According to The Gift of Life Donor Program, kidney transplants have the highest median wait time at 5 years. A lung, on the other hand, has a median wait time of 4 months. The list of needed transplants far outweighs the supply of kidneys from both living and deceased donors (Bastani, 2020). Fifty percent of individuals over the age of 60 waiting for a kidney will die before receiving a transplant (Schold et al., 2009). This is in part due to the need for living donors. Deceased-donor transplants do not meet the current needs for kidney transplants (Schold et al., 2009). The high demand and wait time for kidneys in healthcare is reflected in the black-market as illegal kidney sales dominate illegal transplants and donations/procurements. The World Health Organization estimates that 20% of all kidney transplants are done on the black-market (Mendoza, 2010). Because of the high demand for kidneys and prospering illegal kidney trade, many people argue that kidney markets should be legalized and regulated.
One popular problem that has been proposed for kidney sale legalization and regulation is an increase of coercion (Taylor, 2006). If a regulated and legal market for kidney sales existed, then there would be an increase in people being coerced or forced to sell their kidneys for money that others would benefit from. Taylor argues that this claim should be rejected for three reasons. Legalizing kidney markets would result in benefits that overall outweigh the drawbacks, especially since coercion and organ theft is currently present in the black-market. Secondly, by condemning coercion, then you should also condemn the markets that allow coercion to happen, meaning black-market kidney sales. One way to condemn this market would be to set-up and maintain a legitimate, legal kidney market. Lastly, setting up a legal alternative would encourage donors and recipients to not partake in black-market kidney sales (Taylor, 2006).
I believe the biggest biomedical ethical principle that applies to this topic is autonomy. Individuals have the right to do with their organs as they please, and very little would stop a determined person from contributing to the black-market sale of their kidney. This is especially true considering the fact that they can donate a kidney to a loved one free of charge and continue to live a healthy life with only one kidney. If someone is willing to give up one of their kidneys in exchange for financial benefit, it would be going against their autonomy to prevent them from doing so. By allowing people the right to choose what they do with an “extra” kidney, their autonomy is preserved. By regulating black-market kidney sales, you also legitimize a dangerous and criminal market. Regardless of legal standing, illegal kidney sales still occur on a daily basis. Legalizing and regulating this market would decrease instances of medical neglect and organized crime surrounding these operations. It has been shown that black-market kidney transplants result in higher rates of infection and organ rejection (Jagbir et al., 2008). Through regulation, beneficence can be upheld and quality care can be provided rather than improvised transplants through illegal means.
References:
Jagbir Gill, Bhaskara R. Madhira, David Gjertson, Gerald Lipshutz, J. Michael Cecka, Phuong-Thu Pham, Alan Wilkinson, Suphamai Bunnapradist, Gabriel M. Danovitch
CJASN Nov 2008, 3 (6) 1820-1828; DOI: 10.2215/CJN.02180508
Mendoza, R. L. (2010). Kidney Black Markets and legal transplants: Are they opposite sides of the same coin? Health Policy, 94(3), 255–265. https://doi.org/10.1016/j.healthpol.2009.10.005
Taylor JS. Black markets, transplant kidneys and interpersonal coercion
Journal of Medical Ethics 2006;32:698-701.
Jesse Schold, Titte R. Srinivas, Ashwini R. Sehgal and Herwig-Ulf Meier-Kriesche
CJASN July 2009, 4 (7) 1239-1245; DOI: https://doi.org/10.2215/CJN.01280209
Bastani, B. The present and future of transplant organ shortage: some potential remedies. J Nephrol 33, 277–288 (2020). https://doi.org/10.1007/s40620-019-00634-x
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