHORTAGE:

ECONOMIC CAUSES, HUMAN CONSEQUENCES, POLICY RESPONSES 1 (2013).

Impact Framing
The aff is equally uncertain---the causal effect on the organ
shortage is unpredictable
Julia D. Mahoney 9, John S. Battle Professor of Law, University of Virginia School
of Law, ALTRUISM, MARKETS, AND ORGAN PROCUREMENT, Law and Contemporary
Problems Vol 72:17, http://scholarship.law.duke.edu/cgi/viewcontent.cgi?
article=1535&context=lcp
That the arguments for refusing to compensate organ sources are unpersuasive does not mean that instituting financial rewards
would necessarily prove to be a good policy choice. Introducing financial incentives raises significant challenges, not least among
them overcoming the potential hostility of procurement professionals, bioethicists, and others who fiercely espouse the principle of

Removing,
modifying, or declining to enforce the formal constraintsthat is, the laws and
regulations prohibiting compensation for organ sources will not
altruistic donation. Compounding such resistance are formal and informal constraints on financial incentives.77

automatically dissolve the informal constraints of organizational practice

and social norms. That said, there is reason to suspect that informal institutional limits on financial incentives are
malleable.78 At the very least, some forms of financial incentives might prove both effective and acceptable. But, in
assessing potential institutional modifications, we are hampered by our
limited knowledge of how societal attitudes change. Another stumbling
block is our rudimentary understanding of the organizational framework
that encourages and supports altruism in the context of organ donation.79 It is worthwhile to
examine the four most prominent financial-incentive proposals and assess their feasibility. Any such analysis is
necessarily preliminary , for the long-standing, strict proscriptions against
compensating organ sources make it hard to predict how procurement
organizations and professionals, prospective donors, the general public,
and others will react to policy innovations.80

Precautionary approach key

Mark Jablonowski 10, Lecturer in Economics at the University of Hartford,
Implications of Fuzziness for the Practical Management of High-Stakes Risks,
International Journal of Computational Intelligence Systems, Vol.3, No. 1 (April,
2010), 1-7,
Danger

is an inherently fuzzy concept. Considerable knowledge

imperfections surround both the probability of high-stakes exposures, and the

assessment of their acceptability. This is due to the complex and dynamic nature of risk
in the modern world. Fuzzy thresholds for danger are most effectively
established based on natural risk standards. This means that risk levels are
acceptable only to the degree they blend with natural background levels .
This concept reflects an evolutionary process that has supported life on this planet for thousands of years. By

While the level of such

risks is yet to be determined, observation suggest that the degree of
human-made risk we routinely subject ourselves to is several orders of
adhering to these levels, we can help assure ourselves of thousands more.

magnitude higher .

Due to the fuzzy nature of risk , we can not rely on statistical techniques.
The fundamental problem with catastrophe remains, in the long run,
there may be no long run . That is, we can not rely on results averaging out
over time. With such risks, only precautionary avoidance (based on the
minimaxing of the largest possible loss ) makes sense. Combined with reasonable
natural thresholds, this view allows a very workable approach to achieving safe progress.

2NC

CP

2NC Solves Demand

The CP procures almost 100% of organs with no risk of abuse
Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York,
New York (Aaron, Conscription of Cadaveric Organs for Transplantation: A
Stimulating Idea Whose Time Has Not Yet Come Cambridge Quarterly of Healthcare
Ethics (2005), 14, 107112)
The most important advantage of conscription is that under this plan, the efficiency of
organ procurement should approach 100% , which would dramatically
increase the number of organs available for transplantation. As previously noted,
it is highly unlikely that any other approach could do nearly as well . As a result
of the increased availability of organs that conscription would provide, the lives of many more patients with endstage organ failure could be improved and extended.

this system would be much simpler and less

costly than other approaches to organ procurement. Under this plan there would
be no need to search for the best approach for obtaining consent, no need for expensive, labor-intensive
Another advantage of conscription is that

educational programs designed to encourage more people to say yes, no need to train requestors to obtain and

for complex regulatory

mechanisms to prevent abuse as would be required were financial
incentives allowed.
document consent, no need to maintain donor registries, and no need

A third advantage of conscription is that because permission from the family would no longer be sought, this plan
would eliminate the added stress that devastated families now endure when asked to consider organ donation in

delays in organ
recovery that result from the current need to wait for family approval, and
that jeopardize the quality of organs, would be eliminated.
the midst of the grief and shock that follow the sudden death of a loved one. Furthermore,

A final advantage of conscription is that,

in contrast to other approaches to organ

procurement, it satisfies the principle of distributive justice, which refers to
equitable sharing of burdens and benefits by members of the community. Under conscription, all people
who die with usable organs would contribute to the cadaveric organ pool
there would be no more free riders 1and all people would stand to
benefit should they ever need an organ transplant. This contrasts with our current system in which people can
refuse to donate and yet compete equally for an organ with generous people who choose to give.

Theyre conflating the shortage which is an annual rate with

the size of the waiting list---we provide enough organs to
create an annual surplus which in turn reduces the waitlist
over time
David Kaserman 2, PhD in Econ from the University of Florida, Markets for
Organs: Myths and Misconceptions, 18 J. Contemp. Health L. & Pol'y 567 (2002),
http://scholarship.law.edu/cgi/viewcontent.cgi?article=1222&context=jchlp
For over three decades, there has been a severe and chronic shortage of
cadaveric human organs suitable for transplantation. The ongoing shortage of
kidneys, hearts, livers, lungs, and other solid organs has significantly hampered the ability of physicians to bring
improved life-saving transplant technology to patients suffering from a variety of debilitating and often fatal
diseases. As a result, thousands of individuals die each year because of the failure to obtain a suitable organ in

time.' Thousands more are forced to undergo dialysis and other unpleasant but life-sustaining treatments while

this shortage of transplantable

organs is not attributable to an inadequate supply of potential organ
donors. While estimates of the actual number of deaths that occur each
year under circumstances that would allow for removal and
transplantation of cadaver organs vary widely, all such estimates reveal a
waiting for an organ (or death, whichever comes first). It is noteworthy that

substantial pool of potential organ donors who, for a variety of reasons,

fail to supply the needed organs.2 A review of these estimates conservatively
suggests that organ donations could at least double , given the existing
number of potential donors. The failure of the current procurement system to collect a larger portion
of the cadaveric organs that are potentially available has spawned an extensive literature proffering a variety of
proposals to alter the existing system in various fundamental and not-so-fundamental ways. Among these
proposals, perhaps the most promising is a lifting of the legal ban on cadaveric organ purchases and sales that is
contained in the 1984 National Organ Transplant Act, which would allow markets to form and organ prices to rise to
their equilibrium, market-clearing levels.3 To an economist, this proposal provides an obvious and straightforward
approach to resolving the organ or any other shortage. To many of the commentators on medical policy issues who
are contributing to the literature in this area, however, the organ market proposal is highly suspect and has been
challenged on both ethical and economic grounds.4 Significantly, most, if not all, of these challenges appear to be
founded upon rather blatant misconceptions involving some very fundamental economic issues.5 While errors
involving economic concepts may be inevitable in a literature that has been dominated by non-economists,
correction of such errors is nonetheless necessary if policy discussions and ultimate decisions are to be founded
upon accurate information. The somewhat limited purpose of this paper is to identify and correct some of the more
prominent economic misconceptions involving the organ market proposal that currently plague the literature in the
hope that the resulting increased clarity will help to elevate the level of the ongoing debate. While I certainly do not
intend or expect this discussion to transform readers into economists, the clarifications offered in this article should
improve the overall understanding of the organ market proposal and how it can work to resolve this tragic shortage.
II. MISCONCEPTION 1: DEFINITION AND MEASUREMENT OF THE SHORTAGE Perhaps the most fundamental
misconception surrounding discussions of the organ shortage involves the very definition of the term "shortage,"
and the corresponding measurement of the magnitude of that shortage. Specifically, several authors writing in this
area have mistakenly interpreted the number of patients on a transplant waiting list as a direct measure of the size
of the shortage of a particular organ. Such a view fails to recognize the crucial distinction between stocks and flows
that is routinely emphasized in economic analysis. Economists define a shortage as a condition in which the
quantity of a product demanded exceeds the quantity supplied at the existing price! To appreciate what this
definition implies for the organ shortage, two fundamental aspects of the concepts of supply and demand must first
be understood. First, both of these concepts refer to schedules relating the quantities bought and sold to various
prices paid and received. That is, the term "demand" means a schedule, which may be expressed in the form of a
table, graph, or equation that shows the quantities that will be purchased at all possible prices. A specific quantity,
at some point along that schedule, is then referred to as the "quantity demanded" at the specified price. Similarly,
"supply" is a schedule that indicates the quantities that will be placed on the market for sale at all possible prices.
"Quantity supplied" refers to a single point along that schedule. Thus,

the present shortage of

transplantable organs is equal to the quantity demanded minus the quantity supplied
at the current price of organs. Under the existing U.S. organ procurement policy, that price is zero. Second, and
extremely important for the discussion here,
demand

are flows, not stocks.

the quantities referred to in the definitions of both supply and

In other words, these quantities are expressed as some number of

units of the product per some interval of time . To say that the quantity demanded or
supplied of product X is 100 units at a price of $10 per unit is meaningless unless we specify the time period over
which these 100 units will be purchased or sold.Obviously, the demand and supply of a product will vary
substantially depending upon the time interval over which they are defined. This second point is crucial to
understand, as it has been the source of considerable confusion in debates about the organ shortage and

participants in these debates often

have explicitly or implicitly confused the number of patients on transplant
alternative policies formulated to resolve it. Specifically,

waiting lists, which is a stock, with the concept of a shortage , which is a

flow.8 The size of the waiting lists for transplantable organs represents the

accumulation of the excess demands (shortages) of all preceding periods,

adjusted for the attrition that occurs from patients dying during the specified time interval. As such,
observed waiting lists greatly exaggerate the magnitude of the actual
organ shortage on an annual (or any other time period) basis. To illustrate this important
distinction, data from the United Network for Organs Sharing (UNOS) indicates that the waiting list for
kidneys stood at 42,364 patients in 1998.9 However, the actual annual
shortage of kidneys is not equal to this number. Rather, the shortage is approximated by the increase in
the number of people on the waiting list over the preceding year's figure. It is that number-the annual change in the
waiting list-that indicates the amount by which the quantity demanded in 1997 exceeded the quantity supplied in

the actual shortage in that year

was only 4,128 (42,364 minus 38,236) kidneys, or just over 2,000 donors , if there is no

that year. With UNOS reporting 38,236 people on this list in 1997,

adjustment for attrition due to deaths of patients on the list.'0 Note that this number is less than ten percent of the
number of patients on the waiting list."

FOOTNOTE

8. See Evans et al., supra note 2, at 239; Randall, supra

note 6, at 1223; Siminoff & Leonard, supra note 4, at 20. All of these

articles appear to confuse

waiting lists with shortages. That confusion , in turn, appears to lead these
authors to conclude mistakenly that the potential supply of cadaveric
donors is insufficient to eliminate the organ shortage at any conceivable
collection rate

(i.e., at any rate up to 100%).

END FOOTNOTE

Obviously,

if 4,128

additional kidneys had been supplied in 1997, the waiting list would have
remained stable

at 38,236. That is, the backlog would not have grown. Further, if 42,364 kidneys had

been supplied in 1998, the entire waiting list that had built up over all prior years of shortages could have been
eliminated completely in a single year. Then, if that number of kidneys continued to be supplied in subsequent

given the backlog of patients

annual surplus is highly desirable for some period into the future in order to
reduce that list over 12 time. Once the backlog is eliminated by this series of
surpluses, however, a simple clearing of the annual demand for kidneys will
years, an extremely large surplus would materialize immediately. Of course,
on the waiting list, an

be sufficient to prevent future backlogs

from developing. Clarification of this issue is

important, because it directly affects the perceived ability of any policy change to eliminate the shortage under the

if one mistakenly
views the shortage as being equal to the waiting list, one might then
conclude ( incorrectly ) that complete resolution of the shortage is not
constraint provided by the existing pool of potential organ donors. Specifically,

feasible

under any policy option. 3 In addition, overestimation of the shortage by reference to the waiting list

would lead to a gross overestimate of the price that would be required to equilibrate the market.1 4 Such an
overestimate, in turn, would cause an underestimation of the cost effectiveness of the organ market proposal. As a
result, unbiased evaluation of that proposal requires a correct definition and measurement of the shortage as a flow
rather than a stock.

Since deceased donors are dead, they can give both of their
kidneys and a host of other organs---the actual potential
supply is 40 thousand kidneys a year and 20 thousand each for
other organs
Theodore Silver 88, J.D., M.D., Assistant Professor of Law at Touro College and the
Jacob D. Fuchsberg Law Center, The Case for a Post-Mortem Organ Draft and a
Proposed Model Organ Draft Act, 68 B. U. L. Rev. 681 (1988),

http://digitalcommons.tourolaw.edu/cgi/viewcontent.cgi?
article=1181&context=scholarlyworks
most of their cadaveric organs are not
suitable for transplant. BUREAU OF CENSUS, U.S. DEP'T OF COMMERCE, STATISTICAL ABSTRACT OF THE UNITED STATES 1986,
(table 81) (1986). Transplantable organs must come primarily from brain-dead patients
whose breathing and cardiac activity have been artificially maintained . When
25 Although approximately two million people die annually in the United States,

the heart stops and respiration ceases, oxygen deprivation quickly renders organs unsuitable for transplantation. Telephone conversation with Dr. James
Cerilli, Direc-tor of Transplantation, University of Rochester School of Medicine (Jan. 1989). Because organs must come from brain-dead bodies whose
respiration and circulation have been artificially maintained after death, donors must, first of all, die in hospitals. About one-half of Americans do so. Bart,
Macon, Whittier, Baldwin & Blount, Cadaveric Kidneys For Transplantation: A Paradox of Shortage in the Face of Plenty, 31 TRANSPLANTATION 379-81
(1982) (indicating that 60% of people who die in the United States die in hospitals); Cooper, supra note 10, at 417 (noting that in a study in Washington

Medical wisdom also dictates that donors

must be relatively young and free from disease impinging on the organ to be
salvaged. Though estimates vary, it appears that about two percent of the approximately one
state, nearly half of the recorded deaths occurred in hospitals).

million patients who die annually in U nited S tates hospitals satisfy

these criteria . See, e.g., Mertz, The Organ Procurement Problem: Many Causes, No Easy Solution, 254 J. A.M.A. 3258 (1985); Russel &
Cosimi, Transplantation, 301 N. ENG. J. MED. 470-79 (1979); Cooper, supra note 10, at 416-20 (estimating the potential kidney donors in Washington as
0.0032% of the population per year); Bart, Prevalence ofCadaveric Kidneysjbr Transplantation, in AMERICAN ASSOCIATION OF TISSUE BANKS:
PROCEEDINGS OF THE 1977 ANNUAL MEETING 124-30 (K. Sell, V. Pewy & M. Vincent eds. 1977). If two percent of one million cadavers are suitable donors,

then the potential supply of single kidneys , a paired organ, is approximately

40,000 . The potential supply of hearts, livers, and lung pairs is
approximately 20,000 . This estimate is consistent with that of the Task
Force on Organ Transplantation which suggests that the potential pool of
organ donors is between 17,000 and 26,000 annually , although they recommend further study.
TASK FORCE 1986 REPORT, supra note 7, at 35.

AT: Do Both
The CP alone creates a legal bright line. The perm is the worst
of all worlds mixing sales with conscription blurs the line,
wrecks public trust or the ability to create social change in the
medical system, subjects the government to costly litigation
that inhibits organ use and institutionalizes exploitation and
human rights abuses
Neri, 2 - Rebecca M. Neri, Esq., J.D. 2002, Syracuse University 2002; B.A. 1999,
Hobart and William Smith College. Ms. Neri is the Digest Form and Accuracy Editor
and is an Associate of Devorsetz, Stinziano, Gilberti, Smith & Heintz in Syracuse,
New York (New Organ Donations 10 Digest 67, lexis)

subjecting
corpses to traditional property reasoning, and consequently, to judicial
resolution creates a blanket disincentive to individuals, [*77] families, and members of the
transplant community, including doctors, donors, and transplant centers, to participate in organ
donation. Essentially, the total costs, in terms of money, time and emotional expenditures, simply do not
3. Entering Into a Discussion about the Body as a Commodity - As mentioned briefly above,

outweigh the benefits (i.e., a family knowing their gift let some stranger live). Additionally, requiring the

government to participate
in organ selling and requires the government to set a value scale for each
organ procured. Economically, the government and the people cannot afford to purchase
the organs needed to satisfy the deficit, nor can either afford to be tied up in litigation while
the organ's value dies with its body. In this sense, discussing the body as
property inhibits the goal of increasing organs by increasing the amount
government to set prices for organs offends public policy because it permits the

of red tape one must go through to donate . Nationalization (or the creation of a public
right) of human cadaveric organs could also result in serious human rights violations. n46 A simple, more efficient
way of thinking that embraces societal problems surrounding organ donation, while shaping public sentiment must
take the place of considering the body as property.
Initiating market responses to this problem is not the simple, more efficient way of thinking. Despite this, many
argue that a market approach to organ donation could indeed remedy transactional costs as well as eliminate the
need for litigation over governmental takings. Additionally, these market advocates feel financial incentives are the
most efficient means of remedying the organ shortage. For example, in a recent work David Jefferies proposes that
"the most effective way to increase the supply of organs will involve limited commercialization of bodily
components." n47 In his view, the law should provide for the use of a "middleman" who has the authority to
contract for organs and could halt potential abuses. n48 Upon the death of a willing and contracted donor, doctors
would remove the organ(s), and then the appropriate consideration for the organ would change hands. n49 Jefferies
then proposes that an organ procurement network set up an altruistic-based distribution system, rather than one
conditioned on wealth. n50
This proposal is not an answer to the inefficient means of organ procurement. As will be shown in Section Three,

contracting for body parts will require

more litigation to establish rules, interpret the rules, and to enforce the
rules, requiring efforts of all [*78] branches of government and the private sector. n51 Second, a
contracting scheme exacerbates public fears , rather than reshaping them
towards a better awareness of death, in that a contract for your organs
infra, market theories are inefficient and costly. First,

might breed paranoia that someone is trying to "snatch" the "goods"

prematurely .
III. Critique of the Market Alternatives
As stated above, applying a market strategy to remedy the current organ deficit is neither a more efficient, nor a
more practical remedy to the organ deficit problem.
rather than destroys societal fear,

A market in organs creates paranoia

and as such, does not incorporate the goal of shaping

a new public sentiment . Though it might eventually alleviate the organ deficit, the selling or
contracting

of organs would invite human rights abuses , such as body

snatching , despite retaining the specter of individual autonomy and public

control. This section makes the case that a market remedy for the organ shortage would present more obstacles to

a market strategy denies the

power of substantial societal value systems (such as common notions of
ethics and human rights), and favors a select part of the populatio n. After
meeting the demands for organs. Specifically, this part argues that

discussing current market proposals and the particular faults of the trendy market cure, the discussion will turn to
why market theories are incapable of reshaping the societal preference towards organ donation.
A. The Trend of Market Solutions
Many scholars have proposed market systems as a cure for the organ deficit. n52 Specifically, those in favor of
creating an organ market have argued that since altruistic systems have failed to produce the necessary organs,
self-interest in consideration might provide the adequate incentive to donate. n53 Their basic argument is that
in the market, the supply would be self-regulating because rising demand would raise the price of tissues in short
supply and produce incentives for individuals to sell their organs; these prices would ensure that enough organs
would be available to meet demand. n54
With the demand for organs being met through a market system, these scholars argue that the market is the most
efficient system of resource allocation, and that the market would alleviate the imbalance of how benefits and
burdens between the donor and recipient are distributed. n55 Thus, economically speaking, [*79] Pareto efficiency
is attained - the exchanges are consensual, voluntary, and utility is maximized. n56
Variations to the basic supply and demand model have also been proposed. For example, Lloyd Cohen argues for a
"futures market" to cure the organ deficit. n57 Specifically, Cohen proposes that "healthy individuals be given the
opportunity to contract for the sale of their body tissue for delivery after death." n58 Some would offer alternative
methods of exchange, namely, promises to donate organs in exchange for health insurance, tax breaks, death
benefits, public recognition of the donation, or a bartering system to secure other necessities. n59
Regardless of the economic model proposed or the mode or currency of exchange, each purports to disburse ethical
and human rights concerns that arise from the notion of selling one's organs. The most cited fear about creating a
market in organs is the exploitation of the weak, elderly, poor, and the power the market gives to the wealthy. n60
Another important ethical problem a market must deal with is whether thinking of the body as a commodity is even
appropriate. n61 All proponents of a market system insist that heavy regulation and the creation of strict criteria for
both the procurement and allocation of organs would remedy ethical concerns. n62

Any market system proposed will

surely exploit the poor. First, any market theory that relies
on the availability of something to exchange, and the willingness of participants to exchange necessarily inhibits

The poor, by virtue of their economic state are not in a

position of bargaining power. The poor do not have anything to give to enable the receipt of
an organ, and they are easy targets for unscrupulous organ harvesters who
would offer them a " meal for their left eye ." The tension of economic hardship hardly
the participation of the poor.

provides an optimal market scheme of voluntary and consensual exchanges.

Additionally, market systems that require heavy regulation are neither economically nor politically efficient.
Regulation necessitates a degree of complex rules, requiring judicial and legislative interpretation. In turn, market
regulation of this sort also becomes the embodiment of a recognized property right in one's body. As mentioned

above, inviting the body to interpretation as property brings its own set of ethical problems, as well as problems for
procuring organs. By entering the body into the stream of commerce, people would most likely seek enforcement of
property rights to their body, including rights to privacy, [*80] control, and transferability. People might also fear
the possibility that their bodies could escheat over to the state once their body becomes a commodity in the stream
of commerce. The remedy to this result would be regulation, which in turn forecloses on individual autonomy.
In sum, the free market alternatives to the current system of altruism create rather than destroy social and ethical
barriers to efficient organ procurement. This section attempted to illustrate that although the exchange of organs
on the free market appears to provide individuals with a great degree of control over the disposition of their bodies,
such control is dampened. That damper is created in the face of ethical concerns relating to the exploitation of the
poor, and the end result of having to provide for property rights in the body.
B. Market Models Fail to Shape a Preference to Donate
Market paradigms purport to shape individual preferences to donate by insisting that people act in their own best
interest. In other words, a market paradigm attempts to create specific opportunities for the public so that the
beneficial, logical preference for the individual is to donate their organs. n63 In this sense, using a market strategy
to provide organs must show that donating outweighs social costs associated with selling organs. n64 This part
proffers that the basic supply and demand market paradigm in which money is exchanged for organs is ineffective
in providing the public with the means to effectively weigh the social costs and benefits of donating organs. In this
sense, the prevailing societal preference under a market system would continue to deplete the organ supply. Thus,
any proposed market cure fails as a viable option to correct the current organ shortage.
Humans generally act in their own best interest, though, for the most part, they align with the sense of greater
social values. Indeed, some individuals act in accordance with what one author has termed, "socially responsible
reasoning," which take humans beyond being purely selfish actors. n65 Markets do not function on exchange alone;
they inevitably encompass institutional values, such as social preferences. n66 However, the prevailing social
preference of a market in human organs might very well be corrupt at its core, and thus, incapable of providing a
structure that weighs the personal costs against the social benefits to organ donation.
The corruption lies not in the potential for market abuses, but rather in the existing social consciousness of the
population. As mentioned above, the six [*81] most popular reasons people give for not donating organs are:
"hastiness of organ retrieval and a feeling that declaration of death and immediate subsequent removal of organs
interferes with the family's expression of grief; mutilation; fatalism and superstition; religion; age and ignorance."
n67 If the greater social value of organs is to prevent their being interred without harvesting and to save lives, then
the market must arrange itself around enabling people to weigh their cost or fear concerning donation. But how is a
market to do this when, in fact, the incentive is merely valued in fiscal terms? How can a market theory, which
relies on the wealth of its participants more so than the social justice of its actors effectively push social mores
towards weighing the benefits of giving over the cost of facing ones personal fears? It simply cannot. Though any
market incentive might push people towards realizing that money is preferable in exchange for needed organs, the
market incentive simply fails to account for the underlying fears of the people concerning donation.
The market cannot provide a structure in which ordinary people can rationally weigh costs and benefits of organ
donation, because the market lacks sufficient grounding in the irrational fears concerning donation. A pure incentive

cash , or other necessities is inadequate as it falls short of

effectively replacing existing social fears connected with donating organs
after death. If there really is to be any increase in the organ supply, the
answer lies in reshaping society not through a free market and property system,
program that replaces altruism with

but rather, through structuring discussion around changing social values

at their core .
IV. The Conscription Cure: Mandatory Cadaveric Organ Donation
The general will is always right, but the judgment that guides it is not always enlightened. It is therefore necessary
to make the people see things the way they are<elip>to point out to them the right path they are seeking. Some
must have their wills made to conform to the reason, and others must be taught what it is they will. From
this<elip>would result the union of judgment and will in the social body. From that union comes the harmony of the
parties and the highest power of the whole. n68
Earlier in this article, it was suggested that neither the current altruistic organ donation, nor trendy market
proposals that seek to cure the organ deficit work. n69 It has also been suggested that assigning property concepts
to bodily organs, such as control, transferability and privacy would neither efficiently deal with the organ shortage,

mandatory organ
conscription is the most efficient way to cure the deficit and reshape
nor incorporate a means of social change. In this section, it [*82] will be proved that

social values . Specifically, this part first discusses the doctrine of conscription, the details how conscription
purports to embrace social values and fears in such a way that will mold society into accepting cadaveric organ
conscription.
For the purposes of this article, the discussion will focus on the general policy of a conscription plan. Specific
legislation would be needed to implement such a plan, but I leave those details for later investigation. In doing so, I
briefly touch on presumed consent laws, because they closely relate to the goal of curing the organ deficit, and are
a step on the same path as mandatory conscription.
A. Presumed Consent: A Step in the Right Direction
This section discusses the presumed consent system for organ procurement. Under this system, the presumption is
that unless otherwise expressed and recorded, the decedent has consented to the removal and donation of all
needed organs after his or her death. n70 In the European Union, this practice appears favored over other market
remedies because a market approach seems "inconsistent with the EU objective of a high level of consumer
protection [and] the negative opinion of the European Parliament on commercialization or organs<elip>." n71
Ideally, presumed consent systems eliminate the need to seek out the donative intent of the deceased through his
family or other means. Despite this intent, some European countries still insist on inquiring into the wishes of the
family, while other countries immediately remove organs at the point of death unless there is clear evidence the
deceased desired otherwise. n72
Regardless of the standard employed, the European system is still more effective than the current altruistic system
of the United States. n73 Practically speaking, the European model has its advantages: no need to carry donor
cards, no need for last minute decision-making, and no need to ask for permission from families to harvest. This
system also preserved the semblance of respect for individual autonomy as individuals are on notice to object to
harvesting. n74
This system is not without its imperfections. In practice, most physicians seeking donation still inquire into the
family's wishes. n75 It also does not embrace [*83] the moral objections families or individuals have regarding
donation. n76 In other words, those who objected for moral or social reasons under the system of volunteerism will
probably still object under the presumed consent system. Thus, the goal of substantially increasing organ donation
(as well as reducing transactional barriers) is not accomplished.
B. The Principles of Conscription
This section discusses the virtues of conscription. A general policy towards conscription of organs would empower
every medical provider to harvest "every cadaveric organ suitable for transplantation without regard to any

A system
that permits the removal of all necessary organs at death by medical
providers is also the most efficient means of producing the necessary
supply of organs. A blanket rule such as this reduces judicial and
legislative deliberation over the interpretation of the rule, and demolishes
the barriers created by thinking of the body as property . Conscription would not
contrary wishes expressed by the decedent while he lives or by surviving relatives after he dies." n77

require a "promotional campaign, compensation to donors, or even attempts to gain permission from donors and
their families." n78 Conscription would also remove some medical liability issues: specifically, doctors would no
longer be liable for failing to obtain consent, nor would they have to be burdened by seeking out consent before
donations could be made. n79
Other plans, such as the current volunteerism and the proposed market structures also purport to retain individual
autonomy as well as to operate within the framework of the Constitution. For example, advocates of volunteerism
suggest that permitting individuals to choose whether to donate encourages charity and generosity. n80 Under this
system, generosity and charity drive donating; conflicts between family and individual autonomy are eradicated;
and individual autonomy is retained despite the degree of legitimate coerciveness, as it implements greater social
good and common will. n81 It is not individual autonomy in the sense of choice, rather, it is individual autonomy in
the sense that with enough organs available, a person's capabilities are increased should a personal need for
organs arise. Thus one can live freely and have a more productive life. n82
Some would argue that choice is the touchstone of American freedom, and choice includes the right to direct the
disposition of one's body. Yet, in times [*84] of national crisis (or even potential crisis) the population must be

directed to join into the greater social good; it is for this reason there is a military draft, as well as prohibitions
against assisted suicide. n83 The law has always provided for legitimate yet coercive means of shaping public
attitude towards a greater public good. Conscription of organs is not unlike these examples.
C. The Plan: How Conscription Shapes Social Values
Conscription merely purports to erase all notions of familial and individual property rights in dead bodies. In doing
so, the body will not and cannot be commodified, nor will it escheat over to the state. Instead, conscription will

Conscription is the
most efficient bright line rule the legal system can offer the public and
the medical field. As stated in the introduction to this paper, discussions regarding religious objections to
provide the medical community with the resources it needs to fulfill a need for organs.

conscription are outside the scope of this paper.

Ethically, understanding what it is that the public values and fears most about donating their organs will be crucial
to initiating social change towards conscription. Such values include the ability to grieve, individual autonomy,
superstition, fear of mutilation, fear of desecration, unwarranted governmental intrusion and religious objection.
Arguably, conscription neither denies nor promotes any of these common fears: families will not have to face the
decision of whether to donate, and for all intents and purposes, bodily forms stay intact after select organs are
harvested; individual freedom is retained in the sense that human growth potential and aligning with a common
good will be promoted; and under conscription, the government relinquishes control to the transplant community.
Conscription also alleviates the fear of exploiting the poor, and the over representation of wealthy recipients who

Conscription does not favor the wealthy, nor does it

prey on the poor. Conscription creates no hold-out power for those whose organs are desperately needed.
have greater bargaining power.

V. Conclusion
There is a desperate need for organs in America. Patients lose their freedom and ability to live up to their potential:
instead, thousands awaiting transplantable organs are dying needlessly as thousands more healthy, viable organs

Social values and ideologies, as they stand today, can be flexed and
molded into a new ideology: one of ultimate giving . Conscription provides the cure for
the needless deaths; though the rule is radical, it is appropriately coercive. The conscription cure is
able to flex social values into new values , such as placing the highest
priority in life on saving lives.
are interred.

Perm is net negative even if sales are a last resort it causes

global defection from the organ regime
Budiani-Saberi, 9 - Dr. Budiani-Saberi is the Executive Director of the Coalition for
Organ-Failure Solutions (COFS). She is a medical anthropologist and has conducted
extensive research on organ trafficking, including longitudinal follow-up studies and
outreach on commercial living organ donors, assessing health, economic, social and
psychological consequences (Debra, Advancing Organ Donation Without
Commercialization: Maintaining the Integrity of the National Organ Transplant Act
https://www.acslaw.org/publications/issue-briefs/advancing-organ-donation-withoutcommercialization-maintaining-the-integ-0)
The OTPAs introduction of material incentives to organ donation would
undermine these other important initiatives and the potential they have to
enhance organ supplies. Material incentives, even as a final resort ,
should not be considered, particularly when there are significant strides to be
accomplished in advancing deceased and altruistic donation. Slavish devotion to
market-based solutions should not distract Congresss attention from these
attainable solutions.

V. Conclusion
Transplants are said to be the most social of therapies. They rest on public trust in
medicine. Transplant commercialism and organ trafficking worldwide have
exploited social vulnerabilities to obtain organs for transplant. Although operating in
various models, these practices inevitably target the impoverished and lead
to inequity and social injustice.
OTPAs aim to permit compensated organ donation is contrary to the global
movement to oppose commercial transplantation. The United States transplant
policies are important references for the rest of the world and are
influential in shaping consideration of material incentives in countries
that would not necessarily commit to regulation or best practices in donor
care.
As illustrated at the beginning of this paper, Yuri resorted to selling a kidney when
his poor living conditions became especially destitute and the reward particularly
appealing. Those conditions drove him to the donation and he regretted the
decision afterwards. Existing transplant commercialism operates in countries that
are, by definition, different from the United States. Although proponents of
compensated donation suggest that the experience would be different in the U.S.,
individuals are similarly likely to resort to a donation when compensation includes
rewards such as comprehensive health care for life, health and life insurance,
disability and survivor benefits or educational benefits. Like the cash payment to
Yuri, these forms of compensation are considered to significantly enhance the life of
an individual who cannot afford these basic needs.
The United States must join the international community to rebuild, not
compromise , trust in transplants. This is especially important at this moment
when markets have failed economic and social needs in global and historical
dimensions and altruism has become especially priceless. Guided by the WHO
resolution on organ transplants and the Istanbul Declaration, transplant practices
can advance standards of greater social equality rather than exploit people in
poverty. There are many opportunities to advance organ donation in the U.S.
without subjecting individuals to experiences such as Yuris.

Legalization of organ sales causes organ trafficking---it

promotes inconsistent norms and undermines enforcement
mechanisms
Delmonico 11 (Francis L., Director of the Renal Transplantation Unit
Massachusetts General Hospital, Medical Director New England Organ Bank, The
Declaration of Istanbul Is Moving Forward by Combating Transplant Commercialism
and Trafficking and by Promoting Organ Donation, American Journal of
Transplantation, 12(3), 515-516)
The commentary by Drs. Ambagtsheer and Weimer provide an interesting
criminological reflection regarding the Declaration of Istanbul in which they question

whether efforts to prohibit organ trade have been either realistic or effective since
its widespread adoption (1). They challenge the link of organ trafficking to
transplant commercialism and drawing comparison from other demand crimes,
speculate that the regulation of commercialism would be feasible and justified in
the prevention of trafficking. However, the proposal to curtail trafficking by the
regulation of monetary payments for organs is not convincing. Organ
trafficking is indisputably linked to commercial profits and distinguishable
from other demand crimes. The prohibition of both transplant
commercialism and trafficking is required as essential to provide the
criminological mechanism for detection and enforcement efforts . The
ultimate value of the Declaration of Istanbul as effective policy exists not only
in its prohibitionist stance but also in its promotion of effective donation
and transplantation systems to reduce the demand for transplant tourism that
gives rise to organ commercialism and trafficking.
Transplant commercialism is linked to organ trafficking:
The Declaration of Istanbul defines transplant commercialism as a policy or
practice in which an organ is treated as a commodity, including being bought
or sold or used for material gain. The recommendation of Ambagtsheer and Weimer
to disassociate transplant commercialism from organ trafficking is belied by the
international realities (1). Organ trafficking exists only in the realm of
commercialismthe intent to make profit. Profit is what propels brokers to
prey upon refugees from the Sudan and victims of tsunami catastrophes
or other vulnerable groups to sell their kidneys.
The regulation of monetary payments for organs is not feasible and cannot
be justified:
Financial incentives for organ donation that provide monetary gain cannot
be regulated. Public policy that promotes such incentives becomes veiled
programs of organ sales. Once a scheme that offers money as the motivation
for donation becomes the policy or tolerated practice in one country, it
leads to the development of competitive schemes in other countries.
Countries are indeed soliciting thousands of patients to travel to foreign
destinations for medical care. But transplant tourism is different than medical
tourism because of the documented harm that occurs to paid donors. To cite
programs that aim at harm reduction for prostitution as the basis for supporting
payments for organs debases organ donation as a medical procedure and is
contradicted by the harm that continues by regulated programs of prostitution.

AT: Hughes
This evidence doesnt assume the CP gotta be brain dead
China just kills the people.
Hughes 9
J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School. You Get What You Pay For?: Rethinking U.S.
Organ Procurement Policy in Light of Foreign Models 2009. http://www.vanderbilt.edu/jotl/manage/wpcontent/uploads/hughes-final_x.pdf

Unscrupulous states extend nationalization of cadavers to take advantage of state

control over executed prisoners bodies to remove their organs. 120 China and Serbia
have both been alleged to harvest executed prisoners organs, China at a rate of
two to three thousand organ removals per year.121 Under Chinese law, an
executed prisoners organs may only be removed if the prisoners body is
not claimed, if the prisoner has consented, or if the prisoners family has consented.122 Evidence
suggests, however, that executions may be scheduled around transplants and carried
out in a way that keeps the donor alive until the organ is removed. 123

AT: Backlash
CP Is not about prisoners and not about violation of the 8 th
amendment.
Hughes 9
J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School. You Get What You Pay For?: Rethinking U.S.
Organ Procurement Policy in Light of Foreign Models 2009. http://www.vanderbilt.edu/jotl/manage/wpcontent/uploads/hughes-final_x.pdf

While nationalization serves as a useful example of an extreme system, this Note

does not give it serious consideration as a means of addressing the organ shortage in the United
States and abroad. At the very least, nationalization may be assumed to be both
politically unpalatable and, in the case of prisoners, a violation of the
Eighth Amendment prohibition against cruel and unusual punishment. 124

Religious safeguards inev but nobody bothers using them

Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New
York (Aaron, Conscription of Cadaveric Organs for Transplantation: A Stimulating
Idea Whose Time Has Not Yet Come Cambridge Quarterly of Healthcare Ethics
(2005), 14, 107112)

Another concern is that allowing people to opt out on religious grounds

could greatly reduce the efficacy of the program if many objectors would
claim this exemption regardless of their religious beliefs. But this is unlikely if a
strong burden of proof of religious objection is required of those who
attempt to invoke this exclusion, as was true for conscientious objectors
to military service. Furthermore, because conscription of cadaveric organs
would cause little if any harm, it is likely that for many objectors the
benefit of getting out of the program would not be worth the effort
required to do so.

AT: CP Links
No?
DOI 08

(declaration of Istanbul
http://www.multivu.prnewswire.com/mnr/transplantationsociety/33914/docs/33914-Declaration_of_IstanbulLancet.pdf)

2. Legislation should be developed and implemented by each country or

jurisdiction to govern the recovery of organs from deceased and living
donors and the practice of transplantation , consistent with international
standards .
a. Policies and procedures should be developed and implemented to maximize the
number of organs available for transplantation, consistent with these principles;
b. The practice of donation and transplantation requires oversight and
accountability by health authorities in each country to ensure transparency and
safety;
c. Oversight requires a national or regional registry to record deceased and living
donor transplants;
d. Key components of effective programs include public education and awareness,
health professional education and training, and defined responsibilities and
accountabilities for all stakeholders in the national organ donation and transplant
system.
3. Organs for transplantation should be equitably allocated within countries or
jurisdictions to suitable recipients without regard to gender, ethnicity, religion, or
social or financial status. a. Financial considerations or material gain of any party
must not influence the application of relevant allocation rules.
4. The primary objective of transplant policies and programs should be optimal
short- and long-term medical care to promote the health of both donors and
recipients.
a. Financial considerations or material gain of any party must not override
primary consideration for the health and well-being of donors and recipients.
5. Jurisdictions, countries and regions should strive to achieve self-sufficiency in
organ donation by providing a sufficient number of organs for residents in need
from within the country or through regional cooperation.
a. Collaboration between countries is not inconsistent with national self- sufficiency
as long as the collaboration protects the vulnerable, promotes equality between
donor and recipient populations, and does not violate these principles;
b. Treatment of patients from outside the country or jurisdiction is only acceptable if
it does not undermine a countrys ability to provide transplant services for its own
population.

6. Organ trafficking and transplant tourism violate the principles of equity,

justice and respect for human dignity and should be prohibited. Because transplant
commercialism targets impoverished and otherwise vulnerable donors, it leads
inexorably to inequity and injustice and should be prohibited. In Resolution 44.25,
the World Health Assembly called on countries to prevent the purchase and sale of
human organs for transplantation.
a. Prohibitions on these practices should include a ban on all types of
advertising (including electronic and print media), soliciting, or brokering for the
purpose of transplant commercialism, organ trafficking, or transplant tourism.
b. Such prohibitions should also include penalties for actssuch as
medically screening donors or organs, or transplanting organsthat aid,
encourage, or use the products of, organ trafficking or transplant tourism.
c. Practices that induce vulnerable individuals or groups (such as illiterate
and impoverished persons, undocumented immigrants, prisoners, and political or
economic refugees) to become living donors are incompatible with the aim
of combating organ trafficking, transplant tourism and transplant
commercialism.

AT: Property Rights

NOTA has nothing to do with property rights this is just
awkward for everyone involved 1AC author
Ghosh 14 Samantak Ghosh, PhD, an associate who focuses his practice on intellectual property matters. "The
Taking of Human Biological Products." California Law Review Vol. 102 Issue 2 Article 3
http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=4230&context=californialawreview

Legal Restrictions on the Use of Human Biological Materials Do Not

Dissolve Individuals Property Rights in Those Materials

1.

Among the laws restricting the use of human biological materials, the National Organ Transplant Act (NOTA), which prohibits the
sale of human organs, is perhaps the most prominent. But the scope of NOTAs restrictions is more limited than it appears
superficially. Although the law limits the right to sell human body parts, this prohibition is restricted to organs as [n]o State or
Federal statute prohibits the sale of blood, plasma, semen, or other replenishing tissues if taken in nonvital amounts.100 For
instance, the Ninth Circuit in Flynn v. Holder held that NOTA did not prohibit compensation for bone marrow stem cells obtained from
donors blood because once stem cells were in the bloodstream, they were a subpart of blood, not bone marrow.101 The ruling
allowed a nonprofit organization to compensate donors by providing $3,000 in scholarships, housing allowances, or gifts to
charities.102 Interestingly, although the court upheld the constitutionality of NOTA under rational basis review, it appeared
unpersuaded by the rationale underlying NOTA.103 The court noted that the reasons behind the law were in some respects vague,
in some speculative, and in some arguably misplaced, and recognized strong arguments for contrary views.104 Choosing not to
seek Supreme Court review of the Flynn decision, the federal government implicitly acknowledged the validity of the limits that the
Ninth Circuit placed on NOTAs scope.105

NOTAs prohibitions applied to all bodily materials, not just organs, these
restrictions do not completely eliminate the alienation rights associated with
Even assuming for arguments sake that

property. Prohibition on sale is not

the same as

prohibition on alienation . After all,

one can still donate organs. Furthermore, the right to sell is not such an essential
attribute of property rights that, in its absence, all other property rights
dissolve . It is not necessary that the same bundle of rights attach to all
property . For policy reasons, the law may limit the exercise of certain rights, but that does not
make the object of those limitations nonproperty . There are many examples
of state regulation of the right to dispose or alienate personal property, but none has been considered to
wipe out personal propertys character as property. For instance, public health and safety laws
restrict the ways that items such as food, drugs, and explosives are manufactured,
distributed, and sold.106 These limitations on the right to use and dispose of personal property at a certain time
and space and in a certain manner, however, are not inconsistent with the notion of their
being property . Another example of a sale restriction is found in state codes like the California Fish and Game Code,
which prohibits a sportsman from selling caught fish but not from donating it.107 No one, however, would argue that the fish caught
by the sportsman is not his property. Similarly, prescription drugs possessed by the person to whom they are prescribed can neither
be sold nor given away.108 These

alienation restrictions do not undermine the

proposition that these articles are property . Likewise, human biological materials
are no less property merely because their disposal and alienation are
restricted .

Shortage

Medical Backlash turn

Our ev is more qualified and every market has lapsed into
predatory behavior
Danovitch and Delmonico 8 *Kidney and Pancreas Transplant Program,
David Geffen School of Medicine at UCLA; **Harvard Medical School, Massachusetts
General Hospital Transplant Center (Gabriel M. and Francis L., Current Opinion in
Organ Transplantation, 13:386394, The prohibition of kidney sales and organ
markets should remain)

The idea that a commercialized system of organ sales can supplement or

even replace the noncommercial donation system that has been the core of transplant practice since its
inception is not new. Kidneys and livers are bought and sold in several regions of the world, and though
it might be tempting to think that the evils that are associated with such
commercialization will necessarily escape a regulated market in the
United States, we will show that such an intention is not attainable. The market
experiments done in other countries that have attempted to regulate the
market for organs have been unsuccessful in fixing prices, excluding the activities of
brokers or addressing the health of paid donors. We will review the current international
reality of organ sales both of the proposed regulated and existing unregulated variety and consider how a
commercialized system would impact solid organ transplantation in the United States. The

commercialization of organ donation is fraught with danger: danger to paid donors;

danger to their recipients; danger to patients in need of nonrenal transplants from deceased donors; and
danger to the role of transplant professionals as stewards of the whole organ transplant endeavor.
The trust of the public and the legacy of transplantation are at risk if
organ markets are sanctioned in the United States or the rest of the world.

Global nature of supply means the plan causes a race to the

bottom
J. Mark Raven-Jackson 2K; CBS Business, LawNow, Oct-Nov, 2000; Xenotransplantation: a regulatory
beast of burden, http://findarticles.com/p/articles/mi_m0OJX/is_2_25/ai_n25027587/pg_4/
It is complicated for nations to regulate xenotransplantation in order to protect the xenotransplant recipient, public health, and
donor animals.

All regulatory efforts will be in vain if other nations end up

adopting weaker regulations or no regulations at all. Countries that adhere to

these lower standards have the potential of becoming xeno-havens for unscrupulous
surgeons and researchers. Daniel Salomon, a member of the board of the American Society of Transplant Physicians,
a body that has long waged war on the trafficking of human organs in developing countries, states that the prospects of xeno-

regulations that are now being developed in

industrialized countries will create a strong incentive for poorer countries to traffic
havens scares him. Salomon states that the

in
xenotransplants. The big risk is that recipients will receive disease laden organs from endangered primates and there will be no way
to monitor their movement or interaction with the general public.

Egg sales and surrogacy prove they wont substantially expand

vendors even if prices escalate
Caplan, 14 - Department of Medical Ethics and Director, Center for Bioethics,
University of Pennsylvania (Arthur, Contemporary Debates in Bioethics, ed: Caplan
and Arp, p. 63)
It is hard to imagine many people in wealthy countries eager to sell their
organs either while alive or upon their death. In fact, even if compensation is
relatively high , few will agree to sell (Rid et al., 2009). That has been the
experience with markets in human eggs for research purposes and with
paid surrogacy in the United States prices have escalated , but there are
still relatively few sellers (Baylis & McLeod, 2007).

2nc black market no tradeoff

Wouldnt solve tourism because people want cheap organs
Saberi, medical anthropologist and PhD, 2009
(Debra, Advancing Organ Donation Without Commercialization: Maintaining the
Integrity of the National Organ Transplant Act, June,
https://www.acslaw.org/sites/default/files/Budiani%20Saberi%20and%20Golden
%20Issue%20Brief.pdf)

it would not be possible to completely regulate a market in organs

domestically when, as with other commodities, global prices/rewards would vary . State
compensation for organ donation is still unlikely to satisfy demand
because patients who opt to shorten their wait-time and can afford to go
abroad for an organ will continue to do so. Insomuch as patients might bear a
portion of the financial burden for a compensated donation, they would
also have reason to go where prices were affordable. The proposals in
Finally,

OTPA would not ameliorate these dynamics that facilitate organ

trafficking.

Several other countries besides the U.S. are large consumers

of imported organs
Shimazono 7 Yosuke, Assistant Professor in Medicine @ Osaka University, The
state of the international organ trade: a provisional picture based on integration of
available information http://www.who.int/bulletin/volumes/85/12/06-039370/en/
The organ-exporting countries
The organ-importing countries

The term organ-importing countries is used here to refer to the

A report by
Organs Watch, an organization based at the University of California, USA,
identified Australia , Canada , Israel , Japan , Oman , Saudi Arabia and
countries of origin of the patients going overseas to purchase organs for transplantation.

the USA as major organ-importing countries .19 Yet transplant tourism has
become prevalent in many other countries of all continents and regions .
Data are available through surveys conducted by health authorities and professional societies in these regions

the number of patients going overseas

for kidney transplantation outweighs the number of patients undergoing
kidney transplantation locally. More detailed data available from Malaysia and Oman
show the shifting destinations of overseas organ transplantation (Fig. 1, Fig. 2
(Table 2). It should be noted that in some countries

and Table 3). Although it is premature to undertake a substantial analysis of this issue because comparable data
from other regions are not available,

these data suggest a heavier reliance on overseas

transplantation and transplant tourism in Asia and the Middle East than
in other regions . For example, in Canada and the U nited K ingdom (where,
respectively, 1027 and 1914 domestic renal transplants were performed in

it is estimated by local experts that around 30 to 50 patients undergo

overseas commercial kidney transplants.28,29
2005)26,27

European clients drive illicit markets that the plan cant solve
Walsh 5 Declan, the Guardian's correspondent for Pakistan and Afghanistan
from 2004 to 2011, Transplant tourists flock to Pakistan, where poverty and lack of
regulation fuel trade in human organs
http://www.theguardian.com/world/2005/feb/10/pakistan.declanwalshcc
Despite such qualms,

relentless demand keeps the trade alive. One source in the

medical industry said he was expecting a South African "transplant

tourist" later this month; another said three Bulgarians recently passed
through. Most of Pakistan's clients come from the Middle East , many with
the blessing of their own governments. Although paid-for transplants are
illegal in Saudi Arabia, the Islamabad embassy actively assists citizens
who seek one in Pakistan. The embassy doctor, Eissa al-Harthi, said he visited patients
in hospital and helped to iron out any difficulties, and sometimes his government footed part
of the bill. Pakistan's government has spoken for years of legislating to
regulate kidney transplants, but the idea remains little more than a vague
proposal.

AT: Regs
Illicit organ economies will circumvent legal and regulated
markets
Torrey 14 Trisha, M.A. in Education @ Elmira College, Organ Trafficking and
Transplant Tourism http://patients.about.com/od/healthcarefraud/a/OrganTrafficking-And-Transplant-Tourism.htm
This "transplant tourism" is surging in popularity , even in the United States, for at least
three reasons. First, because the numbers of people who need organs is growing. Second, because the transplant
lists, such as those determined by UNOS in the United States are getting longer and longer. And third, because the
world economic crisis is forcing people to look at ways they can make money. Selling their organs can put food on

Except for transplants that take place in Iran where human organ
sales are condoned, organ trafficking is illegal. However, according to a
the table.

number of news media sources and the World Health Organization, you'll
find plenty of advertising in print and online, offering to buy or sell an
organ, usually a kidney. Those sales, and the transplantation, take place
while authorities turn a blind eye.

Illicit economies will undercut the price of the national organ

market
Scheper-Hughes 6 Nancy, Professor of Medical Anthropology and Director of
Organs Watch, Is It Ethical for Patients with Renal Disease to Purchase Kidneys
from the Worlds Poor? PLOS Medical Journal, October 2006 | Volume 3 | Issue 10 |
e349
Wouldn't a regulated system be better than the current state of racketeering
in human kidneys? Perhaps, but how can a national government set a price
on a healthy, but destitute, human being's body part without compromising
essential democratic and ethical principles that guarantee the equal
value of all human lives? Any national regulatory system would have to
compete with global black markets that establish the value of human
organs based on consumer- oriented prejudices . In today's kidney market.
Asian kidneys are "worth less" than Middle Eastern kidneys and American
kidneys worth more than European ones. The circulation of kidneys
transcends national borders , and international markets will coexist and
compete aggressively with any national, regulated systems.

Surgeons whose

primary responsibility is to provide care should not be advocates of paid self-multilation by anonymous strangers
even in the interest of saving lives.

2nc crowdout turn

Best empirical evidence goes negative
Oliver Decker 14, PhD, Member of the Faculty of Medicine at the University of
Leipzig and Reader at the Faculty of Philosophy at the Leibniz University Hannover,
former Visiting Professor for Social and Organizational Psychology at the University
of Siegen, Commodified Bodies: Organ Transplantation and the Organ Trade, google
books
the market solution begin less with the ethical than with the factual consequences. According to their prognosis,
undermine the desired remedy for the shortage of raw materials by completely

Thus some critics of

the latter

commodifying the human body . The crucial example of the

counterproductive effect of a market solution on the allocation of organs
is blood donation . An investigation of blood donations showed that where the sale of
blood was allowed, donations declined (Tittmus 1971). This sociopsychological
finding helps us answer the question as to how

commercialization of the

body affects the willingness to donate out of altruistic motives. The

answer is clear : an erosion of motivation (Archard 2002, 87) was the result of the
commercialization of trade in blood and can also be expected to be the result
in the event of a legalization of trade in organs. From the Chicago Business
School

itself

comes a serious objection

motivation might change

the

to an incentive system or an organ market:

perception of the activity

Extrinsic

and destroy the intrinsic motivation to

perform it when no apparent reward from the activity itself is expected (Gneezy and Rustichini 2000a, 792). In an experiment in a kindergarten,

parents were fined for being late in picking up their children after school. But the
result was only that most of the parents were late in picking up their children, because
now a service was demanded of them. Even after the experiment was terminated and the fine was no longer
levied, the parents continued to come late. In principle, according to the rationale for the experiment, a service that up to that
point had been provided by the childrens caregivers at no cost was now
offered in exchange for money, as a commodity. This was the investigators conclusion: when a morally
motivated act is replaced by a commercial motivation, this alters the demand and character of the service, and the moral barriers fall: Once a
commodity, always a commodity (ibid., 791). The consequence for trade in organs: if it is begun, it must be done right, because there is no going back:
Pay enough or dont pay at all (Gneezy and Rustichini 2000b). There are many such hidden costs of organ sale (Rothmann and Rothmann 2006, 1525).
In each case

it seems clear that the relationship to other people is in fact

changed : the body parts of others become a good

simple bearer of exchange value (Schneider 2007, 120).

to which claims can be made, and the organ donor becomes a

1NR

CP

Add On
Courts wont uphold property rightsjudicial formalism blocks
solvency
Michele GOODWIN, Professor of Law and Director of the Health Law Institute at
DePaul University College of Law, 6 [Formalism and the Legal Status of Body
Parts, The University of Chicago Legal Forum, 2006 U Chi Legal F 317, Lexis]

entrenched formalism in a rapidly

expanding biotechnological era will stymie meaningful development of
common law jurisprudence on the ownership, dispensation, and remedies
involving body parts. Without judicial adaptation to an evolving society in
which litigation involves body parts, plaintiffs will never prevail . n125 A
common element of the three very different scenarios presented in the above models is that absent a
finding that deems the body as "property," plaintiffs will be barred from
recovery--even in the more disturbing cases that involve the most egregious breaches of medical trust and
ethics. Formalistic rule making (or the lack thereof ), conflicts with reasoned,
evolved decisionmaking. It fails to acknowledge and respond to the
shifting of culture, society, and biotechnology. n126 Such rule making, "to put it baldly,"
The models discussed in Part I demonstrate that

according to the Honorable Mary Schroeder, is to devise "pontifical formulas which relieve courts of the burden of
reasoned decisionmaking." n127
The law too must evolve to address the nuanced byproducts of biotechnology. Legislative and judicial indifference to
the ways in which biotechnology interferes with individual liberties, however, poses several serious problems.
1. Illusory negative rights.
For example, presumed consent legislation tramples individual autonomy while purportedly designed to promote
health and safety. However, that worthy goal is defeated through surreptitious tissue harvesting exclusively from
unsafe victims, including those whose deaths resulted from homicides, poisonings, and other catastrophic means.
n128 Failure to collect social history [*347] data increases the likelihood that insalubrious tissues will enter the
marketplace and harm those whom the statutes are designed to protect. n129 The opt-out provision, as discussed
earlier, is more illusory than real. n130 The fact that there isn't a national or state registry, except in Iowa, where
one can opt-out of tissue donation is a significant barrier.
States that enacted presumed consent laws failed to take secondary measures to give full meaning to an individual
or her family's choice to decline extraction. Their failure to do so unquestionably contributes to legal and social
backlash against presumed consent policies. n131 Thus, without a more serious effort to capture assent or dissent,
the opt-out provision is meaningless. Even in some instances when families refused to donate, state actors
successfully claimed immunity for the "accidental" taking of tissues used for a legitimate state purpose. n132 Why
then, has formalism dominated judicial response to nonconsensual tissue taking and the collateral outgrowths of
biotechnology (in other words, Model C)? [*348]
2. Episodic or collective.
Judges tend to view biotechnology cases involving body parts episodically and not collectively. n133 Viewed
narrowly, Mr. Moore seems to be one lone individual--a single plaintiff--with an isolated case. His disease is rare and
the defendants are located in Los Angeles--their reach falls short of all other Moore-like patients at California's
borders. It appears the instance will not be repeated and the means justify the utilitarian ends; Moore pays the
emotional costs for a private industry gaining competitive strength and furthering scientific understanding and
possibly engineering treatment options for a broader class of individuals affected by leukemia. Here the California
justices are responding to a nationalist principle, an American advantage. Were the company that collaborated with
Dr. Golde a foreign corporation, they may well have reached a different conclusion. Thus, the case is not simply
about the random expansion of biotechnology, but specifically American technology. n134
3. Formalism entrenched.

Formalists necessarily ignore exogenous sources, instead choosing to concentrate on adhering to traditional norms,
n135 lest they be viewed as unmindful of their role, radical or even judi [*349] cially activist. In essence,

judges do not believe it is their role to change the law to respond to

biotechnology. They would argue that it is the legislature's role to
introduce new meaning to the law; the courts simply sort out the statutory
"mishmash." n136 Judge Guido Calabresi suggests that the formalist approach "does not contemplate the
introduction of new or modified values into the scheme as part of their role." n137 Thus the court's function to hear
the new biotechnology cases with an objective ear is usurped not by judicial indifference to plaintiffs, but rather a

In strictly adhering to formalism,

judges ignore the independence of the bench and its secondary function,
which is to sort out the mishmash. Obsequious loyalty to doctrine
necessarily inures heightened blindness to external factors, and in the
face of biotechnological harms to plaintiffs, may undermine the
defense "of the values it finds embedded in the system." n138

perception of the judiciary as an independent, fair, competent arm of the

government .
Although Calabresi suggests that today's formalists "take a bow to exogenous values," Models A-C (and there are

the refusal to tamper with almost

biblically derived notions of the body by introducing new values,

many more) do not support that conclusion. Rather,

recognizing alternative paradigms and hermeneutics, suffocates the law .

Thus, while the law of body parts could be a robust representation of
nuanced thinking on a very complex issue, instead it appears weak,
ragged, and arbitrary.

Exploitation

1NR impact overview

Dont be held hostage to the rhetoric of saving lives they
only count the lives of the affluent few while authorizing the
systematic extermination of the poor. The practical reality is it
serves to conceal the violence
Moniruzzaman, 12 - Department of Anthropology and Center for Ethics and
Humanities in the Life Sciences Michigan State University (Monir, Living Cadavers
in Bangladesh: Bioviolence in the Human Organ Bazaar MEDICAL ANTHROPOLOGY
QUARTERLY, Vol. 26, Issue 1, pp. 6991, DOI: 10.1111/j.1548-1387.2011.01197.x)

some liberal bioethicists have proposed

that a regulated organ market would be an efficient way to save the lives
of dying patients (Cherry 2005; Friedman and Friedman 2006; Hippen 2005; Matas 2008; RadcliffeRichards 1996; Taylor 2005; Veatch 2000). In my opinion, these bioethicists generate a
Although vested interest groups silence the organ trade,

symbolic violence

(if unconsciously)

by emphasizing saving lives of the

affluent few, while allowing bioviolence against impoverished kidney

sellers . A regulated organ market is not an Aladdins lamp that by itself
would eliminate widespread deception, manipulation, and misinformed
consent, or ensure justice, equity, and rights to kidney sellers; rather, it
would escalate the bioviolence for stripping organs from the poor
majority at the high cost of their bodily and social suffering. It would
rationalize, institutionalize, and normalize the bioviolence , which is extremely discriminatory against
the economic underclass. Not surprisingly, 85 percent of the Bangladeshi kidney sellers I
interviewed spoke against an organ market; many of them proclaimed that selling a kidney is an
irrevocable loss; if they had a second chance in life, they would not sell their kidneys.
In summary, the bioviolence against kidney sellers is seriously problematic, even though organ transplant saves
many lives.

As the transplant industry flourishes, the structural violence

against the poor becomes widely institutionalized . The physical violence

for extracting organs from their bodies is increasingly routinized. However, it
is justified by a symbolic violence that masks organ trade by the rhetoric
of saving lives. Meanwhile, bioviolence against the poor remains
concealed to promote the personal interests of vested beneficiaries. The
bioviolence that is entrenched in the transplant enterprise, as well as other emerging biotechnologies, needs to be
fully exposed to strike against the exploitation of the poor. This is the time to write a transplant manifesto that is
grounded in social justice, and that promotes humanitarian ethics.

That causes massive structural violence and worse health

outcomes for vendors and buyers
Emily Kelly 13, Executive Comment Editor for the Boston College International &
Comparative Law Review, International Organ Trafficking Crisis: Solutions
Addressing the Heart of the Matter,

http://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?
article=3324&context=bclr&sei-redir=1

Transplant tourism and organ trafficking have pervasive negative

effects. 57 Organ trafficking exploits poor individuals who are desperate to
make money for survival.58 Because profit-motivated facilitators negotiate most transactions, donor
compensation is often extremely low.59 For example, kidney donors frequently receive less than one-third of the

donors
rarely receive adequate health care after the transplant, generating

price that recipients pay for the organ, despite initial promises of higher payment.60 Furthermore,

negative health outcomes that impede their ability to work and worsening
their long-run financial and physical condition.61 As a result, donors rarely succeed
in paying off the very debts that often lead them to sell an organ in the first place.62
In addition,

studies have exposed the negative sociological and psychological

effects of organ sales .63 Kidney vendors frequently express regret and disgrace associated with the
Communities with high rates of organ sales also shame donors,
leading many to conceal their decision out of embarrassment.65 With regard to recipients, the dangers of
receiving medical care in developing countries can outweigh the benefits
decision to sell a body part.64

of

life-saving

transplant tourism .66 Because governmental disease control agencies do not monitor

recipients risk contracting infectious diseases like

West Nile Virus and HIV.67 Tragically, transplant tourists also have a higher
cumulative incidence of acute [organ] rejection in the first year after
underground organ trafficking,

transplantation.68 Transplant tourism also harms global public health policies.69 Most notably, the underground
market impedes the success of legal organ donation frameworks.70 For example, Thai patients have difficulty
accessing health care because local doctors are preoccupied with the lucrative practice of treating transplant
tourists.71 In 2007, China banned transplant tourism because wealthy foreignersrather than the 1.5 million
Chinese on the waiting listreceived an overwhelming amount of organ transplants.72 Grisly tales of transplant
tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to altruistic
donation upon death out of fear that their bodies may be exploited. 73 This further contributes to the global organ

transplant tourism
and broader medical tourism facilitate the spread of antibiotic-resistant bacteria .75
Because such bacteria are frequently found in hospitals, tourists are easily
exposed and transmit these unique strains across borders upon returning
to their home countries.76 As a result of these effects, transplant tourism has drawn increasing attention
shortage and exacerbates the underlying causes of OTC trafficking.74 Additionally,

to the root of the problem: organ shortages.77

AT: DOI Fails

The new Convention against Trafficking passed by the Council
of Europe solves legal gaps in the current anti-trafficking
framework
Lopez-Fraga et al, 14 - European Committee on Organ Transplantation,
European Directorate for the Quality of Medicines & HealthCare, Council of Europe
(Marta, A needed Convention against trafficking in human organs The Lancet, 7/4,
doi:10.1016/S0140-6736(14)60835-7)
The Convention against Trafficking in Human Organs,7 and 8 soon to be
adopted by the Council of Europe, provides a solution to these problems by
identifying distinct activities that constitute trafficking in human organs, which ratifying states are obligated to
criminalise. The central concept is the illicit removal of organs, which consists of removal without the free,
informed, and specific consent of a living donor; removal from a deceased donor other than as authorised under
domestic law; removal when a living donor (or a third party) has been offered or received a financial gain or
comparable advantage; or removal from a deceased donor when a third party has been offered or received a
financial gain or comparable advantage.
Additionally, the Convention criminalises the use, preparation, preservation, storage, transportation, transfer,
receipt, import, and export of illicitly removed organs and the solicitation or recruitment of organ donors or
recipients, where carried out for financial gain or comparable advantage. The promising, offering or giving of any
undue advantage to or the request or receipt of any undue advantage by health-care professionals, public officials,
or people who direct or work for private institutions for the illicit removal of organs or for the use of organs that
have been illicitly removed are also criminalised. The Convention calls for states to employ preventive measures,
cooperate internationally in investigation and prosecution (including extraditing accused people), and protect
witnesses and especially victims (including through civil damages). Implementation will be monitored and facilitated

the Convention has international scope,

because it is open to any nation and not restricted to the 47 Council of Europe
member states.
by a Committee of the Parties. Importantly,

The Convention is intended to complement the provisions included in other international instruments criminalising
human trafficking for organ removal. The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons9
defines human trafficking as an action (the recruitment, transportation, transfer, harboring or receipt of persons)
that occurs by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of
the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve
the consent of a person having control over another person. Among the purposes identified by the Protocol is
removal of organs. In Europe, human trafficking for organ removal is also included in the Council of Europe
Convention on Action against Trafficking in Human Beings10 and the European Union Directive 2011/36/EU on
Preventing and Combating Trafficking in Human Beings and Protecting its Victims.11 These instruments are
important in countering the use of the human body to give rise to financial gain, as prohibited under the
Convention on Human Rights and Biomedicine.12

the legal instruments intended to combat human trafficking for organ

removal leave gaps because sometimes the three components of this problem
(action, means, and purpose) are difficult to prove.13 Establishing an illegal means can be problematic,
Yet

since force or fraud are not always used and the abuse of a position of vulnerability is somewhat ill defined.
Likewise, when sellers take the initiative, by contacting potential recipients or intermediaries, prosecutors can
struggle to show that the person has been trafficked, even if the seller was driven to act by poverty or other
desperate needs. Moreover, human trafficking for organ removal does not encompass commercial transactions
involving organs from deceased persons, nor the diversion of properly obtained organs for illicit use by physicians
providing transplant services to patients who do not qualify to receive them within national programmes or at
facilities that serve so-called transplant tourists.

The new Convention fills these gaps. It provides an explicit basis for
prosecution of brokers, even if the means they use do not amount to human trafficking. It
criminalises both corrupt officials who abuse their position within the
organ donation system, and health-care professionals and others who remove,
transfer, or use an organ if they know that the donor has not given valid consent or was offered payment.
Physicians are likewise liable under the Convention for removing organs from deceased donors knowing that no
valid authorisation was obtained or that payment was offered to obtain permission from the family. Under the new
Convention, states can choose not to prosecute recipients who have purchased an organ, although recipients would
be liable under instruments regarding human trafficking for organ removal if they knew that the organ came from a
victim of human trafficking. People who sell an organ under circumstances of human trafficking for organ removal
are entitled to protection as victims. If human trafficking is not involved, states can choose to prosecute sellers
under the Convention.
In conclusion,

the Convention will be a seminal international legal instrument

that for the first time reaches illicit transplant practices that currently
escape prosecution . By complementing each other, this Convention on trafficking of human
and the instruments on human trafficking for organ removal provide a
comprehensive legal framework to prevent and combat transplant
activities that violate basic human rights. The worldwide problem of organ trafficking can only be addressed
organs

through concerted action at global level. Therefore, we urge all countries to quickly become Parties to the
Convention.

Physician norms are developing against trafficking theyll

strengthen the international framework and spur wider
adoption
Efrat, 15 - Lauder School of Government, Diplomacy and Strategy,
Interdisciplinary Center (IDC) Herzliya (Asif, Professional Socialization and
International Norms: Physicians against Organ Trafficking Forthcoming, European
Journal of International Relations (2015), academia.edu)

Why establish a shared professional position? Why wasn't the government track sufficient? First,
intraprofessional

activity was needed to create change on the ground, that is, induce
healthcare professionals to cease their direct or indirect participation in the
organ trade. Organ trafficking, after all, is not perpetrated by state agents, but by private
actors: organ brokers and, crucially, transplant professionals. Yet governments are
often reluctant to police professional communities and interfere with their internal workings. Instead, they allow
professionals autonomy in establishing and enforcing their ethical requirements and use the state's enforcement
power only in the most serious, publicly visible cases (Friedson, 1975). Given the low visibility of the organ trade
and its negative effects, governments were unlikely to make the efforts necessary for eliminating this practice. A
fundamental change on the ground required the medical profession to establish its own standards and provide a
clear framework for distinguishing between ethical and unethical conduct. Such a framework would identify
physicians' involvement in commercial transplantations as a transgression; it would also empower ethically
compliant physicians to put pressure on their transgressing colleagues and on hospital administrators: exhortations
against commercial transplantations would be more potent if backed by global professional standards.4
A predominant anti-commercialism view within the profession was also necessary for changing governments'
attitude to transplantation and ending their tolerance of the organ trade. To eliminate the trade, governments had
to address the persistent shortage of organs that was the trade's cause. The WHO thus encouraged governments to
increase deceased organ donations through educational initiatives, and by providing the medical and administrative
infrastructure for maximizing donations (Delmonico et al., 2011). The intraprofessional endeavors were a necessary

reinforcement of the WHO's government-focused efforts, since physicians are key actors in healthcare policymaking
(Immergut, 1990). In reforming transplantation policies, governments were likely to consult local physicians and
make sure that they approved of the proposed changes. Local physicians' endorsement of the efforts against organ
trafficking would have facilitated government support for these efforts; by contrast, resistance on the part of local

since organ
trafficking is a crime involving healthcare professionals, the medical
community had to put its own house in order before urging governments to act. The
physicians would likely have hindered the change of government policy.5 Furthermore,

medical community's denunciation of organ trafficking and commitment to its eradication would in turn legitimize
the community's demands from governments. Armed with global professional standards, the community's call for
government action would be more forceful and credible.

combating the organ trade requires standards that are developed,

owned, and endorsed by the medical profession . Such standards are meant
to express the prevailing ethical view of the transplant community,
identify those defying this view , and provide leverage for pressuring
In short,

them . These standards are also a tool to mobilize the community for
political action and convince governments that eliminating the organ
trade is necessary and feasible. Socialization aimed at establishing and spreading professional
norms thus had to take place in tandem with the efforts to socialize states. How did the anti-trafficking norm
manage to gain wide adherence among transplant professionals?

Transplant professionals are the vital internal link to stopping

trafficking since they do the black market transplants (also
provides extra impact to physician backlash on case)
Scheper-Hughes, 14 - is Professor of Medical Anthropology at the University of
California, Berkeley (Nancy, Human traffic: exposing the brutal organ trade New
Internationalist, May, - See more at: http://newint.org/features/2014/05/01/organtrafficking-keynote/#sthash.MMhZ7cHk.dpuf

Convicted brokers and their kidney hunters are easily replaced by other criminals the rewards of their crimes
ensure that.

Prosecuting transplant professionals, on the other hand, would definitely

interrupt the networks . Professional sanctions such as loss of licence to

practice could be very effective. Outlaw surgeons and their colleagues
co-operate within a code of silence equal to that of the Vatican. International bodies
like the UN and the EU need to take concerted action on the legal
framework in order to prosecute these international crimes.

2nc link wall

a. Purely economic approach to organ sales overlooks the
cultural and social factors that increase exploitation. Even if
the plan is effective in the US the global effects of their
model spur massive exploitation
Hentrich, 12 independent researcher (Michael, Health Matters: Human Organ
Donations, Sales, and the Black Market http://arxivweb3.library.cornell.edu/abs/1203.4289

The implications of permitting the sale of organs also differs by country

based on levels of wealth and cultural norms. The same policy decisions
made in the United States and Kenya would have vastly different results .
Global policy decisions about organ transplant made purely on a
homogenous economic analysis could well be misguided by failing to
account for cultural norms and differing social conditions (Kaserman 2002).
In developing countries the formal institutions involved with organ
transplant are also less advanced. There are fewer doctors in the related areas
and fewer transplant organizations through which to organize a legal market. These
conditions combine to leave developing countries open to poorly regulated
markets, abuse of donors and sellers, and the existence of a black market
for organs obtained in ways that may not be fair and legal (Goodwin 2006).

AT: Iran Indict

Crowdout doesnt occur in Iran solely because the major
deceased donor program prohibits sales
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy,
and Ethics, University of Southern California (Alexander, SIX DECADES OF ORGAN
DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A
MARKET SYSTEM WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY
PROBLEMS Vol. 77:25)

160. A.H. Rizvi, A.S. Naqvi, N.M. Zafar & E. Ahmed, Regulated Compensation Donation in Pakistan and Iran, 14

paying for kidneys has

forestalled development of deceased-donor programs, which are needed for other
solid organ transplant programs). The deceased donation that occurs in Iran, which is
sometimes cited to show that reliance on paid donors does not depress
deceased donation, actually results from the rejection of the national
CURRENT OPINION IN ORGAN TRANSPLANTATION 124, 127 (2009) (arguing that

norm by one major center:

Shiraz Organ Transplant Centre is the largest centre [in] Iran performing liver and kidney
transplant from deceased donors. They started their programme with kidney
transplantation based on live altruistic donors without any monetary
consideration

in the name of compensation. They maintained their policy for several years and finally their

credibility took them to becoming one of the largest centres of deceased liver transplantation in Middle East and
today they are performing the highest number of deceased transplants.
E-mail from Dr. Anwar Naqvi, Professor & Coordinator, Centre of Biomedical Ethics & Culture, Sindh Inst. of Urology
& Transplantation, to author (July 19, 2013, 5:17 AM) (on file with author).

AT: Treaty Fails

And theres been major progress in hotspots globally only the
aff threatens to reverse it
Efrat, 15 - Lauder School of Government, Diplomacy and Strategy, Interdisciplinary
Center (IDC) Herzliya (Asif, Professional Socialization and International Norms:
Physicians against Organ Trafficking Forthcoming, European Journal of International
Relations (2015), academia.edu)

The transplant community managed to place organ trafficking on the

political agenda and bring governments to take measures against it
including in countries that had been the centers of organ trafficking and
transplant tourism.

Legislative changes in the Philippines in 2008-9 nearly

eliminated incoming transplant tourism , and Pakistan's transplant

legislation has considerably reduced the number of commercial
transplants performed there (Rizvi et al., 2011; Padilla, Danovitch, and Lavee, 2013). Israel has
stopped the official funding of transplant tourism, instead taking action to increase local
organ donations (Lavee et al., 2013). Similar changes in policies and practices have
occurred in various other countries (Abraham et al., 2012; Danovitch et al., 2013). The
transplant community brought about these reforms by building support for a set of professional ethical standards

pressure from local and

international physicians, reinforced by media coverage of the organ trade,
resulted in major policy changes and a reduction of the organ trade .
and using them as a foundation for a political advocacy campaign. The

The picture, however, is not entirely rosy, since socialization and coercion may influence some
professionals but not others. While the principles of the Declaration of Istanbul have received broad support,

there are still voices

within the transplant community

who call for a regulated organ

market , defying the norm that requires altruistic donations. Some profit-seeking physicians continue
to perform commercial transplantations, notwithstanding the social pressure and persuasive influence of the
transplant community. In Egypt, the 2010 prohibition on organ trafficking has seen little enforcement in the
unstable political environment that followed the 2011 revolution. In China, the transplant community's efforts have
had a limited effect. High-ranking Chinese officials have indeed brought attention to the community's repudiation of
the practice of using organs from executed prisoners, and the Chinese authorities have stated their intention to
cease this practice and develop an ethical organ-donation system. But while steps in this direction have been made
(Wang, 2012), the use of organs from executed prisoners persists.

While the organ trade has not yet been eliminated, the international
community has certainly made important progress toward achieving this
goal. Previously indifferent to organ trafficking and transplant tourism,
governments have come to recognize these practices as problems and
have taken measures to curb them. Underlying this change of political norms is the move toward
shared professional norms within the international medical community. The socialization of
transplant professionals has laid the foundation for the socialization of
states .

AT: Regulations Solve

Regulations are circumvented
Capron et al, 14 - University Professor and Scott H. Bice Chair in Healthcare Law,
Policy, and Ethics, University of Southern California (Alexander, Organ Markets:
Problems Beyond Harms to Vendors, American Journal of Bioethics, October,
Volume 14, Number 10, 2014)
Further, in all settings where kidneys have been market commodities, the act of selling a kidney is seen as
debasing, something that a person would do only if he or she had no other means of survival. A regulated market
wont change that. Indeed,

it is likely that means would arise to circumvent the

intended limitations on the incentives, such as financial entrepreneurs

arranging for poor kidney sellers to obtain a lesser sum in cash in
exchange for the money deposited into a retirement account for them. From the
viewpoint of transplant programs, this would have the advantage of producing more
kidneys (since in all societies the poor are the readiest source of organs),
but very unjustly and by making a mockery of the notion of a regulated
market .

Its far more likely no regulation would emerge because it

would be seen as a barrier to effective sales
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy,
and Ethics, University of Southern California (Alexander, SIX DECADES OF ORGAN
DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A
MARKET SYSTEM WOULD CREATE AROUND THE WORLD LAW AND CONTEMPORARY
PROBLEMS Vol. 77:25)
a genuine market with
prices set by the forces of supply and demand that reflect the point at which individual sellers
would part with an organ and individual buyers would part with their money to obtain one. The market would qualify as
regulated because of other non-price-based rules aimed at protecting
donors against abuses, such as requirements regarding postoperative care of organ donors. On the
demand side, reliance on a true market would effectively upend the
present allocation system, because successful buyers would be those who
not only place a higher value on receiving an organ transplant but also
have a greater ability to pay (whether from their own wealth or generous medical-insurance coverage). The
result would be differentiation not only among the purchasers, with
willingness to pay determining ones place in line, but also among the
sellers, with the most desirable organs commanding a higher price . Although
The alternativewhich true believers in inducements should embrace would be

some market proponents might not be bothered by this outcome, others have suggested that it should be avoided by keeping organ
donors and recipients anonymous to each other and by having the latter pay into the fund that supports the organ-procurement
system rather than directly to their donor.118 Yet such a system would produce both market inefficiencies and strategies to get
around them, of the sort previously described.119

one must begin with the question of whether, in this era

of trade liberalization, there would be any ground for restricting donation
to domestic sellers. The aversion in certain circles to letting people from other countries come to the United States to
On the supply side of a true market in organs,

work really has no relevance to organ sales, because the persons involved would be coming into the country solely as the delivery
vehicles for their kidneys (or liver lobes), and would return to their country of origin once their cargo had been unloaded. This was
indeed the vision of Dr. Jacobs, whose projected International Kidney Exchange, Ltd. was intended to be a setting where U.S.
patients could exchange their funds for the kidneys of willing donors from Latin America.120 But why should such an institution not
have a more global reach than that, when it is already apparent that thousands of Pakistanis, Indians, Filipinos, and other
impoverished would be vendors of the world, when allowed to decide for themselves about their own best interests,121 are
willing to exchange a kidney for a relatively modest sum of money?
The argument for allowing payments for organs rests on the principle of utility (that the greatest good consists in saving or, in the
case of kidney transplants, extending and improving, human life) and the principle of liberty (that freedom of contract must be
protected). Yet these principles provide no grounds for erecting impediments to patients, physicians, or indeed health systems
seeking potential organ sellers anywhere in the world. As philosopher Janet Radcliffe Richards argues, If

it is
presumptively bad to prevent sales altogether, because lives will be lost
and adults deprived of an option some would choose if they could, it is for
the same reason presumptively bad to restrict the selling of organs .122 Thus,
if restrictions are to be placed on markets, principles other than utility and liberty must justify them. Such justification can be found
in the three basic principles of medical ethics: justice, beneficence, and autonomy.123

Regulation wont spill over internationally guarantees

massive exploitation
Glazer, 11 - Sarah Glazer is an American journalist based in London. She is a
Contributing Writer for the Washington, D.C.-based magazines CQ (Congressional
Quarterly) Researcher and CQ Global Researcher (CQ Global Researcher, Organ
Trafficking, v5 n 14, 341-366)

A government-regulated program will not end the black market , argues Debra
Budiani-Saberi, executive director of the Cairo, Egypt- and Washingtonbased Coalition for Organ-Failure Solutions,
which works with organ sellers victimized by the black market trade. People

will go where the

price is cheaper, and it will always be cheaper somewhere .
where developing countries have almost no mechanism
of regulation, to think that the government could run a regulated [market]
program is idiotic , says Farhat Moazam, chairperson of the Sindh Institutes Centre of Biomedical Ethics
Under the circumstances,

and Culture. She points out that even in the United States a Brooklyn kidney broker was arrested in a 2009 FBI sting
in New Jersey after allegedly arranging for purchased kidneys to be transplanted at reputable U.S. hospitals for
years without being discovered.
Market supporters Matas and Hippen, however, say they are proposing a regulated market only for the United
States and perhaps Western Europe where law enforcement is more trustworthy. And by satisfying demand in
wealthy countries, the trafficking in poorer countries almost could be eliminated, they argue.
However,

Danovitch doubts such a market could be contained within U.S.

borders . In the age of Twitter, he predicts, Within three seconds flat there
will be twice the U.S. price offered in Singapore or somewhere else.
International bodies such as the WHO and U.N. and pillars of the medical world, such as the U.S.-based Institute of
Medicine, all oppose the payment idea, largely on moral grounds. 25 Most people wouldnt want to live in a society
where the government paid the poor to be organ supplies, Budiani- Saberi says.