Wednesday, June 03, 2009

Organ Markets: An Ethical Perspective – Part III

You should probably read Part I and Part II before continuing here.

Next we will consider the complex case of the utilitarian perspective. The utilitarian perspective will attempt to achieve the greatest good for the greatest number of people. The first thing to consider is whether or not a market in human organs would legitimately increase the supply of organs available for transplant. Evidence in India appears to show evidence that there is a market for individuals wishing to sell kidneys “it was estimated that nearly $10 million dollars had exchanged hands for 4,000 transplants in Bombay alone” (Calandrillo, 2004, p. 88).

One concern that is frequently raised is that a market would allow “rich patients buy up all available organs, and leave poorer patients without the chance of a transplant” (Volokh, 2007, p.1839). This may be true, but to some degree is already happening as hundreds of Americans fly abroad each year to purchase organs (Calandrillo, 2004, p. 87). The current ban domestically merely means that the richest of the rich resort to buying organs from the world’s most destitute. Additionally, the long term care of chronic organ failure can be up to $100,000 more expensive than organ transplant costs (Volokh, 2007, p.1839). Therefore, as long as organs can be procured for less than amount it is less expensive to pay for a transplant than to provide the long term care. This would provide considerable incentives for the providers of healthcare, such as Medicaid or insurance providers, to cover some or all of the costs of purchasing organs.

This analysis shows that recipients would certainly benefit from a market in human organs, the question of donors isn’t quite as clear. The large sum of money that they would receive is certainly advantageous. Depending on their income and the amount paid for the organ donors could feasibly be compensated the equivalent of 50% or 75% of their yearly income. This type of compensation would potentially dramatically improve their quality of life, at least over the short term.

One objection to the sale of organs on utilitarian grounds is that the most desperate, tempted by the money, are unwittingly putting their health at risk. There is some evidence that the health risk of donating an organ is quite small. For example, donating a kidney carries a less than 2% chance of death or complications (Volokh, 2007, p. 1841). It is also quite difficult, from an external point of view, to accurately judge the cost benefit analysis required to determine if the health risks outweigh the compensation.

In order to definitively answer the question as to whether organ sales are ethical from a utilitarian perspective the following questions must be answered. Does a market for organs increase the total supply of organs or does material compensation merely erode the supply of altruistic donation? Will a market in organs unfairly favor wealthy recipients over the poor? Or can mechanisms be put into place to ensure that the relatively poor have access to an organ market through charity or government subsidy? Finally, can limits be put into place to ensure that individuals do not sell organs due to desperation or ignorance? This could potentially be resolved by instituting counseling, waiting periods or prohibiting the extremely poor, young or incompetent from participating in the sale of organs.

While legalizing a market in the sale of organs to overcome donor shortages isn’t the only approach it is one that is advocated and derided by many that study the issue. Opponents frequently rely on objections that such a practice is unethical, but when reflecting on such a claim one must ask ‘From what perspective?’ It is true that a categorical imperative analysis of the ethical question will lead to an unethical result if ones values are predisposed to finding the sale of human body as unpleasant. However, alternative approaches to inquiry offer a very different result. An egoistic analysis finds no ethical dilemma while a utilitarian investigation hinges on the answers to some key questions that would protect the most susceptible to harm by such a policy.



Calandrillo, S. (2004). Cash for kidneys? Utilizing incentives to end America's organ shortage [Electronic version]. George Mason Law Review, 13, pp. 69-133.

Delmonico, F. L. & Kahn, J. P. (2004). The consequences of public policy to buy and sell organs for transplantation. American Journal of Transplantation, 4(2), pp. 178-180.
doi: 10.1046/j.1600-6143.2003.00370.x

National Kidney Foundation. (2003, February 1). Financial incentives for organ donation. Retrieved June 2, 2009, from

O’Reilly, K. B. (2008, July 7). AMA meeting: Delegates seek to change law on organ donor incentives. American Medical News. Retrieved from

The Organ Procurement and Transplantation Network. Data. Available from

Volokh, E. (2007). Medical self-defense, prohibited experimental therapies, and payment for organs [Electronic version]. Harvard Law Review, 120, pp. 1813-1846.

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