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Society should help organ donors get a good price for their organs, argues Tan Kin Lian.

Human organs for sale

Tan Kin Lian

While the economic prospects remain dim for the poor people in this economic system, society should allow and help them to have a good price for their remaining few "personal assets".

A Singapore tycoon suffering from kidney failure wanted to buy a kidney from a donor. An Indonesian donor was willing to sell his kidney for over $20,000. This sparked a big debate in the daily newspapers. Should similar transactions be allowed?

I wish to discuss this issue from three angles.

Medical

The medical profession has decided that it is all right for a healthy donor to donate a kidney to a recipient, provided that they pass the appropriate medical tests. The impairment to the lifespan of the donor should be small, and should be more than compensated for by the increase in life expectancy of the recipient.

Society has decided that this should be done for a non-commercial reason, and that the donation be allowed only to a recipient who is a close relative. The law does not allow human organs to be sold for a commercial value. This brings the argument to the ethical sphere.

Ethics

If it is medically acceptable for a healthy person to donate a kidney to a family member, why should this person be prevented from selling the kidney for a commercial value?

Here are two possible reasons:

- People should be discouraged from selling their organs, as it is degrading to the value of human life

- People should be given a fair value for their spare organs and not be exploited by the middlemen.

I agree with both reasons. I wish that society can be fairer to the poorer people, so that they can have a decent standard of life, without having to sell their organs.

But what if society fails to deliver the hope of a better life for the poorer people? It is not right for society to deny this choice to the poor people and not allow them a means to earn a large sum of money (according to their living standards) to take care of the well-being of their families. For some poor people this could be the only way to lift the family out of poverty or to send a child to university.

Perhaps it is better for society to help these poor people to get a good deal for what is perhaps their last "personal asset". This is to compensate for the failure of the free market system in giving poor people a fair deal in other aspects of their lives and the opportunity to lead an economically fulfilling life.

This brings us to the financial aspect.

Financial

What is a fair deal to the donor who is willing to give up a spare organ? They should be helped in the following ways:

- A proper medical assessment that the donor is suitable to make the organ donation, with only an acceptably small impairment to their life expectancy.

- The price for the organ is established at a fair amount, representing a few years of the income of the donor, based on the average living standard of the country.

There could be other systems to determine a fair price of the human organ. This can be left to another discussion.

Prevention of crime

There appears to be a demand for human organs and people who are willing to pay. In the absence of a regulated arrangement, criminals are willing to meet this demand by playing the middleman. I have heard horror stories about the gruesome methods used by these criminals, although there is no evidence to substantiate these stories.

It is important that the supply of human organs should not be left to the black market for criminals. The criminals steal the human organs from unwilling victims and sell them to wealthy recipients who are desperate and willing to pay a large sum of money for this last hope to extend their lives.

By having properly-managed arrangements, we can deny the criminals this market.

Experiences in other countries

Donors in India are usually poor people who sell one of their kidneys while they are still alive. The buyers are mostly people from the rich countries of the Arabian Gulf. Poor people sell one of their kidneys to pay debts, to pay for necessary surgery, or for other family needs. Many poor villagers even expect that they will have to sell a kidney to provide a dowry for their daughters.

The Indian government tried to stop this trade in 1997 by making it illegal. But the organ trade is probably increasing instead, just that now it has gone "underground' and is controlled by crime gangs. There are also stories of organ theft, where people are told they need a small operation but one of their kidneys is removed instead.

In Brazil, it is common to buy and sell kidneys, although people try to make it look less commercial. Private arrangements are made between the donor and the person who wants the kidney. The donors might pretend to be relatives. Many doctors are comfortable performing the operations and ask no questions.

As one doctor in Rio de Janeiro said, "I don't want to know what kind of private exchanges have taken place between my kidney patients and their living donors. But obviously you have to suspect something when the patient is a wealthy Rio socialite and her 'donor' is a poor, barefoot 'cousin' from the country."

Who decides?

I hope that the final decision on the sale of the human organs be left to potential donors. They can be assisted in making informed choices by a proper medical assessment of their suitability to make the organ donation and be given a fair price for this donation.

This decision should not be left to the more affluent members of the community, who do not face the economic plight of poor people, unless they are willing to pay higher taxes to lift up the living standards of the poverty-stricken.

A better solution

A better solution is to improve the living standards of the poor, so that they do not need to consider this last desperate measure to have a better future for their families. While the economic prospects remain dim for the poor people in this economic system, society should allow and help them to have a good price for their remaining few "personal assets".

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