If the Price is Right: The Ethics and Efficiency of Market Solutions to the Organ Shortage

Abstract

Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide.

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Notes

  1. 1.

    See also Bowles (2016), who is somewhat more hopeful about what incentives can achieve. For a recent critique of the crowding-out thesis, see Semrau (2019).

  2. 2.

    The Iranian experience and the lesson to draw from it is contested (for influential articles, see (Zargooshi 2001; Ghods 2004; Larijani, Zahedi, and Taheri 2004; Ghods and Savaj 2006; Rizvi et al. 2009; Aramesh 2014; Pajouhi et al. 2014).

  3. 3.

    It is often pointed out that altruistic procurement systems accept donations from people in circumstances that would presumably undermine the validity of their consent to a similar extent (e.g., a father choosing to donate his kidney because his daughter is sick or people pressured by their families to donate) (see Anonymous 1974; Denise 1985; Hartman 1979; Kishore 2005; Liberto 2013; Manga 1987; Robinson 1999). Such claims rely on the empirical assumption that the two kinds of circumstances affecting the validity of consent are equally hard to detect in a screening process. Furthermore, as Malmqvist highlights, it is a reasonable fear that this new kind of pressure may supplement existing pressure to part with an organ (Malmqvist 2014b).

  4. 4.

    Donation can of course in itself be harmful. A large Norwegian study found that kidney donors have an increased long-term risk of end-stage renal disease and higher mortality compared to a control group of non-donors who would have been eligible for donation (Mjøen et al. 2014).

  5. 5.

    The latter kind of concern is discussed in (Björkman 2006; Chadwick 1989; Kerstein 2009; Tadd 1991).

  6. 6.

    Admittedly, other interpretations of exploitation may have a similar feature. See for example versions of exploitation discussed in Koplin (2017).

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Acknowledgements

This paper has benefitted significantly from comments received on a number of occasions. It was presented at ECPR General Conference in Montreal, August 2015; Nordic Network for Political Theory in Copenhagen, October 2016; Higher Seminar, Department of Philosophy Stockholm University, April 2016; Higher Seminar Linköping University, April 2016; Center for Medical Ethics, Karolinska Institute Stockholm, April 2017; and Political Theory Section, Department of Political Science Aarhus University, September 2017. I am very grateful for comments provided by Didde Boisen Andersen, Gustaf Arrhenius, Isra Black, Helene Bodegård, Greg Bognar, Krister Bykvist, Hege Cathrine Finholt, Markus Furendal, Barbro Fröding, Madhuri Gogineni, Erik Gustavsson, Gert Helgesson Fredrik Dybfest Hjorthen, Mats Ingelström, Niklas Juth, Eszter Kollar, Kasper Lippert-Rasmussen, Sune Lægaard, Erik Malmqvist, Søren Flinch Midtgaard, Lasse Nielsen, Daniel Weinstock, Åsa Wikforss, Anna Slettmyr, Manne Sjöstrand, András Szigeti, Daniel Ramöller, Jens Damgaard Thaysen, Frej Klem Thomsen, Rasmus Uhrenfeldt, Gustav Østeraa, and two reviewers.

Funding

The work on this article was part of a project funded by the Carlsberg Foundation (Grant number: CF14-0896)

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Albertsen, A. If the Price is Right: The Ethics and Efficiency of Market Solutions to the Organ Shortage. Bioethical Inquiry 17, 357–367 (2020). https://doi.org/10.1007/s11673-020-09981-y

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Keywords

  • Organ markets
  • Future markets
  • Exploitation
  • Coercion
  • Organ trade