Abstract
One common objection to establishing regulated live donor organ markets is that such markets would be exploitative. Perhaps surprisingly, exploitation arguments against organ markets have been widely rejected in the philosophical literature on the subject. It is often argued that concerns about exploitation should be addressed by increasing the price paid to organ sellers, not by banning the trade outright. I argue that this analysis rests on a particular conception of exploitation (which I refer to as ‘fair benefits’ exploitation), and outline two additional ways that the charge of exploitation can be understood (which I discuss in terms of ‘fair process’ exploitation and complicity in injustice). I argue that while increasing payments to organ sellers may mitigate or eliminate fair benefits exploitation, such measures will not necessarily address fair process exploitation or complicity in injustice. I further argue that each of these three forms of wrongdoing is relevant to the ethics of paid living organ donation, as well as the design of public policy more generally.
Similar content being viewed by others
Notes
In anticipating a similar objection to his own account of exploitation, Wertheimer has suggested that those who reject his definition of exploitation should treat his work as being about being some other concept—“mexploitation or shmexploitation or whatever” [44, p. ix] Wetheimer’s primary aim—and my own—is less about defining the concept of exploitation than about investigating “the moral character of certain sorts of transactions and relationships, whatever we want to call them” [44, p. x].
There is some ambiguity on this point. As Jansen and Wall point out, some of Wertheimer’s earlier comments on exploitation are consistent with what they call the ‘inclusive thesis’: that an unfair process and an unfair outcome are necessary and jointly sufficient for exploitation [18, p. 384]. My application of Wertheimer’s theory to markets in organs is ultimately compatible with either interpretation of Wertheimer’s theory.
Although this paper focuses on Wertheimer’s account of exploitation, it is worth noting that there are other ways of defining a fair price. Angela Ballantyne, for example, suggests that in the context of international research, a fair transaction is better defined in terms of Rawls’s ‘maximin’ principle of distributive justice [1].
This is not to say that a fair benefits account of exploitation entails that such transactions are necessarily unproblematic; they may be wrong, but not because they are exploitative.
The extent of employers’ duties depends partly on the nature of the employment relationship; part-time employment and one-off employment relationships will tend to impose lesser demands on employers than full-time work [39, p. 397].
Importantly, the inverse is also true; in contexts where political agents have fulfilled their political responsibilities (which on some views of social justice may already be the case in many countries), a market in organs would not be exploitative. I thank an anonymous reviewer for raising this point.
Admittedly, ‘few’ does not necessarily mean ‘none’; as two anonymous reviewers pointed out, it is possible to imagine some people having a genuine preference for kidney selling because (for example) kidney selling provides immediate financial benefits and/or because they enjoy the sick role. While such transactions may raise moral concerns, these concerns are not necessarily connected to complicity in injustice.
References
Ballantyne, A. J. (2010). How to do research fairly in an unjust world. The American Journal of Bioethics, 10(6), 26–35.
Becker, G. S., & Elías, J. J. (2007). Introducing incentives in the market for live and cadaveric organ donations. The Journal of Economic Perspectives, 21(3), 3–24.
Budiani-Saberi, D., & Karim, K. (2008). The social determinants of organ trafficking: A reflection of social inequity. Social Medicine, 4(1), 48–51.
Cohen, I. G. (2014). Regulating the organ market: Normative foundations for market regulation. Law and Contemporary Problems, 77(3), 71–100.
Delmonico, F. L. (2015). An open letter to HHS secretary burwell on ethically increasing organ donation. Transplantation Direct, 1(1), 1–19.
Dworkin, G. (1994). Markets and morals: The case for organ sales. In G. Dworkin (Ed.), Morality, harm, and the law (pp. 155–161). Boulder, CA: Westview Press.
Epstein, M. (2009). Sociological and ethical issues in transplant commercialism. Current Opinion in Organ Transplantation, 14(2), 134–139.
Erin, C. A., & Harris, J. (1994). A monopsonistic market: Or how to buy and sell human organs, tissues and cells ethically. In I. Robinson (Ed.), Life and death under high technology medicine (pp. 134–153). Manchester: Manchester University Press.
Erin, C. A., & Harris, J. (2003). An ethical market in human organs. Journal of Medical Ethics, 29(3), 137–138.
Fabre, C. (2008). Whose body is it anyway? Justice and the integrity of the person. Oxford: Clarendon Press.
Feinberg, J. (1983). Noncoercive exploitation. In R. E. Sartorius (Ed.), Paternalism (pp. 201–235). Minneapolis: University of Minnesota Press.
Gill, M. B., & Sade, R. M. (2002). Paying for kidneys: The case against prohibition. Kennedy Institute of Ethics Journal, 12(1), 17–45.
Goodin, R. E. (1987). Exploiting a situation and exploiting a person. In A. Reeve (Ed.), Modern theories of exploitation (pp. 166–200). London: Sage.
Gorr, M. J. (1989). Coercion, freedom, and exploitation. New York: Peter Lang.
Harris, J. (1998). Clones, genes, and immortality: Ethics and the genetic revolution. New York: Oxford University Press.
Holm, S. (2010). Is bioethics only for the rich and power? In M. Häyry, T. Takala, P. Herissone-Kelly, & G. Árnason (Eds.), Arguments and analysis in bioethics (pp. 23–36). Amsterdam: Rodopi.
Hughes, P. M. (1998). Exploitation, autonomy, and the case for organ sales. International Journal of Applied Philosophy, 12(1), 89–95.
Jansen, L. A., & Wall, S. (2013). Rethinking exploitation: A process-centered account. Kennedy Institute of Ethics Journal, 23(4), 381–410.
Koplin, J. J. (2014). Assessing the likely harms to kidney vendors in regulated organ markets. The American Journal of Bioethics, 14(10), 7–18.
Lawlor, R. (2011). Organ sales needn’t be exploitative (but it matters if they are). Bioethics, 25(5), 250–259.
Lawlor, R. (2014). Organ sales: Exploitative at any price? Bioethics, 28(4), 194–202.
Liberto, H. (2013). Noxious markets versus noxious gift relationships. Social Theory and Practice, 39(2), 265–287.
Logar, T. (2010). Exploitation as wrongful use: Beyond taking advantage of vulnerabilities. Acta Analytica, 25(3), 329–346.
Malmqvist, E. (2012). Are bans on kidney sales unjustifiably paternalistic? Bioethics, 28(3), 110–118.
Malmqvist, E. (2013). Taking advantage of injustice. Social Theory and Practice, 39(4), 557–580.
Malmqvist, E. (2015). Better to exploit than to neglect? International clinical research and the non-worseness claim. Journal of Applied Philosophy. doi:10.1111/japp.12153.
Mayer, R. (2007). What’s wrong with exploitation? Journal of Applied Philosophy, 24(2), 137–150.
Meyers, C. (2004). Wrongful beneficence: Exploitation and third world sweatshops. Journal of Social Philosophy, 35(3), 319–333.
Miller, D. (1987). Exploitation in the market. In A. Reeve (Ed.), Modern theories of exploitation (pp. 149–165). London: Sage.
Panitch, V. (2013). Exploitation, justice, and parity in international clinical research. Journal of Applied Philosophy, 30(4), 304–318.
Phillips, A. (2011). It’s my body and I’ll do what I like with it: Bodies as objects and property. Political Theory, 39(6), 724–748.
Phillips, A. (2013). Our bodies, whose property?. Princeton, NJ: Princeton University Press.
Richards, J. R. (2012). The ethics of transplants: Why careless thought costs lives. Oxford: Oxford University Press.
Rid, A., Bachmann, L. M., Wettstein, V., & Biller-Andorno, N. (2009). Would you sell a kidney in a regulated kidney market? Results of an exploratory study. Journal of Medical Ethics, 35(9), 558–564.
Rippon, S. (2014). Imposing options on people in poverty: The harm of a live donor organ market. Journal of Medical Ethics, 40(3), 145–150.
Rivera-López, E. (2006). Organ sales and moral distress. Journal of Applied Philosophy, 23(1), 41–52.
Sample, R. J. (2003). Exploitation: What it is and why it’s wrong. New York: Rowman & Littlefield.
Scheper-Hughes, N. (2008). Illegal organ trade: Global justice and the traffic in human organs. In R. Gruessner & E. Benedetti (Eds.), Living donor organ transplants (pp. 106–121). New York: McGraw-Hill Medical.
Snyder, J. (2008). Needs exploitation. Ethical Theory and Moral Practice, 11(4), 389–405.
Snyder, J. (2010). Exploitation and sweatshop labor: Perspectives and issues. Business Ethics Quarterly, 20(02), 187–213.
Snyder, J. (2013). Exploitation and demeaning choices. Politics, Philosophy and Economics, 12(4), 345–360.
Valdman, M. (2008). Exploitation and injustice. Social Theory and Practice, 34(4), 551–572.
Valdman, M. (2009). A theory of wrongful exploitation. Philosopher’s Imprint, 9(6), 1–14.
Wertheimer, A. (1999). Exploitation. Princeton, NJ: Princeton University Press.
Wertheimer, A. (2010). Rethinking the ethics of clinical research: Widening the lens. Oxford: Oxford University Press.
WHO. (2010). WHO guiding principles on human cell, tissue and organ transplantation (WHA63.22). http://www.who.int/transplantation/Guiding_PrinciplesTransplantation_WHA63.22en.pdf. Accessed December 20, 2016.
Wilkinson, S. (2003). Bodies for sale: Ethics and exploitation in the human body trade. London: Routledge.
Wilkinson, T. M. (2011). Ethics and the acquisition of organs. Oxford: Oxford University Press.
Wood, A. W. (1995). Exploitation. Social Philosophy and Policy, 12(02), 136–158.
World Health Assembly. (2010). Human organ and tissue transplantation (WHA63.22). http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R22-en.pdf. Accessed December 20, 2016.
Zwolinski, M. (2007). Sweatshops, choice, and exploitation. Business Ethics Quarterly, 17(4), 689–727.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Koplin, J.J. Beyond Fair Benefits: Reconsidering Exploitation Arguments Against Organ Markets. Health Care Anal 26, 33–47 (2018). https://doi.org/10.1007/s10728-017-0340-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10728-017-0340-z