Organ donation has always been regarded as an altruistic act. Thus all government, professional societies and ethics committees regard it as unethical to allow for sales of kidney. Altruism is implied that a person donates an organ (usually a kidney) without coercion and receiving any compensation including financial ones. Their only reward is satisfaction in their self-sacrificial action. Unfortunately there are not many altruistic persons around. Most organs for transplants come from brain dead or dead donors (cadaveric organ transplants). Very few living persons come forward as donors. The result is a scarcity of organs for transplants which results in thousands of deaths for want of organs.
By not allowing sales of organs, these organisations have unwittingly created a black market for organs sales. Unscrupulous middlemen have arisen to take advantage of the needs of organs. In countries where the laws were not so stringent, a commercial transplantation trade of transplant tourism has arisen where one may buy a kidney if one is willing to pay and not ask too many questions. There is no protection for donors. Horror stories abound of people being kidnapped and their kidneys removed, the poor exploited or prisoners forced to donate their kidneys. The middlemen reaped large amount while the donors were given pittance. In a recent court case in Singapore, the donor received $23,700 for his kidney out of the $300,000, magnate Tang Wee Sung paid the middleman. This is the unregulated free market!
In an effect to address the scarcity of organs for transplantation, the Singapore government has taken the bold step of legalising the monetary ‘compensation’ for kidney donors (The Straits Times, Nov 1, 2008). The amount which may be in five or six figures will compensate the donors for their kidneys. It is also suggested that all transplants be regulated through an independent organisation to ensure that the donors will not be taken advantage of. Singapore sidestepped the ethical issue by allowing monetary compensation rather than sales. This is the semi-regulated approach to organ donations.
A third alternative is the Iranian model which the fully regulated model. In Iran, all organs transplants are done through a state-sponsored body which regulate organ transplant in a transparent, non-commercial, and middle-man free process. Donors are paid by this government sponsored agency. It has worked well so far and in Iran there is no waiting list; all patients (rich, poor, educated, uneducated) have receive their transplants. Iran has a government sponsored healthcare system so the model may not work in other countries.
Is there a difference between a sale and compensation? A sale is a business transaction while a compensation is something given for something lost or given. However when it comes to human organ, it is a thin line between the two. It is interesting to note that while it is unethical to sell one’s kidney, however it is acceptable to sell one’s sperms or eggs or in some countries, blood. The moral ethical basis that lies behind the forbidding of sale of human organs come from the group of moral theories called virtue-based theories. The virtue-based theories are based on the premise that human beings are basically good and altruistic. Reality has however shown how far that is from the truth. It may be time for us to review the ethics of human organ sales.