Organ market debate

Since the organ trade was first prohibited, an ongoing debate has been dominating the discourse on whether or not to allow payments for organs. Already in 1997, the Bellagio Taskforce wrote that international declarations against commercialism are “put forward in one or two terse sentences with no supporting arguments.” Its authors further stated that “the grounds for condemnation are not as obvious as declarations imply” (Rothman et al., 1997). The overarching question in this discourse is whether allowing government-controlled payments for organs would increase organ donations, reduce patient mortality on transplant wait lists and whether it would reduce the harms on the black market.

Those who are critical of prohibiting payments for organs under all circumstances have been proposing experiments and trials on a so-called 'monopsonistic market'. Such a market designates a central government-run body to reward/pay organ donors and allocate organs. All organ donations would be anonymous and payments between donors and recipients would be strictly forbidden (Erin & Harris, 1994; Matas et al., 2012; Hilhorst & Van Dijk, 2007). Because of the worldwide ban on payments for organs, it is currently not possible to test whether government-incentivized organ donations would be an effective and ethical solution to the organ scarcity and black market abuses.

In the absence of this data, we do not favor one model above the other. Rather, our view is that experiments on incentivizing organ donations would generate data that enables comparative research with current prohibitionist systems. This, in turn, would help evaluate the efficacy, ethics and impact of different models towards organ scarcity and black market abuse.

In 2017 the ELPAT Working Group on Organ Trade and Trafficking wrote a paper advocating for separation of 'trade' (payments for organs) versus 'trafficking' and for the decriminalization of organ sales in order to better protect organ sellers and enable them to safely report abuses without risking conviction:

• Columb, S., et al., (2017. "Re-conceptualizing the organ trade: separating 'trafficking' from 'trade' and the implications for law and policy" . Transplant Int. 30(2): 209-213

 

Selected articles on the pro/con debate 

• Sterri, A. B. (2021). "Why States Should Buy Kidneys." J. Appl. Philos. 38(5): 844-856.
• Danovitch, G. M., et al. (2021). "The True Meaning of Financial Neutrality in Organ Donation." Am J Kidney Dis 77(6): 967-968.
• Delmonico, F. L., et al. (2015). "Living and Deceased Organ Donation Should Be Financially Neutral Acts." American Journal of Transplantation 15(5): 1187-1191.
• Koplin, J. (2014). "Assessing the likely harms to kidney vendors in regulated organ markets." The American Journal of Bioethics 14(10): 7-18.
• Working Group on Incentives for Living Donation. (2012). Incentives for organ donation: Proposed standards for an internationally acceptable system. American Journal of Transplantation, 12(2), 306.
• Radcliffe Richards, J. (2012). The ethics of transplants. Why careless thought costs lives. Oxford: Oxford University Press.
• Hilhorst, M. T., & Van Dijk, G. (2007 ). Financial incentives for organ donation. An investigation of the ethical issues. Available at www.ceg.nl or here.
• Radcliffe-Richards, J., Daar, A. S., Guttmann, R. D., Hoffenberg, R., Kennedy, I., Lock, M., Tilney, N. (1998). The case for allowing kidney sales. The Lancet, 351(9120), 1950-1952.
• Rothman, D. J., Rose, E., Awaya, T., Cohen, B., Daar, A., Dzemeshkevich, S. L., Smit, H. (1997). The bellagio task force report on transplantation, bodily integrity, and the international traffic in organs. Transplant Proceedings, 29(6), 2739-2745.
• Erin, C. A., & Harris, J. (1994). A monopsonistic market: or how to buy and sell human organs, tissues and cells ethically. In I. Robinson (Ed.), Life and death under high technology medicine (pp. 134-156). New York: Manchester University Press.

 

Empirical studies on allowing payments for organs

• Held, P. J., et al. (2018). "Would government compensation of living kidney donors exploit the poor? An empirical analysis." PLoS ONE 13(11).
• Elias, J. J., Lacetera, N., & Macis, M. (2019). Paying for Kidneys? A Randomized Survey and Choice Experiment. Am. Econ. Rev., 109(8), 2855-2888.
• Elias, J. J. (2017). The role of repugnance in the development of markets: The case of the market for transplantable kidneys. Social Economics: Current and Emerging Avenues, The MIT Press: 234-244.
• Hoeyer, K., Schicktanz, S., & Deleuran, I. (2013). Public attitudes to financial incentive models for organs: A literature review suggests that it is time to shift the focus from 'financial incentives' to 'reciprocity'. Transplant International, 26(4), 350-357.
• Kranenburg, L., et al. (2008). "Public survey of financial incentives for kidney donation." Nephrol Dial Transplant 23(3): 1039-1042.