With too many people needing organ transplants and too few transplantable organs available, some argue that the best way to increase the supply of organs is by allowing them to be bought and sold.
Arthur Caplan, chair of the department of medical ethics and director of the Center for Bioethics at the University of Pennsylvania, disagrees, arguing that this exchange of human tissue is “dehumanizing” and will primarily harm “the poorest of the poor.”
He elaborated on his views in a lecture, titled “What is wrong with markets using persons to increase the supply of organs?” delivered before a large crowd of first-year students, upperclassmen, and faculty at Zoellner Arts Center’s Baker Hall on Aug. 29, the second day of classes.
Caplan addressed issues raised by this past summer’s required reading Never Let Me Go
by Kazuo Ishiguro, which tells the story of three clones who are raised for the sole purpose of donating organs. This year marks the fourth year that incoming first-year students have been asked to read a book and arrive on campus prepared to discuss it during orientation.
The program has two purposes, said Lori Bolden, assistant dean of students for First-Year Experience
. “It encourages intellectual inquiry and provides an opportunity for you to connect with faculty and staff,” Bolden said.
Before discussing current moral dilemmas in organ transplant, Caplan first provided a brief history of transplant surgery since the 1950s, when the first such surgery was performed. Initially, scientists knew nothing about blood or tissue types, but experiments on animals showed that the body may reject foreign organs.
To prevent rejection, the first organ transplant was performed on identical twins. Without proper chemical and temperature controls, organs began to die within seconds after they were removed from the body, so the time between harvesting the organ and transplanting it had to be almost nothing. And in the early stages of transplant surgery, scientists did not know how to harvest organs from cadavers.
Over time, the process of organ transplanting improved. “Today, you can transplant any organ,” Caplan said. The heart, lung, skin, bone, and even limbs can be donated, and in the next three to four years, Caplan predicts that doctors will perform ovary and uterus transplants as well. Chemical and temperature control can extend the life of a disembodied organ for several hours, allowing them to be flown across the country or the world.
Transplantable organs in short supply
But these new technologies come with a price. “There is a huge problem in transplant, and the problem is that it works very well,” Caplan said. Those who would benefit from organ transplants are far greater than the number of donors, resulting in long waiting lists.
At the University of Pennsylvania Medical Center, Caplan said, 400 people are waiting for a new kidney, and they will wait an average of two years. The waiting list for a donated liver is only six months, but during those months, 60 percent of the people on the list die. Those waiting for a heart transplant have even lower success rates, and children rarely find matching donors because few children die in car accidents.
The waiting list for organs continues to grow as surgeons become more skilled, and those who were previously ineligible for transplants, such as AIDS patients or those with Down Syndrome, can now receive organs.
Caplan jokingly suggested a few plans to increase organ donations: “Keep those helmets off when you ride motorcycles. At Penn, motorcycles are referred to as ‘donor-cycles,’” he said. “Encourage people to drive fast. Drink when you drive. Don’t wear seat belts.”
For obvious reasons, those are not the most popular options. Increasingly, many organ donations come from the living. For example, more livers were donated by living people than dead, Caplan said.
In the U.S., only volunteers can donate organs, but they cannot sell their tissue nor can they be coerced into donating. Before performing the surgery, doctors are required to privately ask donors if they truly want to donate.
“Many people say, ‘It’s my brother. Of course, I’m giving him a kidney,” Caplan said. But others may say, “‘It’s my brother. Of course, I’m not giving him a kidney.’”
Frequently, donors are friends or family members of the recipient, but the prospects for those without willing or able donors are bleak. In order to increase the number of organs available, some people have suggested that organs should be bought and sold. Although a market for human tissue may increase the number of transplants, Caplan believes it should not be attempted.
First, he said, “the only people who would sell are the poor people and college kids.” Those desperate enough to sell would be the “poorest of the poor,” and even after selling, their condition would not improve much. “A civil society won’t let you do that [sell your organs]. It’s too dehumanizing,” Caplan said.
Once a market is created, the number of people coerced into donating also increases, and many people will undergo the risks of surgery unwillingly.
Caplan also argued that desperate people will lie about their health conditions in order to receive money. In the 1970s, people received money for donating blood, and the chance of contracting hepatitis from a transfusion was one in eight. When blood donations became strictly voluntary, the risk of contracting hepatitis fell to one in 500 transfusions. In India and China, people receive money for donating organs, but in those countries, organ transplants fail about 10 times as often.
Caplan demonstrated his final point with a short clip from a Brazilian TV ad. The clip showed an apartment building on fire and members of the fire department standing under the windows with a small trampoline painted like a bull’s eye. People trapped in the burning building called out bids for the trampoline. An elderly woman won the auction and the fireman held the trampoline under her window. The woman jumps, but as she falls a second voice offers a higher bid and her safety net is gone. The moral of the story, Caplan said, is that the wealthy will receive the organs and the poor will suffer.
Caplan believes that Ishiguro’s book speaks out against the abuse of power and de-humanizing of people that would be created by a market for organs.
“The issue of the book is should we exploit people?” Caplan said. A nation that allows organs to be bought and sold will “use the market to exploit them.”