Why we need a market for human organs

We have a significant and growing need for reform of organ donation in the UK.

457 patients died last year while waiting for organs that didn’t come in time, and there are 6,414 waiting for life-saving organ transplants. The World Health Organisation currently estimates that of the 660,000 people in the world who require any form of transplant, 10 per cent receive one each year.

Instead of relying on the kindness of family members or organs harvested from those who have opted in to the system, we should allow those who are willing to sell their organs for transplant to do so. And the pressure is only growing to find a solution.

The demand for organs like kidneys is rising every year, and in our current state, we simply cannot cope. It is estimated by the NHS that 2.8 million here in the UK have chronic kidney disease (CKD), and that the numbers reaching end-stage renal failure are growing every year. So, as a matter of practicality, organ donation and possibilities for reform is an important one.

Some health professionals are also challenging the status quo. Professor Peter Bell, former vice-president of the Royal College of Surgeons, said: “It is time to debate it again. There is a great shortage of organs.” Medical advances have also minimised risks associated with organ donation that could impede progression to a market for organs. According to Bell, “kidney donation has now become so safe it’s something you could ethically justify.”

It is also generally established that we have ownership over our own bodies. We can eat what we want, decide whether or not to exercise, have tattoos or piercings; we can even sell our sperm or eggs to effectively create new life, for a fee. There is, as such, no ethical barrier to the sale of our organs.

We can safely remove one kidney, a lung, or a portion of the liver, pancreas or intestine while alive. Health and living standards are such that a donor can live their lives as normal after an operation.

The practice could be regulated in a number of ways, including individual-to-individual transactions, utilising the government as a “middleman” or even a fully state-run reward scheme. Private clinics could perform tests and match donors to buyers for a small fee. Safeguards would have to be put in place to prevent coercion, such as ensuring that the buyer and donor have had no prior meeting. 

In whichever fashion a system like this is administered, it would have marked benefits for individuals and society as a whole.

To begin with, “transplant tourism” would be severely undercut here in the UK. Those in desperate need of an organ have been known to travel abroad in order to illicitly purchase one. These operations are in most cases highly unsafe for both the donor and the buyer, and botched operations often require further surgery when patients return to Britain. Moreover, in situations where there are no regulations, the donors are maximally exploited and often left with no supportive care once the donation has taken place. A strictly regulated system here would, therefore, make practical and ethical sense.

Crucially, the sale of organs would not decrease our current supply, which derives primarily from the deceased and from family members. As such, those able to pay would have access to the sold organs, which would, in turn, allow an increased number of organs from the deceased to go to those unable to pay. Simply put, a monetisation system would dramatically increase the organs available for transplant, while avoiding a shock to current supply. 

On top of that, the sale of an organ could be a significant monetary boost for any donor. A huge number of opportunities could be created through the sale of an organ, or part of one. According to a cost-effectiveness analysis from the American Journal of Transplantation, a kidney could be sold for approximately £94,000. UK Transplant estimates that, per patient, dialysis costs £65,000 per year. If the system was fully state-administrated, therefore, the sale of organs could, in fact, relieve some financial pressure for the NHS.

As such, it has been suggested that the government should control the monetary aspect of the transactions rather than payment passing directly from one individual to another. The donor would, therefore, effectively sell their organ to the state, which would then allocate it on the basis of clinical need. By making the process more medically transparent, this may, to an extent, placate those who accuse pro-monetary transplantation advocates of disregarding the exploitation of the poor by the rich. The state would, in this case, have to be careful in setting prices such that they remained market-related.

When the possibility of a market for human organs is raised, most of us instinctively recoil and dismiss the idea. But we must realise that in the face of a growing problem, the path for reform is ethically and practically justified. Let’s put squeamishness aside and choose to save lives.

Written by Max Young

Max Young is Deputy Editor at 1828.