9.2. Organ donation (2).

Distribution
 Brain death as opposed to ‘total death’
required for organ donation to occur.
 The ‘Ad Hoc Committee’ of the Harvard

Medical School publish report in 1968.

 Based upon pragmatic decisions, as opposed

to sound medical reasons.

 Alleviated hospitals.
 Solution to shortage of transplantable organs.
 Conceptual difficulties: how can someone be

dead and breathing

 1. non-market and market solutions to the
organ shortage
 2.Property rights in the body
 Commodity
 People should be free to make decisions about their
own bodies: “a legal, regulated market for human
organs…both vendors and buyers could expect to
reap the benefits of voluntary trade.” (J.S. Taylor, J
Med Ethics. 2007 33(4): 201–204)
 Mandatory
 - Is organ donation mandatory on utilitarian
grounds?
 Gift
 Humans both are and have a body. For those who
view the body in more collectivist terms as a gift…
the body cannot be sold, while it can be re-gifted
and re-circulated in humanitarian acts”
(Schepher-Hughes, 2005, p. 164)
 1. Presumption of consent

 Many governments in Europe demand the

people opt out of rather than into organ
donation registries

 English speaking countries are exceptions

 Australia – voluntary registry for over 16s
 In Spain, 15% of people opt out
 In USA, 28% of people opt in
 People overwhelmingly support organs

donation but the ‘status quo bias’ kicks in.

People will go along with the existing option.

 So, should we change the law in Australia to

assume that the health system gets to
presume they are entitled to your organs?
 Pro: 1) people approve of organ donation so
we are just helping them to do what they
want really and 2)lack of organs means
avoidable deaths

 Con: your body is yours and the government

should not presume to use it
 Regulated and/or Black Market
 Gift and/or Commodity
 Individual Autonomy and/or Coercion
 The displaced and  Independent international
socially marginalized. transplant coordinators
 - The desperate, (via internet)
 Hospital administrators
hungry and  Organized crime
unemployed  Patients Rights
 - People caught in Organizations
debt.  Local (kidney hunters):
 - Refugees and  Small time bandits human
prisoners. smugglers
 Former kidney sellers
 - The young, naïve and  Corrupt police
mentally challenged

Sellers Buyers/brokers
 Organ theft – urban  Trafficking of living
myth? paid donors.
 Whose organ?  “Transplant tourism”
 - Where did it come
 - Flagrant violations of
from? international regulation
 - How was it procured? prohibiting the sale of
organs and tissues.
 - Gift, theft or  - Corruption of clinics
commodity?
and surgeons

Organ Watch Problems

 WHO approximate that 60,000 kidney
transplantations take place every year –
conservative estimate as some countries
don’t keep records of transplants.
 Approximately 20,000 are living donors,

several thousand of which are sold.

 Not as extensive as sex, drugs or gun trade.
 individual authority regarding the use of
one’s body
 self-ownership,
 people’s abilities to make decisions for

themselves.
 Prohibit the organ trade = restrict voluntary

commercial activity and prohibit voluntary

capitalist acts between adults
 "Trafficking in persons" shall mean the
recruitment, transportation, transfer, harboring or
receipt of persons, by means of the 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, for the purpose of exploitation.
 (Protocol against the Smuggling of Migrants by
Land, Sea and Air, adopted by the United Nations
in 2000.)
 Exploitation
 Social pathology – engenders hostility between
buyers and sellers.
 Erodes altruism.
 Corrupts doctor and patient relations – surgeons
become brokers. - “The belief in the absolute
value of a single human life saved or prolonged
at any cost ends all ethical inquiry and erases any
possibility of a global social ethic. And the traffic
in kidneys reduces the human content of all the
lives it touches.” (N. Scheper-Hughes, p. 157-8)
 Q: How free is the transaction if I am broke and
desperate?
 A: As free as any other transaction you make

while broke and desperate. Some people have

no good options and have to make the best of
things. This is a social, systemic problem that
will not be fixed by prohibiting organ trades

 It’s not a caring act if you are paid

 what about nurses or social workers? Caring

and making a living are not exclusive.

 A market will lead to more organs being
available.
 Doesn’t rely on altruism, but does not

undermine it.
 In the absence of compelling reasons against

it, there should be market for body parts.

 Body parts should be treated as goods

comparable to any other.

 A regulated market in organs would replace

the current exploitative black market.

 The people operating in a market are the donors
not the recipients. While an individual would be
free to sell an organ, they would not be free to
buy an organ.
 Instead, organs would be bought by distribution
agencies, which then make organs available to
hospitals according to principles of health equity
etc.
 This takes away some of the criticisms against
market based approaches
 Distribution side could be market-based and
regulated– subsidy for poorer people to get the
organs they need.
 If our bodies are ours in the sense that we own
them, and if we have the right to dispose of our
property in ways that we see fit, then it follows
that we have to right to dispose of our body in
the ways that we see fit. If that is selling a
kidney, or sexual services, or physical labour,
fine…
 What kind of relation do you have with your own
body – is it literally your property?
 The problem: In Australia (and elsewhere)
property rights over body tissue are not legally
recognized.
 Traditionally, law has considered human
tissue as res nullius (a thing belonging to no-
one)
 All Australian states prohibit trade in human

tissue - but tissue can become property

through labour processes.
 Oddly enough, we are regarded as the owners

of our gametes!