MOTION #36: THIS HOUSE WOULD LEGALIZE THE SALE OF HUMAN ORGANS

As our knowledge of surgical and diagnostic techniques has increased with time, so has the success rate of organ transplants. However, the number of patients who require organ transplants exceeds the number of organs available, particularly if the patient has a rare blood type or belongs to an ethnic minority where organ donations are even lower than normal. For example, although black people are three times more likely than the general population to develop kidney failure, and the Asian community has a particularly high demand for organs, organ donation within these groups is relatively low. It is important for the donor and recipient to have the same blood type and similar genetic make-up in order to minimize the change of the receiver’s body rejecting the organ. More than 10,000 people in the UK currently need a transplant, and 1,000 people die every year while on the waiting list. In the US, over 100,000 people are still on the waiting list. Although these figures are astonishing in themselves, the genuine figure is probably higher, inflated by the deaths of patients who are never waitlisted for a transplant. Some patients are never placed on the waiting list because they have certain habits – such as smoking – and the precious few organs available are prioritised for patients who fit recipient categories.

The sale of human organs offers a possible solution to this crippling shortage of organs. There is already an established black market trade in organs. Entrepreneurs offer British and Western patients the opportunity to receive privately financed transplants in countries such as India and Malaysia. In 2006, investigators discovered that Chinese hospitals were providing organ transplants using the organs of executed prisoners. In 1983, Dr. Barry Jacobs requested that the US government should create a fund to compensate the families who donate the organs of their deceased relatives. He also proposed a business plan to buy kidneys from living donors to transplant to American patients. However, these is still plenty of opposition to these ideas, and the National Organ Transplantation Act of 1984 still prohibits the sale of human organs from both dead and living donors.

The proposition line could argue that organs are the property of the donors, and so they have a right to do with them as they wish. In this case of buying human organs, it is much easier to argue that the profits would go to the donor rather than (for example) hospitals or governments which may not have a vested interest in those concerned. It would be useful to outline in the mechanism that these organs will be transferred through a unique medical group or business which has the technology available to match up donors to potential recipients and so avoid potential medical complications as far as possible. After this, it would be like any other financial transaction. This debate will focus on the United Kingdom, but the arguments would be relevant to most countries considering this policy change.

Pros	Cons
We already recognize the benefits of individuals who are able to pay for their healthcare doing so. The ethics of private healthcare are not in question here; indeed, the UK government has stated that as many people as possible should be encouraged to pay for private healthcare in order to relieve the strain on national resources. Critics have understood this as the government prolonging waiting lists until the patients ‘remove themselves’ either by going private, or dying. There is, however, a general understanding that the NHS in the UK is overburdened and that increased private healthcare would help to balance this. Meanwhile, in the US, private healthcare is the norm. Allowing the sale of organs is merely an extension of this principle and provides utilitarian benefit. Not only would those who are able to pay for an organ enjoy a much better chance at recovery, but there would be more time, space, and resources for the people who could not afford to do this privately.	If payment-for-organs is introduced as a general norm, this will extend to the state-financed hospitals which are so burdened in the first place. Few families would turn down the opportunity to receive ‘compensation’ or payment for the families of their loved ones which could ensure financial stability, particularly if the family member who died was the sole or main earner. Therefore, either these families will charge the hospitals the same prices, or they will refuse to donate the organs, and turn to a private market instead. Given that the black market price for organs can reach tens of thousands of pounds, it seems unlikely that struggling health systems would be able to afford it, and this would only encourage an incredibly harmful disparity between the wealthiest and the poorest. Unless the proposition case wants to argue that a rich person inherently has a greater right to an organ than a poor person, their point falls.
Legalising the sale of organs will eradicate the black market and ensure safer transplants. Legalisation can help to eliminate the corruption currently associated with the organ market. It can also make it easy to regulate, and so safer. Given the mystery of the black market, medical complications are much more likely; it is necessary to match the donor and recipient together, but this cannot be easily done when every step of the organ collection and donation must be hidden for fear of prosecution. Legalisation could also stop the ‘theft’ or organs and abuse of people like Chinese prisoners who are currently exploited for their organs – authorities will become accountable to a publicly recognised and enforced system.	If certain people are already risking punishment by harvesting and transplanting organs illegally, it seems unlikely that they will suddenly become accountable to a system that recognises that organs can be bought and sold arbitrarily. If Chinese officials are already suspected of these activities, it would be very difficult to ensure that profit from the donated organs did go to the donors or their families rather than corrupt authorities. Finally, legalizing an action that is currently carried out in appalling conditions essentially legitimizes appalling human rights violations, and allows human sacrifice.
People should have rights over their own body and body parts. The proposition is not concerned with live people trying to donate their hearts, or other vital organs which they cannot live without. No matter how impoverished that person might be, they will not choose certain death for a cash payoff. However, organs like kidneys, and sections of liver, can be and often are donated from a live donor without significant lasting damage. It is patronising to forbid an individual to sell or donate an organ when it is possible for them to live without it. Similarly, the family of a deceased relative, as next of kin, should have the right to receive financial remuneration from their organs.	The state often denies individuals the right to do certain things with their bodies. For example, the state makes hard drugs illegal because it recognizes that sometimes individuals do not make the best decisions for their health or lifestyle choices, and that the physical damage to their bodies is often lasting and life-changing in ways which that individual did not apprehend. Furthermore, somebody who is selling an organ to try and pay off debts or to relieve financial pressure is unlikely to be thinking entirely rationally; this is an incredibly extreme measure, and allowing individuals to take control over it for a cash reward is a dangerous way to create an incentive to cause bodily harm.
The donor should be able to benefit financially, rather than being expected to donate organs with no reward. Given that the doctors, nurses and surgeons who work around organ transplants are all paid, it is nonsensical that the donor, the most important figure in the organ transplant, should be left out. The United States already allows markets for sperm, blood, human eggs and surrogate wombs. There is no good reason why organs should be excluded when these other human products are not; there is no moral difference between a kidney and an ovum. Moreover, organ donation is a lifesaving process, whereas sperm and egg donation are not. Simply put, incentivizing donations through payment will save the lives of many patients in need. The payment from these organs could also hugely improve the quality of life of the donors by lifting them out of debt, or allowing struggling individuals, such as students, to improve their career potential by paying for their university fees.	It is exactly because organs are potentially life-saving that it would be dangerous to legalize their sale. Sperm and egg donations are a last resort for a couple struggling with infertility; they have had time to weigh their options. Similarly, when sperm, blood or eggs are donated, they regenerate – kidneys do not. When an organ is the only and final chance for the patient’s recovery, the patient loses rationality and becomes desperate to obtain one – to the point where the donors can essentially name any exploitative price he or she likes. Not only are these individuals then exploited, and the poorer patients left to die, but hospitals will be unable to afford them – so the overall chance of a patient receiving an organ will plummet for the majority without the money to pay for it.
It is just as bad to forbid those who can afford to buy an organ from taking a life-saving action as it is to allow poorer people to die. In an ideal world, there would be unlimited organs; but as organ shortages continue, if anybody can afford to skip the queue by buying an organ – whether they are generally rich or poor – we should allow them to do so.	Allowing the sale of organs will harm state-financed health services and create a two-tier system. There is almost no chance that a state-financed health service will be able to afford the prohibitive cost of purchasing organs under this model. While it is difficult to track the exact price of organs on the black market, they often reach many thousands of pounds and there is no reason to believe that the proposition’s model would suddenly reduce this price. In effect, this would turn essential organs into luxury items which the state cannot afford to provide, and so the poorest and neediest would be left to die. This would condone the most gross discrimination between rich and poor where a rich life, perhaps even despite a previously neglectful lifestyle (for example drinking and smoking), could be prioritised over a poor person’s life where their medical condition may not have been caused by their lifestyle choices.
Given the necessity of a close match between donor and recipient blood types, and a higher rate of transplant success within the same race rather than between races, it is a huge exaggeration to imply that people in poor countries, such as African states, will be scavenged for organs. Donors from these countries simply will not always match the medical requirements of Western recipients. In fact, if the organ did match, the balance of harms still falls in favour of donation. While the donor should obviously be paid the amount (or very close to, given administration and surgical costs) paid by the recipient, $10,000 to a struggling family in an impoverished country could literally be a life-changing opportunity to lift them out of poverty. In this case, while there may be financial pressure to donate, it is still a reasoned and logical trade-off for financial security for a family, and could greatly improve quality of life for both donor and recipient.	Allowing the sale of human organs in the First World will impact negatively on the Third World. The existing black market already shows a firm flow of organs in one direction; from the Third World to the First. Those who battle with poverty in poor countries will see the opportunity to sell their organs to the wealthy West; however, current disparities between how much donors are paid for their organs and how much these are then sold on for shows that the donors are already exploited. Levy Izhak Rosenbaum, a New York City resident, was accused of paying poor donors in Israel $10,000 for a kidney but charging up to $160,000 to recipients. There is no reason to believe, even if we legalize and regulate the organ trade within Western countries, that people in poorer countries will not continue to be exploited in this manner when they do not share the same legislation as us.
Would the idea of ‘presumed consent’ stand up in any other area of the law, particularly in cases considering a drastic action performed on the body? The BMA system completely undermines the UK’s current conception of consent, particularly that you ‘must be given enough information to enable you to make a decision’. There is no way to assess if a patient who has not opted-out of a system like the BMA proposes has truly had enough knowledge of the subject to make an informed decision – especially considering that 36% of the nationwide survey conducted by UK Transplant ‘were unaware the NHS Organ Donor Register existed’. Until the general public has a much, much better understanding of the donor system – in which case most citizens would likely opt-in anyway – this system is inherently flawed. Moreover, the potential impact on a grieving family, if they find out that their relative’s organs had been ‘presumptively’ taken, is very serious. Family objections are already a problem even in cases where the relative actively opted-in; this would continue to cause greater outrage if the BMA system were implemented.	There are better solutions to the problems of organ shortages, such as the BMA system of ‘presumed consent’. The British Medical Association (BMA) is pushing to introduce a policy of ‘presumed consent’, whereby organs may be taken from a patient who has died unless they expressly registered their objection to this before their death. Given that a far larger percentage of people indicate that they would be happy to donate than the percentage who actually do donate, this scheme could combat apathy on behalf of the general society and encourage them to act rather than ignoring or forgetting the option to donate their organs. This is particularly true in the categories of people who said that they ‘didn’t know how to register’, ‘had never thought about joining’ or who ‘hadn’t got round to it’ – comprising a total of 53% of the participants in the NHS nationwide survey. This scheme could have an enormous impact in saving the lives of others through a much greater number of available organs. Several countries, including Spain and Austria have already adopted an opt-out system, and studies have shown that this policy has caused a dramatic increase in the number of donations. We can solve the organ shortage without all of the problems inherent in the proposition’s proposal.
Even if there is not an ‘absolute’ right of property over organs, we still grant individuals to actively choose organ donation, or to refuse to. In this way, we do accept that each individual has a practical say over the use of their physical body, just as we must gain consent from a patient to allow a medical procedure, or allow him or her to refuse it. There is a huge tangible benefit in this motion – namely that fewer people will die when there is the option for them to receive organs – and this should take precedent over complicated legal theory which is often inconclusive one way or another. Just because law and philosophy do not definitively grant a right of property over the body, they do not definitively deny it either. The balance of harms lies firmly in favour of the motion because more people benefit, either financially or medically.	Individuals do not have an inviolable right of property over their organs. The notion of property over body parts is very complex, both legally and philosophically. Generally, judges have shown ‘abhorrence’ at the idea of defining human bodies or parts of, whether living or dead, as ‘goods or materials’; if a right to property over the body could ever be exercised, it appears most strongly where the individual shows ‘no intention of abandoning or donating it’. While this continues to be an incredibly complex issue, it essentially demonstrates that there is no absolute right of property over an individual’s own body parts; it is open to interpretation in each case. A proposition line that grants authority to any potential donor over the selling of organs assumes a right of property which does not, in fact, exist. As such it can, and should, be prevented.