Ethical Considerations And Organ Transplants

Liver Cancer
My father died from liver cancer.

My stepmother, my brothers, my sisters, and I would have put up billboards, we would have advertised in the papers and on the internet, we would have done almost anything (short of murder) to get a liver for our father. All of us would have pawned, mortgaged, and sold everything we had for a chance that he could live.

Is it ethical? When a person whom you love dearly is dying and in need of an organ transplant, you don't think about what is ethical or what is not ethical or if someone else is more deserving of the available organs. You want your loved one to live.

No qualms about advertising the need. Offering payment? I'll think on it.

I believe the recipiants are selected by committee, based on a number of factors, including the survival chances. That is, someone threatened by cancer of the pancreas might not be a likely candidate for a scarce kidney donation. This could lead the very wealthy to adsorb the available pool of organs, in spite of diminished odds of increased longevity.

Also, consider the possible increase in black/grey market organs.

I'm kind of against the idea of payment, I guess, but go ahead and convince me otherwise, firefly.

Can't go with offering payment. It would result in only the wealthy getting transplants. I'd also like to see all the developed nations make laws to prevent people from going to the third world to buy organs for transplant.

I think that the wealthy already get better medical care, and, at the very least, they can get the best medical care they can afford. They are less restricted by the decisions and cost-cutting measures of HMOs because those with financial assets can go outside the system and pay for their own care.
So, we may already have inequality in health care. I'm not sure that allowing people to advertise for organs, or even allowing people to "purchase" organs would make matters worse. I'm not talking about creating illegal black markets to harvest organs for sale, and I'm not talking about exploiting the indigent in third world countries. I'm talking about the case in this topic, where the man was desperately seeking an organ for himself, or the type of family tragedy described by Debra_Law, where the family would have been willing to do anything to secure a new liver for their loved one. What is wrong, if anything, with allowing people to advertise, or to offer financial compensation, for organs in such circumstances?

People donate organs, all the time, to be used by specific recipients (generally a relative) who need an organ transplant. If people can donate organs out of love or altruism, why shouldn't they be allowed to do it for money as well? They are making a sacrifice, and payment should not be entirely out of the question. Aren't sperm donors and maternal surrogates paid?

To some extent I am being the devil's advocate with this issue, for the sake of discussion, and in order to clarify my own feelings on this matter. But I often do think that arguments raised about allowing payments for organs often fail to take note of already existing realities--such as the fact that the wealthy always have more options, and the fact that, when the donor is a living, healthy person (as might be the case with a kidney donor), sacrifice is involved, and payment shouldn't be entirely out of the question.

Suppose people use the internet to solicit funds so that they can purchase an organ or compensate a family for an organ donation. What makes this ethically or morally wrong, if the solicitation of funds is for a specific dying recipient?

I am reminded of the fact that Mickey Mantle received a new liver very quickly, even though his chances of survival, even with a transplant, were slim to none at the time. Can anyone say that his celebrity was not a factor in allowing him to get a liver transplant more quickly than someone on a list with a better chance of surviving with a new liver?

If one insists on absolute "fairness", requiring everyone to wait their turn on a transplant list, we will have even more people dying because we do not have an adequate supply of donated organs. Even allowing advertising for organs favors those who are wealthier or more attractive or appealing in some way because they can afford the ads and because they will receive more media attention. So, why not go one step further and allow recipients to solicit organs in any way they can, including offering payment for the organs?

I think we have enormous problems about money and about the ethics of paying for certain things. Wealthy childless couples, for instance, can pay for maternal surrogates to carry a child, and they can afford costly private adoptions which might include paying the biological mother's health and living expenses. Yet we cringe at the notion of "buying" an infant. It seems to me that we sometimes draw a very fine line.

Do our attitudes about money, and about payment for certain things, influence our views about allowing a recipient to pay for a donated organ?
Is this at least partly about the ethics and morality of certain monetary transactions? Do we so fear greed that we are unwilling to let a dying recipient try to purchase an organ to save his/her life? Is that an ethical or moral stance to take?

I'm not advocating anything. I'm just offering some food for thought.

Remember, life isn't simple. Getting a transplant organ isn't as simple as standing in a single line or filling in an application and waiting for your turn.

Organs are cross typed by blood/tissue matches as well as by size. I believe that geographic location also plays a part. A PA donor organ might first be checked against the waiting list in PA, then in the Middle Atlantic States, then nationwide.

Putting up billboards worked for the case in point. Putting up billboards for the ostensible benefit of one patient also raised awareness of the screaming need of donor organs.

Personally I think the laws forbidding selling organs are inspired by an officious, paternalistic protectionism. I "own" both kidneys. If I can choose to donate a kidney to a family member or a relative stranger, then I should also be able to sell my kidneys--for a fixed price.

Selling to the highest bidder would be tacky.

A "good" college education these days can cost $100,000. Selling a kidney might reduce that debt--and the worry over that debt--considerably.

Of course there would be feckless fools who would run up thousands of dollars in frivolous credit card purchases--and then clear the debt by selling a kidney. Who would be hurt? The debtor? The credit card companies?

Noddy - I think that is what has happened in third world countries where people have been kidnapped, murdered etc in order for thugs to get kidneys and other organs that aren't their own in order to sell. It quickly became an underground market of stolen organs as referred to by Wilso. Also, get behind on your mortgage and suddenly banks are pressuring you to give over an organ...

Debra - So sorry to hear about your Dad and his lack of proper treatment. I'm finding my Dad is going through a similar situation with care being very hard to get. Tough to reconcile considering all the care that should be available in the US.

Squinney--

A lot of those third world kidney-nappings are probably urban legends. After all while the Grim Reaper may harvest whom he will, kidney donors have to be cross-matched with the recipients. Just any old kidney won't fly.

Just off the top of my head, I'm sure that cancer, Lyme disease, HIV, obesity, diabetes, and many other conditions would disqualify a debtor--or anyone else--from selling an organ.

Donation would be an option, not a requirement. Safe guards would have to be created--but they could be created.

This story seems a bit fishy to me. I mean what are the chances that some guy direct the organ to a specific person and have it fit? It just seems a bit to miraculous.

Was this in the Houston paper?

Having read the book "Stiff: The Curious Life Of Human Cadavers" I have a hard time believing that organs could be successfully stolen and transplanted.

I'm a big believer in whole body donation. I believe you should have to specifiy that you AREN'T willing to donate and that we should otherwise assume you'll share.

I would rather have the choice of opting in, rather than having to opt out. That's a moderately strong feeling, actually.

Why so, roger?

Even to allow the advertising is to allow a form of "high bidder gets the organ." Whomever spends the most on advertising will have most shots at the organ. Those who have no money to spend on advertising won't get a shot.

In the USA, we like to shoot for fairness, but a lot of stuff is for sale on some level. The presidency, legacy college admissions, houses in the right neighborhoods, premier medical care..., organs?

Ideally, I'd rather not see the organs for sale. But there's a whole host of other things we currently sell that could be argued to be just as unethical.

Many here seem to think that because some unethical practices are already allowed, then why stop people buying organs. It really leaves me speechless.

Wilso, it is not just unethical practices which are already allowed. There are ethical precedents as well.
We already pay people for donating blood, sperm, ova, and, in the case of maternal surrogates, they are compensated for the use of their bodies to carry someone else's child. So, why would financial compensation for donation of a kidney, for instance, suddenly be seen as unethical? Why would it be unethical to compensate the family of a deceased donor for a liver or a heart? Who would suffer by that transaction?

What kind of ethics determine that it is right to pay someone for donating blood, but wrong to pay them for donating a kidney? Why is it ethically wrong to use financial incentives to motivate the families of deceased individuals to donate organs?

Is the problem our attitudes toward money, or is the problem our attitudes toward certain bodily organs?

Well stated, Firefly.

I think it's unethical to "buy" an organ. The requirements for recieving an organ should be based on need/chances of survival. If a wealthy man needs a liver, but he has only a 50/50 percent of surving, and a poor man with a 90/100 percent chance of surving, the poor man should get it.

Also another thought on organ donors... I am an orgon donor, and I am glad knowing that if I were to die that I could give someone else a chance at living. But I heard from someone that if you were for example, in an unexpected car accident and the doctors knew you were an organ donor, they would not try their best to keep you alive for the sake of using your organs. So now I'm teetering against staying an organ donor or not. To me, my life is the most important! But if the doctors did everything in their power to keep me alive and my body just couldn't hang on... I'm totally for donating my organs. But how would you know the doctors are doing their best?? Crazy thought or what?

mchol--

Why do you think the medical establishment would be less ethical and less altruistic than you are--to say nothing of lacking common sense?

Every death in every hospital is reviewed and studied. Every preventable death counts against the reputation of both the hospital and the doctors.

Donated organs are rarely harvested and transplanted in the same hospital. Why would a hospital or the doctors of a hospital risk their reputations and accreditations by killing you for a transplant recipient for whom they have no legal responsibility?

Conspiracy theories often don't stand up to critical analysis.

Stated even better. THAT is the reason that's it's not right for organs to be for sale. The wealthy should not get the available organs just because they're wealthy. They can and do go to South America and buy them like the vampires most of them seem to be.

Commen sense? I have a lot of common sense thank you very much. . That's how I survived being homeless.
So are you saying that for one to have "common sense," you shouldn't question anything and trust everything? Just because someone has gone to school for 12 years? Psh- Doctors have a way of making their money. Selling organs...? It'd be a good way to pay of their school loans... Lol. But anything is possible. It's a sick and cruel world out there... Who are you going to trust?? Just because someone is a doctor, or pharmacist, or R.N., or president of the freaking US... that doesn't make them human? Without flaws or error? They are just perfect? I don't think so. Like I said, anything is possible.

This position rests upon an implicit notion of fairness that is, frankly, not well-supported. It is, I believe, based upon a belief that "fairness equals equality" -- in this case, an "equality of need." Yet "equality," like "fairness," is not an unproblematic concept.

For instance, let's suppose there are two candidates for one available liver. One of those candidates, Dr. Happy, is a well-respected member of the community, a generous benefactor to charitable causes, a noted scientist who is currently working on a cure for a previously incurable disease. The other candidate, Mr. Angry, is a convicted felon, currently on parole, jobless, a casual user of illicit drugs and a recovering alcoholic. Dr. Happy needs a liver because she contracted hepatitis while on a humanitarian mission ministering to the sick in a third-world country. Mr. Angry needs a liver because alcoholism led to cirrhosis.

Both candidates are in the same amount of need: i.e. both will die very soon if they don't get a liver transplant. There is only one liver available, and both candidates are suitable recipients. There's only one difference: Dr. Happy is willing to pay $1 million for the liver -- with the money going to programs designed to pay for organ donations for the less fortunate. Mr. Angry, on the other hand, has no money at all. So, who gets the liver?