Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, (...) that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide. (shrink)

In recent years, there has been a considerable increase in the degree of philosophical attention devoted to the question of the morality of offering financial compensation in an attempt to increase the medical supply of human body parts and products, such as plasma. This paper will argue not only that donor compensation is ethically acceptable, but that plasma donors should not be prohibited from being offered compensation if they are to give their informed consent to donate. Regulatory regimes that prohibit (...) donor compensation thus unethically prevent the typical donor from being able to give her informed consent to donate. (shrink)

Shortages in the number of donated organs after death and the growing number of end-stage organ failure patients on waiting lists call for looking at alternatives to increase the number of organs that could be used for transplantation purposes. One option that has led to a legal and ethical debate is to have regulated markets in human organs. Opponents of a market in human organs offer different arguments that are mostly founded on contingent factors that can be adjusted. However, some (...) authors have asked the question whether we still have a reason to believe that there is something wrong with offering human organs for sale for transplantation purposes, even if the circumstances under which the practice takes place are improved. One prominent argument regarding this appeals to the notion of human dignity. It is argued that organ selling violates human dignity. This paper presents a systematic discussion of dignity-based arguments in the organ selling debate, and then develops a social account of dignity. It is argued that allowing the practice of organ selling inherently runs the risk of promoting the notion that some persons have less worth than others and that persons have a price, which is incompatible with dignity. The approach is defended against possible objections and it is shown that it can capture the notion that autonomy is linked to human dignity in important ways, while dignity at the same time can constrain the autonomous choices of persons with regards to certain practices. (shrink)

The essays in this issue of The Journal of Medicine and Philosophy explore an innovative voucher program for encouraging kidney donation. Discussions cluster around a number of central moral and political/theoretical themes: What are the direct and indirect health care costs and benefits of such a voucher system in human organs? Do vouchers lead to more effective and efficient organ procurement and allocation or contribute to greater inequalities and inefficiencies in the transplantation system? Do vouchers contribute to the inappropriate commodification (...) of human body parts? Is there a significant moral difference between such a voucher system and a market in human organs for transplantation? This paper argues that while kidney vouchers constitute a step in the right direction, fuller utilization of market-based incentives, including, but not limited to, barter exchanges, would save more lives and further reduce human suffering. (shrink)

Advocates of paid living kidney donation frequently argue that kidney sellers would benefit from paid donation under a properly regulated kidney market. The poor outcomes experienced by participants in existing markets are often entirely attributed to harmful black-market practices. This article reviews the medical and anthropological literature on the physical, psychological, social, and financial harms experienced by vendors under Iran's regulated system of donor compensation and black markets throughout the world and argues that this body of research not only documents (...) significant harms to vendors, but also provides reasons to believe that such harms would persist under a regulated system. This does not settle the question of whether or not a regulated market should be introduced, but it does strengthen the case against markets in kidneys while suggesting that those advocating such a system cannot appeal to the purported benefits to vendors to support their case. (shrink)

Some bioethicists have proposed a legalized market in human organs as a solution to transplant waiting lists and global poverty. Solutions to organ procurement problems that are solely market-based would unfairly shift the burdens of medical procedures onto developing nations. Market advocates base their claims on the understanding of organs as property, a position that should be problematized. Instrumentalizing people in this way is part of the broader commodification of animals and the environment. Combating the market mentality requires a return (...) to the holistic view of bioethics that led to the founding of the field. (shrink)

A prominent defence of a market in organs from living donors says that if we truly care about people in poverty, we should allow them to sell their organs. The argument is that if poor vendors would have voluntarily decided to sell their organs in a free market, then prohibiting them from selling makes them even worse off, at least from their own perspective, and that it would be unconscionably paternalistic to substitute our judgements for individuals' own judgements about what (...) would be best for them. The author shows that this ‘Laissez-Choisir Argument’ for organ selling rests on a mistake. This is because the claim that it would be better for people in poverty to sell their organs if given the option is consistent with the claim that it would be even better for them to not have the option at all. The upshot is that objections to an organ market need not be at all paternalistic, since we need not accept that the absence of a market makes those in poverty any worse off, even from their own point of view. The author goes on to argue that there are strong theoretical and empirical reasons for believing that people in poverty would in fact be harmed by the introduction of a market for live donor organs and that the harm constitutes sufficient grounds for prohibiting a market. (shrink)

The papers in this special thematic issue of HEC Forum critically and carefully explore key issues at the intersection of patient privacy and commodification. For example, should hospitals be required to secure a person’s consent to any possible uses to which his discarded body parts might be put after his treatment or should it only be concerned with securing his informed consent to his treatment? Should a hospital be required to raise the possibility of the commodification of such body parts, (...) or should it only be required to address this issue if the patient asks about it? Should persons be paid to engage in medical research, or should they only be compensated for their time, on the grounds, perhaps, that such payment would be coercive or exploitative, for it might move some persons to agree to participate in research who otherwise would not have done? This number of HEC Forum illustrates the widespread implications of these issues upon which healthcare ethics committees are called to deliberate. (shrink)

The debate over financial incentives and market models for organ procurement represents a key trend in recent bioethics. In this paper, we wish to reassess one of its central premises—the idea of organ shortage. While the problem is often presented as an objective statistical fact that can be taken for granted, we will take a closer look at the underlying framework expressed in the common rhetoric of “scarcity”, “shortage” or “unfulfilled demand”. On the basis of theoretical considerations as well as (...) a socioempirical examination of public attitudes, we will argue that this rhetoric has an economic subtext that imbues the debate with normative premises that have far-reaching social and ethical consequences and need to be made explicit and discussed. (shrink)

One of the most common arguments against legalising markets in human kidneys is that this would result in the widespread misuse that is present in the black market becoming more prevalent. In particular, it is argued that if such markets were to be legalised, this would lead to an increase in the number of people being coerced into selling their kidneys. Moreover, such coercion would occur even if markets in kidneys were regulated, for those subject to such coercion would not (...) be able to avail themselves of the legal protections that regulation would afford them. Despite the initial plausibility of this argument, there are three reasons to reject it. Firstly, the advantages of legalising markets in human kidneys would probably outweigh its possible disadvantages. Secondly, if it is believed that no such coercion can ever be tolerated, markets in only those human kidneys that fail to do away with coercion should be condemned. Finally, if coercion is genuinely opposed, then legalising kidney markets should be supported rather than opposed, for more people would be coerced were such markets to be prohibited. (shrink)

In a recent commentary, S R Benatar criticised the debates over organ donation and kidney selling for being located within a “narrow and inadequate framework”. Benatar levels four charges against those who engage in the current organs debate: that they myopically focus on saving lives; that they accept the dominance of market orientated approaches to health care; that they reify individualism, and that they engage in limited moral arguments. Given the importance of the organs debate it is imperative that the (...) misunderstandings of it on which Benatar’s criticisms are based are dispelled. Accordingly, I will consider and reject each of his objections in turn. (shrink)

Several commentators have tried to ground legal prohibitions of kidney sales in some form of Kant’s moral arguments against such sales. This paper reconsiders this approach to justifying laws and policies in light of Kant’s approach to law in his political philosophy. The author argues that Kant’s political philosophy requires that kidney sales be legally permitted, although contracts for such sales must remain unenforceable. The author further argues that Kant’s approach to laws, such as those governing kidney distribution, was formed (...) in part by considering and rejecting an assumption frequently employed in the bioethics literature, namely, that legal duties can be grounded directly in moral duties. The author explains some of Kant’s reasons for rejecting this assumption and concludes that arguments pertaining to the legality of kidney sales developed on the basis of Kant’s moral philosophy should no longer be considered tenable. (shrink)

Referring to Kant’s arguments addressing the moral relationship between our bodies and ourselves is quite common in contemporary debate about organ selling, although he does not provide us with any specific arguments related to this debate. It is widely argued that the most promising way to show the moral impermissibility of organ selling is to mount an argument on Kantian grounds. This paper asks whether it is possible to argue coherently against organ selling in a Kantian framework. It will be (...) shown that by mounting the argument on Kantian grounds no compelling argument can be given against sale of organs, either because the arguments apply to donation of organs, too, or the arguments are not convincing for other independent reasons. In the first section, it will be argued that donation and selling are not distinguishable in a Kantian framework, since the concern about commodification of the body and its parts shall be raised by both actions. In the second section, some contemporary accounts inspired by Kant will be presented and discussed separately. It will be argued that the reasons for promoting organ donation while arguing against selling clash with each other in an unconvincing way. -/- More Info: DOI: 10.1007/s11019-015-9623-z. (shrink)

In accordance with a recent statement released by the World Health Organization, the Canadian province of Ontario is moving to ban payment for plasma donation. This is partially based on contentions that remuneration for blood and blood products undermines autonomy and personal dignity. This paper is dedicated to evaluating this claim. I suggest that traditional autonomy-based arguments against commodification of human body parts and substances are less compelling in the context of plasma donation in Canada, but that there is another (...) autonomy-based objection to paid plasma donation that has not received sufficient attention. Namely, the stigma that surrounds exchanging plasma for payment makes it difficult to make an autonomous decision to engage in this activity. I suggest that this problem can be overcome in one of two ways; by banning payment for plasma, or by reducing the stigma surrounding this practice. I provide an indication of how we might work to achieve the latter, contending that this possibility should be taken seriously, due to the difficulties in achieving a sufficient supply of plasma without remuneration. (shrink)

Although transplantation surgeries are relatively successful and save the lives of many, only few are willing to donate organs. In order to better understand the reasons for donation or refusing donation and their implications on and influence by public policy, we conducted a survey examining public views on this issue in Israel. Between January and June 2010, an anonymous questionnaire based on published literature was distributed among random and selected parts of Israeli society and included organ recipients, organ donors, soldiers, (...) university and high school students, and the general population. The analysis of 799 questionnaires revealed that, although 74.7 percent have not signed a donor card, 60.8 percent of participants consider doing so. Additionally, 54.3 percent of respondents objected to giving or receiving compensation for donation, and, if at all, priority in transplantation care is the most desired form of such compensation. The health status of the donor and knowing that donation saves lives or that there exists a shortage of organs for transplantation are the two factors most affecting motivation to donate. Lack of information, relatives’ views on donation, and type of organ involved in donation are factors most inhibiting donation. Willingness to donate is significantly affected by the proximity of the recipient to the donor. With regard to most organs, their contribution to one’s sense of “self” and its symbolic role strongly affects motivation to donate, except for donation to relatives. Compensation for organ donation has little effect on motivation to donate during life and after death. Our findings suggest new ways to construct a more effective public policy on this issue. (shrink)

Research Articles Matt Zwolinski, Social Philosophy and Policy, FirstView Article.

Julian Koplin, drawing extensively on empirical data, has argued that vendors, even in well-regulated kidney markets, are likely to be significantly harmed. I contend that his reasoning to this conclusion is dangerously mistaken. I highlight two failures. First, Koplin is insufficiently attentive to the differences between existing markets and the regulated markets proposed by advocates. On the basis of this error, he wrongly concludes that many harms will persist even in a well-regulated system. Second, Koplin misunderstands the utilitarian assessment of (...) the market. He focuses on the costs and benefits of the transaction for the vendor. But, the relevant comparison is between an individual’s welfare across different courses of action, namely, vending and the nonvending alternative. Although Koplin’s empirically informed contribution is a welcome addition to this literature, the mistakes that pervade his interpretation of the data demand correction. (shrink)

David Friedman posed a number of libertarian philosophical problems (Friedman 1989). This essay criticizes Walter Block’s Rothbardian responses (Block 2011) and compares them with J C Lester’s critical-rationalist, libertarian-theory responses (Lester [2000] 2012). The main issues are as follows. 1. Critical rationalism and how it applies to libertarianism. 2.1. How libertarianism is not inherently about law and is inherently about morals. 2.2. How liberty relates to property and can be maximized: carbon dioxide and radio waves. 2.3. Applying the theory to (...) flashlights. 2.4. Applying the theory to the probability of imposed risks. 2.5. “Homesteading” or initial acquisition. 2.6 What is “essential” for a “true libertarian.” 2.7. Crime and punishment. 2.8. Extent of punishment. 2.9. The libertarian response to a madman with a gun. 2.10. How contradictions in rights are possible. 2.11. The draft. 3.1. Utilitarian libertarianism and “nose counting”. 3.2. How interpersonal comparisons of utility are possible and utility monsters are not a threat. 3.3. Why it is not utilitarian in practice to kill an innocent prisoner to prevent a riot. 3.4. Why David Friedman should not be forced to give up one of his eyes. 3.5. How utilitarians can be libertarians. Conclusion: a proper theory of liberty combined with critical rationalism offers superior solutions to Friedman’s problems. Appendix: replies to two commentators. (shrink)

Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear (...) that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it. (shrink)

The origins of professional ethical codes and oaths are explored. Their legitimacy and usefulness within the profession are questioned and an alternative ethical source is suggested. This source relies on a commonly shared, naturally knowable set of principles known as common morality.

This paper argues that the rules that constitute a market protect autonomy and increase welfare in healthcare. Markets do the former through protecting rights to self-ownership and a cluster of rights that protect its exercise. Markets protect welfare by organizing and protecting trades. In contrast, prohibition destroys legitimate markets, giving rise to so-called black markets that harm both the autonomy and well-being of agents. For example, a fee-for-service medical system is a highly developed and specialized market. It is individuals working (...) together, through the division of labor, to provide mutual insurance. This coordination, and the benefits it makes possible, is not possible without injunctions against harm. Prohibitions on harm are not mere ethical niceties, they are practice rules for both healthcare and markets. Placing the doctor within a healthcare market actually reinforces the doctor’s moral obligation, and the legal enforcement of that obligation, not to harm. Similarly, markets reinforce patient rights to self-determination through legal and institutional enforcement of the harm principle in the form of the protection of certain basic welfare rights to life, bodily integrity, property, trade, and contract. Since the establishment of markets protects agent autonomy and welfare, and prohibition directly harms the same, there are strong reasons for establishing markets to protect trade in precisely those areas where autonomy and well-being are most vulnerable to exploitation, for example, the trade in human kidneys. (shrink)

The article argues that altruistic giving based on anonymity, which is expected to promote social solidarity and block trade in human body parts, is conceptually defective and practically unproductive. It needs to be replaced by a more adequate notion which responds to the human practices of giving and receiving. The argument starts with identification of the main characteristics of the anonymous altruistic donation: social separation of the organ donor from the recipient, their mutual replaceability, non-obligatoriness of donation, and non-obligatoriness of (...) reciprocation on the recipient’s part. Since these characteristics are also central to typical market relations, anonymous altruistic donation not only cannot promote solidarity but may encourage proposals for markets of transplantable organs. Thus, transplant ethics needs to be reframed. It needs to be rooted in, rather than promote, the practices of giving and receiving known to human societies. As the basis for such reframing, the idea of sharing in another’s misfortune is proposed. It relies on the human practices of giving and receiving and, with appropriate regulatory safeguards, can provide a better conceptual basis for blocking commercial exchanges of human body parts. (shrink)

An innovative program recently initiated at the University of California, Los Angeles Medical Center allows people to donate a kidney in exchange for a voucher that a loved one can redeem for a kidney if and when needed. As a relatively new practice, the ethical implications of advanced kidney donation have not yet been widely discussed. This paper reflects on some of the bioethical issues at stake in this new donation program, as well as some broader philosophical issues related to (...) the meaning and moral salience of commodification. I first consider whether the literature on commercial markets in organs––a longstanding topic of bioethical debate––can meaningfully inform ethical analysis of kidney voucher programs. Specifically, I consider whether and to what extent common objections to the exchange of kidneys for cash also apply to the exchange of kidneys for “kidney vouchers.” Second, I argue that the contrast between the ethical issues raised by these two practices highlights the need to understand commodification as existing on a continuum, with different degrees of commodification giving rise to different ethical issues. Doing so can help sharpen our understanding of commodification as a moral concept, as well as its relevance to broader debates about the moral limits of markets. (shrink)

The UCLA Medical Center has initiated a “voucher program” under which a person who donated a kidney would receive a voucher that she could provide to someone of her choosing who could then use it to move to the top of the renal transplantation waiting list. If the use of such vouchers as incentives for donors is morally permissible, then cash payments for kidneys are also morally permissible. But, that argument faces five objections. First, there are some goods whose nature (...) allows them to be exchanged for similar goods but renders them monetarily inalienable. Hence, kidneys might be exchanged for kidneys but not sold for cash. Second, voucher programs respect donor autonomy, whereas the offer of cash payments does not. Third, the burden of proof lies with the advocates of cash payments for kidneys to show that their benefits would outweigh the costs of their legalization. Fourth, allowing cash payments for kidneys would stifle medical innovation. Fifth, allowing cash payments for kidneys would result in these organs being used as collateral to secure loans—and that this would disadvantage potential borrowers who did not want to risk their kidneys in this way. This paper will rebut all these objections. (shrink)

Petersen and Lippert-Rasmussen argue that persons who decide to be organ donors should receive a tax break, and then defend their view against eight possible objections. However, they misunderstand the Titmuss-style concerns that might be raised against their proposal. This does not mean that it should be rejected, but, instead, that when it is reconfigured to meet the Titmuss-style charges against it, they should support legalizing markets in human organs rather than merely offering tax breaks to encourage their donation.

In a recent article (“The current state of the platelet supply in the US and proposed options to decrease the risk of critical shortages”) published in _Transfusion,_ Stubbs et al. have argued that platelet donors should be paid. Dodd et al. have argued against this proposal, supporting their response with survey data that shows that blood donors (and by extension platelet donors) and potential platelet donors are uninterested in receiving incentives to encourage them to donate. Instead, argue Dodd et al., (...) prospective platelet donors are motivated more by the ease of donation than the prospect of payment. This article defends Stubbs et al. from the criticisms of Dodd et al. It first argues that the preferences that persons state they have in response to survey questions might not reflect the preferences that their actions would reveal they have in actual rather than hypothetical situations. This hypothetical bias is especially likely when persons respond to surveys that ask them about the performance of morally commendable actions (such as platelet donation). This article then argues that the survey that Dodd et al. rely on exhibits serious selection bias with respect to the set of persons it considers to be potential platelet donors. (shrink)

Drawing on empirical evidence in medicine, economics, law, and anthropology, I argue that a market is uniquely capable of meeting the demand for transplantable kidneys, and that it may be arranged so as to operate safely. The welfare gains, expected to accrue to both vendors and recipients, are sufficient to justify sales. Having spelled out the considerations recommending a kidney market, I address the most forceful objections facing the proposal. Despite its currency, the claim that incentives will crowd out altruistic (...) donors and result in a decrease in supply is empirically unsupported and predicated on an implausible view of donorsâ motives. A host of objections claim vendorsâ will not give informed consent. Many such objections identify easily remediable problems, or impose unreasonable standards â standards that would rule out morally permissible kidney donation. And all presuppose a model of morally transformative consent that, I argue, is deficient. Two further challenges point to harms inflicted on those who do not participate in the market. Some claim that those in poverty will be subject to harmful social and legal pressure to vend. This objection fails to distinguish between being pressured to perform a specific act, and being under general economic pressure and having the option to perform an act. It, moreover, presupposes vending more common than is possible. Others worry that the market will give rise to unfair pecuniary externalities. This objection also presupposes that kidney sales will occur more often than is possible. But more importantly, the normative consideration that is supposed to make such externalities especially objectionable, in fact, recommends allowing sales. I also make a political case for kidney sales. I offer an account of the stateâs proper role in the market. I begin with a conception of democratic equality according to which the state is responsible to secure for its citizens the preconditions for democratic participation. I then show that this end would be promoted were the state to end the current prohibition on sales. (shrink)

It is widely agreed that living kidney donation is permitted but living kidney sales are not. Call this the Received View. One way to support the Received View is to appeal to a particular understanding of the conditions under which living kidney transplantation is permissible. It is often claimed that donors must act altruistically, without the expectation of payment and for the sake of another. Call this the Altruism Requirement. On the conventional interpretation, the Altruism Requirement is a moral fact. (...) It states a legitimate constraint on permissible transplantation and is accepted on the basis of cogent argument. The present paper offers an alternative interpretation. I suggest the Altruism Requirement is a moral fiction—a kind of motivated falsehood. It is false that transplantation requires altruism. But the Requirement serves a purpose. Accepting it allows kidney donation but not kidney sale. It, in short, rationalizes the Received View. (shrink)

It is generally agreed that the current methods of providing health care in the West need to be reformed. Such reforms must operate within the practical limitations to which any future system of health care will be subject. These limitations include an increase in the demand for costly end-of-life health care coupled with a reduction in the proportion of the population who are working taxpayers (and hence a reduction in the proportionate amount of health care funding that can be secured (...) through taxation) and the fact that the imposition of bureaucratic regulations on health care systems is costly. Recognizing these limitations should naturally lead one to consider market-based reforms. Yet despite the practical impetus for such reforms, there is still widespread concern that market-based health care is unethical. The purpose of this paper is to address this concern and, in so doing, to pave the way for the market-based reform of health care to proceed. (shrink)

In his review of my book Whose Body is It Anyway, Wilkinson criticises the view (which I defend) that confiscating live body parts for the sake of the needy is (under some circumstances) a requirement of justice. Wilkinson makes the following three points: (a) the confiscation thesis is problematic on its own terms; (b) there is a way to justify coercive resource transfers without being committed to it; (c) the thesis rests on a highly questionable approach to the status of (...) the body. Wilkinson’s paper is challenging, and some of his points are well taken. On the whole, however, it does not constitute an insurmountable challenge for my thesis. (shrink)

Moshe Tati, a sanitation worker in Jerusalem, was among the first of more than a thousand mortally sick Israelis who signed up for illicit and clandestine ‘transplant tour’ packages that included: travel to an undisclosed foreign and exotic setting; five-star hotel accommodation; surgery in a private hospital unit; a ‘fresh’ kidney purchased from a perfect stranger trafficked from a third country. Although Tati’s holiday turned into a nightmare and he had to be emergency air-lifted from a rented transplant unit in (...) a private hospital in Adana, Turkey back to Israel, Moshe became a poster-boy of transplant tourism for the next decade. João Cavalcanti was among the first of 38 residents of the slums of Recife recruited by retired military Captain Ivan da Silva and his sidekick Captain Gadddy Tauber to travel to Durban, South Africa to provide a spare kidney to an Israeli transplant tourist in Durban. This article examines the logics and practices through which kidney buyers and kidney sellers, organs brokers, surgeons and their accessories convince themselves that they are engaged in an illegal but still mutually beneficial ‘medical-recreational’ adventure, an ‘extreme medical sport’ of sorts. While life, health and survival motivate ‘transplant tourism’, a euphemism for human trafficking in spare body parts, the freedom to roam, mobility, is an essential feature of transplant tours for kidney buyers and kidney sellers. (shrink)

I am very pleased to see the response by J S Taylor to my critique of the “organs debate”. He makes some notable and important points, but also some errors to which attention should be drawn.Taylor erroneously attributes to me concern that the organ debate excessively focuses on saving the lives of a few people. My concern was about the narrow framework within which the debate is embedded and that it focuses on the lives of a few privileged people—those who (...) can pay—while largely neglecting the lives of those who cannot. The fact that some attention has been paid to such issues in some journals does not negate the importance of my claim. Moreover, it is not that the question of millions of premature deaths has …. (shrink)

The organ donor shortfall in the UK has prompted calls to introduce legislation to allow for presumed consent: if there is no explicit objection to donation of an organ, consent should be presumed. The current debate has not taken in account accepted meanings of presumption in law and science and the consequences for rights of ownership that would arise should presumed consent become law. In addition, arguments revolve around the rights of the competent autonomous adult but do not always consider (...) the more serious implications for children or the disabled. (shrink)

The market for kidneys offers a case study of Baptists and Bootleggers. In almost every country, sales are currently illegal and donated organs are allocated by a central planner. Thousands of people die every year, because of the shortage caused by the absence of markets. This paper starts by examining the free-market alternative, and shows that a market would solve the shortage. It then uses gains-from-trade analysis to explain why current vested interests oppose a move to a market, despite the (...) immense potential for saved lives. In a shift to a market, gains from trade would be distributed away from lucky patients and various industries that benefit from the shortage ; these “Bootleggers” form an alliance with “Baptists”. (shrink)

An increasingly common objection to kidney sales holds that the introduction of monetary incentives may undermine potential donors’ altruism, discourage donation, and possibly result in a net reduction in the supply of kidneys. To explain why incentives might be counterproductive in this way market opponents marshal evidence from behavioral economics. In particular, they claim that the context of kidney sales is ripe for motivational crowding. This reasoning, if sound, would have a profound influence on the debate over kidney sales. What’s (...) perhaps the principal reason to favor a market – the increase in supply it would bring – would be called into doubt. However, on inspection it becomes apparent that the evidence touted by market opponents not only lends no credence to their claims, but also provides some positive reason to doubt them. The near-ubiquitous references to motivational crowding in the literature on kidney sales are fundamentally misplaced. (shrink)

In The Gift Relationship, Richard Titmuss argued that the practice of altruistic blood donation fosters social solidarity while markets in blood erode it. This paper considers the implications of this line of argument for the organ market debate. I defend Titmuss’ arguments against a number of criticisms and respond to claims that Titmuss’ work is not relevant to the context of live donor organ transplantation. I conclude that Titmuss’ arguments are more resilient than many advocates of organ markets suggest, and (...) more relevant to the debate than is commonly appreciated. (shrink)

Luke Semrau argues that the documented harms of existing organ markets do not undermine the case for establishing regulated systems of paid kidney donation. He offers two arguments in support of this conclusion. First, Semrau argues that the harms of kidney selling are straightforwardly amenable to regulatory solution. Second, Semrau argues that even in existing black markets, sellers would likely have experienced greater harm if the option of selling a kidney were not available. This commentary challenges both of Semrau’s claims. (...) I argue that there is no reason to believe that kidney sellers benefit from the current black market trade in organs, and highlight a number of potential issues regarding the effectiveness and feasibility of Semrau’s proposed market regulations. (shrink)

In this essay, I argue that the Commodification Objection, locates a phenomenon of real moral significance. In defending the Commodification Objection, I review three common criticisms of it, which claim firstly, that commodification doesn’t always lead to instrumentalization; secondly, that commodification isn’t the only route to such an outcome; and finally, that the Commodification Objection applies only to persons, and human organs are not persons. In response, I conclude that moral significance does not require that an undesirable outcome be a (...) necessary consequence of the phenomenon under examination; the relative likelihood of an undesirable mode of regard arising provides a morally-relevant distinguishing marker for assessing the comparative moral status of social institutions and arrangements; and sales in blood products are sufficiently distinct from sales of everyday artefacts and sufficiently close to personhood to provide genuine grounds for concern. Accordingly, criticisms of the Commodification Objection do not provide grounds for rejecting the claim that human organ sales in general and compensation for blood plasma donation in particular can have morally pernicious ‘commodificatory effects’ upon our attitudes, for what human organ sales provide is a distinctive ethical hazard. (shrink)

Clinical investigators must engage in just subject recruitment and selection and avoid unduly influencing research participation. There may be tension between the practice of keeping payments to participants low to avoid undue influence and the requirements of justice when recruiting normal healthy volunteers for phase 1 drug studies. By intentionally keeping payments low to avoid unduly influenced participation, investigators, on the recommendation or insistence of institutional review boards, may be targeting or systematically recruiting healthy adult members of lower socio-economic groups (...) for participation in phase 1 studies. Investigators are at risk of routinely failing to fulfill the obligation of justice, which prohibits the systematic targeting and recruiting of subjects for reasons unrelated to the nature of the study. Insofar as we take seriously the obligation to engage in just subject recruitment and selection, I argue that we must acknowledge the implications low payments might have for subject recruitment and selection and examine the effect of low payments. If low payments de facto target the less well-off for phase 1 studies, we must defend the priority ranking of the obligation to avoid undue influence over the obligation of justice or adopt an alternative recruitment approach. This paper identifies a number of alternatives to the current system of low-value payments to research participants. (shrink)

This essay does not directly address organ transplantation or even issues of justice, fairness, or equality in access to organs for transplantation. Instead, it engages a higher-order question: the justice of coercively and globally imposing any particular contentfull view of justice, fairness, and/or equality under circumstances that would violate peaceable, consensual choice. It is argued that state coercion, as in the prohibition of the sale of organs or the coercive imposition of equal access to transplantations or health care, is unjust (...) when there are insufficient grounds to establish with certainty the canonical normative character of the particular account of justice, fairness, or equality, as well as the warrant for the use of coercive force to impose such an account. (shrink)