Selling Organs Should it be Legalized?

Introduction
The question of whether selling of human organs should be legalized has been the subject of debate between those who support the sale of organs in order to save lives, and those who are opposed to it from a moral and ethical point of view. Leading surgeons are among the key proponents of legalising the sale of organs, and they have called upon the Government to take into account the benefits to be had by legalising the sale of organs (Smith, 2011). Holding of public discussions on the possibility of permitting the sale of organs, the surgeons argue, would translate into better-informed decisions on such issues of medical and moral significance (Smith, 2011). Even though many people and governments are opposed to the sale of organs, it is important to appreciate the fact that it is still happening in the black market. Patients in many countries such as the UK and the United States who are in need of organ transplant have to be put on a waiting list and it takes very long before they receive a donor because of the large number of people on such a waiting list. Consequently, proponents of organ transplant have argued on the need to regulate and legalize the commercial sale of organs in order to develop a standard that shall market the trade, and avoid exploitation of poor donors by rich buyers, and especially brokers. Legalizing organ trade would solve the issue of shortage in organ donors and reduce the control of black market on organs prices. On the strengths of these reasons, I intend to argue in favour of legalizing the sale of organs in this paper. In keeping with this position, the study shall endeavour to demonstrate how legalizing of organ trade would go a long way in solving the health issues of patients who have been on the waiting list for long. To begin with, the history of organ transplant shall be explored, as well as the impact that religion has had on the organs sale industry. In addition, the benefits of organ sale on society shall be explored, and the possible side effects of permitting organs sale. Finally, the study shall give recommendations on what could be done in order to support legalizing of the organ trade.
History of organ transplantation
The idea of organ transplant is now new, and dates back to 1954, when the first human organ transplant was carried out. This maiden organ transplant was a kidney transplant involving an identical twin, Ronald Herrick, who donated a kidney to his brother, Richard Herrick. The transplant was successfully performed by Dr. Joseph Murray at the Birmingham Hospital in Boston, Massachusetts. For his efforts, Dr. Murray was awarded the Nobel Prize. After receiving the kidney, the recipient lived for another eight years. In 1963, Dr. James Hardy and his team at the University of Mississippi Medical Centre performed the first ever successful lung transplant (Clemmons, 2009). The first successful heart transplant was performed in Cape Town, South Africa, in 1967, at Groote Schuur Hospital. The surgical team was led by Dr. Thomas Starzl. Since then, we have had other major breakthroughs in organ transplants across the globe. This has given a new lease of life to patients who only had a short time to live, but for these medical interventions. Recently, in 2010, a 31 year old Spanish man who had been badly injured in a shooting accident became the first recipient ever of a full face transplant. The surgery took place in Spain.
How does the religion affect the organs sale industry?
No religion is formally opposed to receiving or donating of organs. In addition, no religion appears to be formally opposed to organ transplantation either from a deceased or living donor (Bruzzone, 2008). On the other hand, Roman Gypsies, Native Americans, Shintoists, Confucians, as well as some Orthodox rabbis, seem to discourage organ transplantation from deceased donors. Bruzzone (2008) also reports that a number of South Asia Muslim jurists (muftis) and scholars (ulemas) are opposed organ donation from either deceased or living human organ donors as they regard the human body as a trusteeship (“amanat”) from God and as such, should not be desecrated upon death. Nevertheless, these ulemas and muftis seem to encourage xenotransplantation research (Bruzzone, 2008). At the same time, we need to note that no religion compels or obliges its followers to either refuse or donate organs. Moreover, no religion formally compels its believers to regard cadaveric organs “a societal resource” or regard organ donation “a religious duty” (Bruzzone, 2008). However, we have an exception here as well. Some isolated Christian, Muslim scholars and rabbis do so.
On the issue of the waiting list for organ donation and the subsequent organ transplantation, no religion appear to have taken a formal position regarding “bonus points”, or giving of priority to certain organ recipients over others. Bruzzone (2008) also reports that no religion is opposed to the practice of living organ donation. On the other hand, some Islamic Muftis/Ulemas as well as some Orthodox Jews have been reported to be opposed to direct organ donation to recipients of the same religion as the donor. At the same time, only a handful of some Asian religions and Muslim Muftis/Ulemas have been shown to demonstrate a preference for living donation in favour of cadaveric donation. Nonetheless, no religion per se appears to be in favour of cadaveric donation in place of living donation (Bruzzone, 2008).
The role of religious issues in informing the decision on organ donation has also been reviewed by Oliver et al (2010). According to the authors, religious concerns could be a significant reason why some patients refuse to list for renal transplant. They further note that religious concerns could also be significant when discussing matters of live donation. This seems to indicate that religious concerns on matters of organ donation are much more important than the transplant teams and clinicians care to admit. The issue is obviously aggravated when you consider that only a handful of patients, if any, opt to discuss their religious concerns possibly because the idea of transplantation is rather novel to them. In addition, they get to meet transplant teams that they are not familiar with. In contrast, health professionals could opt to avoid delving into this controversial issue entirely because they may have limited knowledge on transplantation.
What benefits does this action have of society?
Clemmons notes that over the past five decades, surgeons across the globe have developed capabilities to transplant “virtually every vital organ in the human body” (2009). As a result, organ transplantation is today regarded as being among the most important medical breakthroughs, an achievement that is laden with enormous demand. Currently, some 79,748 patients in the United States are on a kidney transplant waiting list while a further 15,771 patients are on the liver transplant waiting list (Clemmons, 2009). Elsewhere, Gore-Langton (2003) notes that more than 5,000 patients in the UK are on a waiting list for organ transplant. Again, like in the case with the U.S population, majority of patients on the waiting list are in need of a kidney transplant. What these statistics appear to plainly show is that the demand for organ donation by far outstrips the supply. This is in spite of several decades of public education regarding the virtues involved in organ donation, as well as the important legislation that reinforce this goal.
A study carried out by the U.S. Department of Health and Human Services (as reported by Clemmons (2009) reveals that in the past decade alone, there has been a two-fold increase in the national donor waiting list to 101,953, up from 46,961. This is a clear indication of the many lives that are at stake, and this further reinforces the need to sanction a legal market that facilitates the selling and buying of organs. From a societal point of view, it is important to appreciate the fact that there has been a dramatic evolvement in societal norms in the last five decades. As a result, Clemmons (2009) argues that Americans can now enjoy more freedoms in regards to what they can and cannot do with their bodies. However, such increased freedom without a legal framework to sanction the procurement of organs could do society more harm than good as it would be hard to monitor the process from possible abuse by unscrupulous middlemen or surgeons, or the exploitation of the gullible and poor donors.
What are the side effects of permitting organs sale?
There appears to be strong arguments for legalizing organ trade on the understanding that doing so would raise standards, effectively eliminating the black market and its associated issues of organ shortage and health risks. However, this argument is defective on certain levels. For example, some opponents have argued that in this day and age of the internet, regulation of the organ market would not work. Those with money would obviously benefit from the best-matched organs, while the rest would have no choice but to go for bargain-basement deals (Clemmons, 2009). As a result, they are likely to get organs from unquestionable sources, including the homeless and illegal immigrants. As a matter of fact, a number of surgeons are of the opinion that the idea of legalizing the organ market is, to say the least, frankly horrific (Gore-Langton, 2003).
Even as several individuals regard a legalized system that facilitates the sale of organs as an effective means of increasing limited organ resources, majority of the patients on the waiting list of organ donation are fearful that such resources could be allocated to just the individuals who are financially capable of paying for them. At the same time, most sceptics of a legalized system are of the view that most donations will likely be from the poor, effectively benefiting the rich from the ensuing disparity. Questions have also been raised regarding the quality of organs being donated (Clemmons, 2009). There is also growing fear among sceptics that legalizing the organ market is likely to transform the U.S. Society “into one that sells body parts for money” (Clemmons, 2009). In addition, sceptics argue that such a service is likely to be hijacked into a money-making venture in an attempt to get ahead financially, as opposed to the noble cause for which the policy was implemented for, in the first place.
What could be done to support legalizing organs trade?
While most developed countries seem to have legalized artuistic organ donation, however, none has so far sanctioned the formation of a legal organ market (Arora, 2012). Presently, majority of the patients on a wait list for organ transplant depend heavily on transplant tourism where patients in need of organ transplant have to travel abroad where they get organs from the foreign donors and also undergo organ transplants in such countries as India. Alternatively, patients can depend on the black market for organ trade that is highly corrupt. Given such a scenario, it is the opinion of many that legalizing the organ trade would only increase the number of annual organ transplants and reduce the prevalence of the black market, as opposed to eliminating it altogether.
When considering the possibility of legalising the organ market, there are two key aspects involved: how economically effective such a market is, and the social problems linked to organ trade. In this case, the environmental situation of the donor is important. While organ donation is linked to a number of health risks, the market has gained prominence in Brazil and India, countries that are also characterized by high levels of poverty. In Brazil, donors do not have access to basic health care and clean water, and majority of them are afflicted by major health issues following surgery (Arora, 2012). In India, women have been reduced to collateral damage on account of the levels of poverty. The limited power possessed by poor Indian women means that their husbands could also coerce them to sell organs, as evidenced by the fact that 79% of women donors in India are married women.
The lack of governmental regulation and limited infrastructure in such poor countries as Brazil and India where the black market for organ trade is well established also means that the success of legalizing the trade would only enjoy limited success. Moreover, taking into account that the organ sellers resort to the sale of body organs as a means of escaping poverty, there is no guarantee that enhanced awareness of the operational risks involved in organ donation will act as a deterrent to donating. However, there is a high likelihood that governmental regulation could be useful in eliminating a number of the social issues that affect organ trading.
If at all the organ market is to be legalized, there is need to base it on the fundamentals of economics. For example, it is important to give incentives to organ donors as a means of stimulating the supply of organs. A possible strategy that has been proposed is the establishment of a federal funded family death benefit for individuals who choose to act as organ donors. This can be accomplished via the potential donor’s license registration. The family of such an organ donor could be given benefits in the form of covered burial or funeral costs, or direct cash reimbursement (The Lancet, 2007). Alternatively, living donors could be given a healthcare voucher, tax exemption, or education voucher. In addition, donors could be directly compensated for their organs with money. Not only do all the three options increase the supply of available organs, but they would also result in a dramatic reduction in the number of organ recipients on the waiting list.
In the United States, even as both NOTA (The National Organ Transplant Act) and UAGA (The Uniform Anatomical Gift Act) have played a role in developing the organ procurement process, they have nonetheless failed to alleviate the shortage of organs. In a bid to overcome this shortcoming, states such as Utah, Idaho, Virginia, and South Dakota have resolved to revise UAGA. The revision of this act will ensure that sensitive issues in the 1968 legislation are clarified, such as the case of critically ills patients who may opt to donate organs but nonetheless, have no intention of remaining on life support.
Legislation on organ donation that is being developed is to increase federal funding on therapeutic cloning. This involves extraction of a patient’s DNA and inserting it into an egg that has had its nucleus removed. The ensuing stem cells after the egg has undergone cell division can then be harvested. They would then find use in the creation of a genetically matched and identical organ for the patient. One key benefit of stem cells is that while transplanting them into the patient, there is no risk of rejection, and neither does the patient need to take immunosuppressant drugs (Gore-Langton, 2003).
Another possible legislative option for the legislation of the organ market involves encouraging xenotransplantation. This refers to the use of organs that have been harvested from species other than humans (Arora, 2012), such as pigs. Already, the approach has found application, albeit at a small scale, whereby diseased heart valves in humans are being replaced with heart valves obtained from pigs. In addition, various biotechnology companies are involved in trial projects whose aim is to ensure that they engineer organs that will produce organs that cannot be rejected by human recipients. Should this approach be approved, it could herald an unlimited supply of organs. However, producing such animals is laden with a lot of technical difficulties, not to mention the likely risk of infectious diseases being spread from one species to another. In addition, the use of animal organs could raise objections from religion, especially the Islam, where pigs are concerned.
Conclusion
The idea of whether selling of organs should be legalized or not, has elicited mixed feelings from various quarters. There is no denying that the demand for organ transplant by far outstrips the supply, going by the number of patients on the waiting list for organ transplant in the United States and the UK. Nonetheless, the black market for human organs seems to be thriving in such countries as Brazil and India. From a religious context, no particular religion appears to be opposed to the donation or receiving of body organs, although certain factions of Islam and Christianity have raised concerns. Given that organ transplants give a new lease of life to an individual who would otherwise have no hope of living, I feel compelled to argue in favour of legalizing organ trade. Not only would this increase the supply of human organs, but it would also reduce the risks associated with the black market of organ trade. Legalizing the trade would also lead to the development of elaborate compensation options for the families of the dead donors, and the living donors as well. However, it is also important to consider revising the existing legislation on organ transplant to permit the use of novel techniques like harvesting of stem cells and xenotransplantation as a means of meeting the rising demand for human organs.

References
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