As demand for organs has soared, nations are considering creating a regulated market for them. More than 100,000 Americans are currently on the national waiting list and each day 17 Americans die waiting for a transplant. Despite the unmet demand, bioethicist Arthur Caplan says organs and markets are a bad match.
Providing donors economic incentives can help meet the growing demand for organs, he said, but it is not a viable option because it will ultimately lead to exploitation of the poor and a drop in altruistic donations.
|Arthur Caplan, director of |
The Center for Bioethics at
the University of Pennsylvania
In the 1980s, Congress banned organ sales in the U.S. in response to a proposal by Dr. H. Barry Jacobs - whom Caplan calls the “Madoff” of medical fraud - to buy and sell kidneys.
Caplan said selling organs on the open market is immoral, in that it can put poor people in the position of choosing between selling a kidney or starving. And providing incentives, he said, creates another set of ethical questions. As an example, he described a situation in which an employee receives two weeks of vacation in exchange for donating a kidney. Some may argue that the vacation is an incentive, while others may contend that the employer is simply providing the employee time to recover.
Incentives could also produce religious opposition, said Caplan.
“The Pope says your body is a gift from God, your job is to steward it, not sell it,” said Caplan. As soon as organs become a commodity, he said, the U.S. will lose a third of its donors due to religious reasons. Doctors may also decline to participate, he said, because their job is to heal not to help someone make a living with their body.
For Caplan, adopting a national policy of presumed consent would solve a lot of the problems encountered with economic incentives.
Under presumed consent, all individuals are considered organ donors unless they choose to opt out. Although several European nations have adopted the policy, it is still an unpopular one in the U.S. Last year the Delaware legislature voted against a bill that would have mandated presumed consent.