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  • Writer's pictureJaisimar Singh

Organ Trafficking: The Ethical Challenges of Organ Transplantation

Organ and tissue transplantation has been a topic of heavy debate since the first organ

was successfully transplanted in 1954. Ethical dilemmas surround the topic on both the donor

and recipient sides of the exchange. The national transplant list has over 100,000 people just in

the United States waiting for an organ donor. However, only 17,000 organs from living and

deceased donors are transplanted annually, creating a growing shortage of life-saving transplants.

As a result of this insufficiency, patients are starting to turn to different methods of securing

organ transplants, many of which have ethical strings attached. This includes conducting

business exchanges with the organ market on a local and international level. The 1984 US

National Organ Transplant Act, however, prevents people from buying or selling organs in the US

or across the seas.


Sarah Satel, a psychiatrist and resident scholar at the American Enterprise Institute,

discusses organ transplants and the modernization of the bioethics surrounding the topics. The

1984 act’s creation originated from the leaking of the news that a Virginia physician was

recruiting indigent people from foreign countries to fly to the United States and have organs

donated in return for a small percentage of the profits. The outcry resulted in legislation against

the brokering of organs and their trade. Satel writes in her New York Times articles that the main

resistance against an organ market is that impoverished citizens will be coerced into selling their

organs out of desperation for short-term financial stability, an action that they will later deeply

regret. However, Satel also acknowledges that we must find a solution to this heightening issue if

organ markets are to remain closed. Satel supports the idea that donors should be granted some

form of incentive by the government in the form of tuition, retirement funds, or income tax. She

believes that such additions will help convince healthy young and middle-aged adults to give

their organs to a stranger.

Michael Sandel, a Professor at Harvard University, however, takes a firmer approach than

Satel to the debate. He supports the notion that the commercialization of organs has repressed the

expression of altruism and eroded community values. In his Boston Review article, he says that

“not only are there some things money can’t buy, but there are some things money shouldn’t

buy.” Sandel believes that the market scheme of organ trade has yielded injustice to people in

economically dire circumstances and that market corruption has further degraded the valuation of

products. He also hints that assigning a market value and brokerage claims to such life-sustaining

operations is harming the moral importance of the organs.


Emily Kelly, an executive editor for the Boston College International and Comparative

Law Review, supports in her journal article that illicit organ markets have been a disaster and

have created more harm than good on an international scale. She discusses organ, tissue, and cell

(OTC) trafficking and human trafficking along with their effects on the local communities in

organ hub countries. Kelly believes that instead of adopting a criminal law framework to combat

illicit organ markets, which has proven to be unsuccessful, countries need to tackle the issue

from the root: the shortage of organs. She suggests that countries should focus on introducing

and maintaining presumed and mandatory consent for organ transfers combined with public

information campaigns to educate families about their options. Kelly also supports Satel’s idea of

donors receiving governmental incentives for being organ donors to inspire greater participation

in organ donation programs.


Organ traffickers prey on the desperation of both the donor and the recipient for profits.

Around 80% of foreign donors live below the poverty line. This foreign demographic is a very

vulnerable source of organs as they often are looking for quick methods for cash to be used

towards food, supporting their families, and paying debts. As a result, they are easily coerced

into entering into the organ harvesting process. As Sandel says, “a peasant may agree to sell his

kidney or cornea to feed his starving family, but his agreement may not really be voluntary. He

may be unfairly coerced, in effect, by the necessities of his situation.” However, donor lives are

not improved at all by the organ donation process. They often only receive a small fraction of

revenue from the organ sale which is always below the promised amount. On top of that, the

illicit organ traffickers do not guarantee health care for the donors leaving them to fend for

post-surgical costs. The inaccessibility to healthcare leads donors to have worse outcomes than

before. They are faced with the chance of complications, have to take time off from work, and

may worsen their physical condition in the long term. All of these negative side effects may

cause the donor to take on more debts in the future as a result of their venture to cure their

short-term charges. Kelly stated that donor victims often regretted their decisions in hindsight

due to the pain and little benefit actually achieved. Overall, organ traffickers are misleading and

abusing troubled donor populations for their financial benefit.


Most of the dirty work is happening overseas. Since the previously discussed 1984 act

prohibits donors from receiving compensation for donating, organ traffickers have taken their

business overseas to foreign countries which are OTC trafficking centers such as the “kidney

bazaar” in Pakistan. US, Canadian, UK, and other wealthy recipients engage in “transplant

tourism” where they travel to foreign countries to receive transplants. However, recipients are

also harmed as they pay heavy tolls for the procedure, and incur a heavy infection risk as a result

of the surgery. In addition, when they return to their home countries, they are likely to bring

antibiotic-resistant bacteria from the foreign country which poses a global public health threat.

The local healthcare in these foreign countries is also worsened as a result of illicit organ

trafficking markets. Local doctors spend more time caring for lucrative, wealthy patients who

just received a transplant rather than treating the ailments of the surrounding community.

With a ban on organ markets, and altruism not doing the job, I think it is time that the US

government enact policies to reduce the developing gap of the organ crisis. As concluded by

Satel, altruism simply is not cutting it. People are dying by the day as they wait for five to six

years for a compatible organ donor match. A simple solution is to make amends to the 1984

National Organ Transplant Act. It should be permissible for donors to at least receive some

indirect benefits for their significant donation. A charitable fund could be set aside by the

government to assist donors with tax breaks, education, healthcare, or retirement. Adding

benefits might push healthy people to continue with the act of altruism and donate.


However, will simple benefits still convince enough people to donate organs? After all,

more noticeable compensation for the donors in the thousands could make the issue turn a new

leaf. This would be possible with an organ market system in the US. However, to prevent illicit

trade actions, the websites and organizations would be run by the government. Donors would

have to go through a rigorous background, physical, psychological, and emotional screening

along with a six-month wait time before they are eligible to become donors. The wait time would

allow the donors to fully evaluate the weight of their proposed actions and then act with full

consent. There already are successful websites that allow for donation matching to occur. These

model systems could be applied to a controlled, monetary organ market system. Adding a market

system would significantly decrease the wait time for patients to receive life-saving transplants

and the national organ wait list would be nearly sliced in half. This would also benefit the donors

as they would be guaranteed their side of the bargain in a controlled system rather than having

their organs brokered by illicit organizations.


The issue with markets though is the corruption of product valuation. As open markets

become more popular, the prices of products become inflated along with investors. This critique

posed by Sandel regarding open organ markets is that the price of organs would skyrocket

leaving accessibility only to those with full wallets. However, my counterargument to the open

market critique presented here is that the government could keep full control of the prices and

prevent the organ trade from being a truly open market. With standardized pricing, the market

still won’t be accessible to everyone, but at least a majority of the population would not be cut

off from dramatic price shifts. There is also an ethical dilemma here when placing a price tag on

life-saving treatments. The system of donation altruism is set up to allow people to stand for their

community, and introducing financial benefits would erode that meshing with people acting out

instead with self-interest.

Another counterargument to solving the organ shortage crisis brewing in the United

States would be to convert to an opt-out system rather than opening controlled organ markets.

The US currently operates on an opt-in system which means that adults have the mandated

choice to opt-in to become organ donors in the case of death when filing taxes or renewing their

driver’s license. The issue with this system is that everyone starts by default as not being organ

donors, and then convincing young, healthy adults to opt in can prove to be challenging. Instead,

some European countries such as Spain, France, Italy, Norway, etc. utilize the opt-out system,

where everyone is automatically an organ donor unless the person goes out of their way to

remove themselves from the organ donation list for personal, religious, or cultural reasons.

Countries with a successful opt-out system paired with outreach education systems about

becoming donors have a high organ donation rate. However, the problem with both systems is

that people rarely die in methods that preserve the viability of vital organs causing a degree of

insufficiency with this proposal. Various noncommunicable diseases, physical traumas, or

infections can render organs unusable. In addition, time is a major factor for the viability of the

organ transfer and the cadaver would have to be brought immediately for processing. As a result,

the consideration for an organ market system remains high.


In conclusion, the organ shortage in the United States is a developing issue that demands

action by the government. The rise in demand for organs and the stalling number of annual

transplants are causing desperate patients to turn to more illicit methods for life-saving

treatments. However, policy action can be taken to prevent organ trafficking which entails

solving the root cause. The availability of organs can be improved with further monetary benefits

to donors by amending the 1984 US National Organ Transplant Act and creating a governmental

controlled market system for organ donation matching and selling. These solutions, along with

the support of an opt-out system and educational outreach programs for becoming an organ

donor, can help turn the tide against organ trafficking on a local and international scale. Though,

it might be wishful thinking to believe the government could manage these solutions effectively.


Jaisimar Singh is a 3rd Year student at the University of Virginia studying Global Public Health. He is also an Emergency Medical Technician.


References


Kelly E. International Organ Trafficking Crisis: Solutions Addressing the Heart of the Matter.

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2144900. Published May 1, 2013.

Sandel M. How Markets Crowd out Morals.Boston Review.

https://www.bostonreview.net/forum/forum-sandel-markets-morals/#:~:text=It%20points

%20to%20the%20degrading,by%20establishing%20fair%20bargaining%20conditions.

Published August 27, 2021.


Satel S. An internet lifeline, in search of a kidney. The New York Times.

https://www.nytimes.com/2005/11/22/health/an-internet-lifeline-in-search-of-a-kidney.ht

ml. Published November 22, 2005.


Satel S. Why people don't donate their kidneys. The New York Times.

https://www.nytimes.com/2014/05/04/opinion/sunday/why-people-dont-donate-their-kidn

eys.html. Published May 3, 2014.

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