This article was downloaded by: [George Washington University] On: 29 December 2014, At: 17:03 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

The American Journal of Bioethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uajb20

Avoiding Harms to Kidney Vendors through Legal, Regulated Markets a

James Taylor a

College of New Jersey Published online: 17 Sep 2014.

Click for updates To cite this article: James Taylor (2014) Avoiding Harms to Kidney Vendors through Legal, Regulated Markets, The American Journal of Bioethics, 14:10, 21-22, DOI: 10.1080/15265161.2014.947802 To link to this article: http://dx.doi.org/10.1080/15265161.2014.947802

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions

Kidney Vendors in Regulated Organ Markets

Cohen, I. G. In press. Regulating the organ market: Normative foundations for market regulation. Law and Contemporary Problems 77. Goodwin, M. 2006. Black markets: The supply and demand of body parts. New York, NY: Cambridge University Press. Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 14(10): 7–18.

Downloaded by [George Washington University] at 17:03 29 December 2014

Rouchi, A. H., et al., Compensated living kidney donation in Iran: Donor’s attitude and short term follow-up, 3. Iranian Journal of Kidney Diseases 3(1): 34–39.

Satel, S. 2013. How much is your life worth?, Huffington Post, November 4. Available at: http://www.huffingtonpost.com/ sally-satel/how-much-is-your-life-wor_b_4212266.html Wertheimer, A. 1987. Coercion. Princeton, NJ: Princeton University Press Zargooshi, J. 2001a. Iranian kidney donors: Motivations and relations with recipients. Journal of Urology 165(2): 386–392. Zargooshi, J. 2001b. Quality of life of Iranian kidney “donors.” Journal of Urology 166(5): 1790–1799.

Avoiding Harms to Kidney Vendors Through Legal, Regulated Markets James Taylor, College of New Jersey Julian Koplin’s “Assessing the Likely Harms to Kidney Vendors in Regulated Organ Markets” (2014) is a welcome addition to the philosophical literature on the ethics of using payments to living vendors to attempt to increase the number of kidneys that are available for transplant. Drawing on a wealth of empirical data, Koplin argues that typically vendors in both the legal and the illegal markets for kidneys that currently exist suffer considerable harms as a result of their sales. He also argues that owing to the nature of the harms they suffer there is no reason to believe that these harms would disappear if markets in human kidneys were to be legalized and regulated. Koplin notes that while this does not settle the issue of whether or not such markets are ethical, it both strengthens the argument against them and weakens the case for them. Koplin’s article is careful, well-reasoned, and thorough. However, despite appearances it does not provide a case against legalizing a market in human kidneys. To show this, it is first argued that Koplin’s argument shows at best only that the scope of markets in human transplant kidneys should ethically be restricted, not that they are unethical. Second, it is argued that the harms to sellers that Koplin outlines could be mitigated or eliminated in a legal kidney market. Koplin’s argument focuses on the adverse health, economic, and psychological effects that kidney sales have had on impoverished vendors in developing countries. As he recognizes, it thus leaves untouched promarket arguments that are based on deontic considerations such as the rights of persons to engage in voluntary transactions or the value of liberty (Cherry 2005, 65–68, 83–88). (Koplin holds that his argument would also leave untouched arguments

that are based on the value of personal autonomy, but this would only be true if the value of autonomy were intrinsic. And there is reason to believe that it is not. See Taylor [2009, chap. 10].) But Koplin’s argument also fails as an argument against kidney markets on its own consequentialist terms. As Hippen (2006) has noted, there is no reason to believe that the health effects that Koplin outlines would be replicated in a legal market if vending were limited to well-off persons (who would not run the health risks of the poor) and who meet current U.S. safety standards for kidney donation (Hippen 2006, 60–61). Rather than offering a consequentialist argument against a market in kidneys simpliciter, then, Koplin is merely arguing over who should participate in it. Koplin implicitly recognizes this, and observes that “limiting markets [by excluding the poor as vendors] raises the uncomfortable possibility that kidney markets might not substantially increase—or could even decrease—the number of kidneys available for transplantation” (14). If either of these possibilities transpired then the consequentialist argument for kidney markets would be weakened. But not only is there no reason to believe that these possibilities would transpire, there is reason to believe that they would not. The cost savings of a renal transplant have been estimated at $270,000 (Matas and Schnitzler 2004, 216–221). This marks the upper boundary of payment that could be made to a vendor. Given this, the prices that could be offered for kidneys would be likely to motivate even welloff persons in developed countries to sell, so it is likely that permitting a legal market would substantially increase the numbers of kidneys procured for transplant. And there is no reason to believe that such payments would decrease

Address correspondence to James Taylor, Department of Philosophy, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628, USA. E-mail: [email protected]

October, Volume 14, Number 10, 2014

ajob 21

Downloaded by [George Washington University] at 17:03 29 December 2014

American Journal of Bioethics

the number of kidneys procured. Koplin notes that when kidneys are commercially available, persons are disinclined to donate kidneys to family members. But this does not support the claim that making kidneys commercially available would decrease the overall number of kidneys procured. The family members concerned might have only failed to donate as they recognized that the would-be kidney recipient could substitute a commercial organ for one for theirs. Indeed, this fact supports a market, for it shows that persons who would otherwise have had to reluctantly donate an organ to a family member would be relieved of this burden. Even if the market were restricted so as to exclude the poor as vendors (hence meeting Koplin’s concerns), there is reason to believe that it would be successful in substantially increasing the number of kidneys that are available for transplant. But once the magnitude of the cost savings of renal transplant are recognized, Koplin’s concerns can be met without suggesting that the opportunity to sell a kidney should be restricted only to the well-off. Koplin expresses concerns about the health, economic, and psychological effects that the sale of a kidney could have on impoverished vendors. Let us address these in turn. First, only vendors that meet the same health criteria as donors for a safe nephrectomy could be allowed to participate as vendors. Payments for successful vendors could be arranged so that they could not only mitigate their future risk factors for subsequent kidney disease or hypertension (through, e.g., improved diet, access to clean water, lowered stress, better preventative medical care, and being freed from labor-intensive work), but would be incentivized to submit to the same degree of postoperative care provided to affluent donors. This could be achieved by paying vendors in part with enhanced medical insurance, with better housing, and with education concerning health, diet, and for employability in a nonmanual field, in addition to cash. And the cash payments could be structured so that receipt of them would be dependent upon the vendor’s compliance with the health and education regimens developed for her to mitigate her risk factors. Second, given the magnitude of savings that could be made from real transplantation and the consequent prices that could be paid to vendors for their kidneys, it is clear that the economic distress that is currently experienced by some kidney vendors could be readily alleviated, especially if international markets in kidneys were to be permitted. What, then, of the adverse social and psychological effects of kidney sale that vendors report experiencing? There are two points to be made here. First, only persons who sell their kidneys in conditions where this is perceived to be shameful will be likely to experience these effects. Since these effects are socially and culturally relative they could be mitigated through changing social views of kidney sellers. This leads to the second point: that such

22 ajob

social change could be affected by compensating kidney sellers well for their organs. As Timon observed in Shakespeare’s Timon of Athens, gold will Make the hoar leprosy ador’d; place thieves, And give them title, knee, and approbation, With senators on the bench. (IV:3)

The alchemic power of money was also recognized by Marx, who noted that “I, according to my individual characteristics, am lame, but money furnishes me with twentyfour feet. [A reference to the purchase of six stallions in Goethe’s Faust.] Therefore I am not lame. I am bad, dishonest, unscrupulous, stupid; but money is honoured, and hence its possessor” (Marx 1963, 190). While Marx was here condemning the distorting power of money, the opposite conclusion can be drawn from the same observation: that the low status of kidney sellers, and hence the desperation, despair, and debasement associated with selling, could be alleviated simply by paying them enough to elevate their social status. Koplin thus gives us no reason to believe that the adverse social and psychological effects that he details would necessarily be experienced by sellers in a legal kidney market. The preceding proposals for protecting sellers might strike some as being unjustifiably paternalistic. Whether this is the case or not, however, should be part of the discussion about how to organize a legal market in human kidneys. And while Koplin has provided no reason to reject markets in kidneys simpliciter, he has done a salutary job in showing that we should have an ethically and empirically informed discussion of how such markets (or pilot studies for them) should be arranged. &

REFERENCES Cherry, M. J. 2005. Kidney for sale by owner: Human organs, transplantation, and the market. Washington, DC: Georgetown University Press. Hippen, B. 2006. The case for kidney markets. New Atlantis Fall:47–61. Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 14(10): 7–18. Marx, K. 1963. Economic and philosophical manuscripts. In Early writings, trans. and ed. T. B. Bottomore, 61–219. London, UK: Watts. Matas, A. J., and M. Schnitzler. 2004. Payment for living donor (vendor) kidneys: A cost-effectiveness analysis. American Journal of Transplantation. 4(2): 216–221. Taylor, J. S. 2009. Practical autonomy and bioethics. New York, NY: Routledge.

October, Volume 14, Number 10, 2014

Avoiding harms to kidney vendors through legal, regulated markets.

Avoiding harms to kidney vendors through legal, regulated markets. - PDF Download Free
62KB Sizes 3 Downloads 4 Views