Selling Human Organs for Transplantation: Ethics Under Siege

I have previously posted on the ethics of paying for organ donation. I find this notion to be ethically troubling, but I believe the issue deserves fair debate. In general, my belief is that a personal anecdote should not drive policy in medical ethics. There are many individual vignettes that are poignant and heartbreaking that tempt us to relax our ethical boundaries. For example, permitting us to harvest organs from folks who are ‘not quite dead’, would save lives, but society’s rights outweigh this benefit, in my view. For similar reasons, I resist efforts to relax the definition of death in order to increase the reservoir of available organs. If death is redefined as a result of a search for truth, then the process is ethically permissible. Participants in these discussions would include medical professionals, theologians, ethicists, legal experts and ordinary people. If a result of this process would be that there would be more organs available for transplantation, then I would be supportive. The distinction is that increasing organ supply would not be the primary objective. In other words, I reject the approach of ‘hey, we need more organs to save lives. Let’s roll back the definition of death to get there.’

Recently, two sisters who were serving life sentences in Mississippi for a crime related to armed robbery were released by Governor Haley Barbour. They were not pardoned, but their sentences were indefinitely suspended. A condition of their release was that one woman must agree to donate a kidney to her sister.

The women have always maintained their innocence, and supporters have argued that the verdict was wrong or disproportionate to the crime. I am not knowledgeable on the facts and offer no view on the whether the verdict and sentence were just.

More details on this case can be found at Everything Health, often among the first to present medical controversies to the blogosphere.

Governor Barbour cited the estimated $200,000 yearly cost of dialysis that the state would bear as a factor in his decision to release the women. This created ethical angst for many of us. Organ donation, at least currently, is supposed to be an altruistic event, when the donor does not receive monetary or other tangible benefits for the gift. (I am not referring here to compensating donors for their time, medical expenses, lost wages, etc. But donors should not view donation as a revenue stream.) If the Governor’s rationale became established policy, then we would become ethically unmoored. The drift that began with a Mississippi prison would seep out across society. Which of the following scenarios would we support?

• Paying for organs on the open market
• Organ auctions
•  Selling your kids’ stem cells to support their college funds
• Releasing female prisoners for serving as surrogate mothers or egg donors
• Tax breaks for bone marrow donations
• A pay raise and promotion if you give your boss a kidney
• Admission to an Ivy League institution for a piece of your liver

You get the idea here. Too often in the medical ethical arena, an action precedes thoughtful discussion and debate. The danger here is that the action spreads out and becomes prematurely established as policy. It becomes harder to undo an action that has developed roots and is multiplying. Indeed, a change in medical ethics policies should be the final part of the process and not the opening act.

When do you think the proper time would be to debate human cloning? Now, or after several Whistleblowers have been cranked out in cloning farms around the country?

Two Mississippi women have been unshackled and released from prison. Is medical ethics now in handcuffs?

What's your view?