Organ sale—for example, allowing or encouraging consenting adults to become living kidney donors in return for money—has been proposed as a possible solution to the seemingly chronic shortage of organs for transplantation. Many people however regard this idea as abhorrent and argue both that the practice would be unethical and that it should be banned. This entry outlines some of the different possible kinds of organ sale, briefly states the case in favour, and then examines the main arguments against.
•1. Different Kinds of Organ Sale System
•2. The Case for Organ Sale ◦2.1 Arguments Based on the Principle of Respect for Autonomy, on Libertarianism, or on a notion of Self-Ownership
◦2.2 The Saving of Lives
◦2.3 Consistency
•3. Harm
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While Wilkinson (2003, 132) is typical of organ sale defenders in wishing to distance himself from today's (largely ‘underground’) organ trade:
… far from being a reason to continue the ban on sale, the dreadfulness of present practice may be a reason to discontinue prohibition, so that the organ trade can be brought ‘overground’ and properly regulated.
Different scholars have different views about the precise scope and extent of the regulation required, but most support the requirements that organ sellers give valid consent, are paid a reasonable fee, and are provided with adequate medical care. Taylor (2005, 110) for example, says that:
At minimum … a market should require that vendors give their informed consent to the sale of their kidneys, that they not be coerced into selling their kidneys by a third party and that they receive adequate post-operative care.
One noteworthy policy proposal comes from Erin and Harris (1994; 2003) who suggest that a market in human organs should have the following
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Prices are set at a reasonably generous level to attract people voluntarily into the market.
Features (1) and (2) combined are supposed to rule out exploitative organ trafficking from poorer countries, while the ban on direct sales and allocation by a central agency ensure that the organs go not to those most able to pay, but to those in most need. In common with many other defenders of organ sale, Erin and Harris also propose building in practical protections for donors and recipients (e.g., adequate medical care and thorough health checkups before donation takes place).
When ethically evaluating organ sale therefore it is best to focus not on the worst aspects of today's organ trafficking practices (since that is not what any serious ethicist is defending or proposing) but rather on what a reasonably well-regulated system of organ sale, controlled by some combination of the medical profession and state regulators, would look like. More specifically, it should be assumed (as it is in what follows) that the doctors, nurses, and transplant coordinators implementing an organ sale system should at least adhere to the standards around consent and clinical care advocated by The Transplantation Society and the World Health Organisation (leaving aside of course those bodies' opposition to organ sale itself) (see Other Internet Resources section