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A considerable breakthrough in medical science, which took place in recent decades, has provided mankind with unique opportunities for overcoming once incurable diseases. The increasing progress made the society think about the limitations imposed on the introduction of medical technologies to widespread use. One of the achievements of science is transplantology, which allows the transplantation of vital human organs. In the United States, the idea of creating the market of human organs is unpopular because of moral and ethical considerations. The fact that in conditions of extreme shortage, only people who are able to pay the highest price for an organ get it explains this statement. Offering organ donors compensation is not an ethical solution to the organ shortage issue since it contributes to developing inequality between people who want to receive organs.
Problem of Organ Shortage
At the end of the 20th-the beginning of the 21st century, transplantology became the field of medicine that collected the latest achievements of anesthesiology, surgery, immunology, resuscitation, pharmacology, and other medical and biological sciences. One uses this sphere of high biomedical technologies in cases of such pathological changes in human organs and tissues, which inescapably lead to the death of a patient. Organ transplantation as a method of treating severe patients is of great social importance. It allows not only life prolongation but also ensuring its higher quality level. Due to transplantation, a significant number of people who suffer from wide range of diseases received a chance for a new, healthy, and fulfilling life.
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Transplantology has been able to pass from demonstrating a surgical miracle to doing routine surgeries, which saved the lives of hundreds of thousands patients. However, the potentially broad capabilities of this area of medicine quickly reached a limit due to the restricted number of organs available for performing transplants (Rudge et al. 48). So far, no country in the world has managed to reach the zero waiting list that would fully satisfy people’s need for organ transplantation. Shaikh and Bruce emphasize the fact that “more than 122,000 people are waiting for a transplant in the United States, and 22 people on the waiting list die each day” (109). The problem of the development of organ donation is one of the most difficult moral and ethical concerns of modern medicine (Ravitsky 380). Being one of the most complex types of medical care that require high level of professional and material support, this area cannot develop without the help of society and active participation of the population.
The discrepancy between the existing demand for this type of medical assistance and the number of available donors has raised the following issue: the society needs to develop social mechanisms of obtaining donor organs and increasing donor activity among the population. From the economic perspective, the optimal solution to this problem should be the introduction of free sale of human organs (Ravitsky 380). However, the application of market principle to the sphere of organ donation has caused a wave of criticism from not only bioethics specialists and sociologists but also the general public. As a result, from being strictly medical problems, the questions of the development of donation and organ transplantation have transformed into moral, ethical, and legal ones.
Ethical and Moral Issues
The problem of the marketization of organ donation is associated with the commodification of human life, which means giving it certain characteristics of a product. The financial incentives include income tax credit, contribution to retirement fund, global health insurance, and tuition voucher. Even in cases when cash is not exchanged, such incentives possess the monetary value. However, in the society, sacred values that do not concern monetary relations exist. Using market logic in areas that do not relate to trade or sale carries the danger of devaluation of their social and cultural significance.
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The dissemination of market principles in the sphere of organ donation can lead to the violation of the social order. It is associated with the transformation of a person into a commodity; due to it, the exploitation of a human body becomes possible. The introduction of monetary mechanisms can result into the situation where the possession of capital will put in the subordinate position those who have smaller reserve of resources (Ravitsky 380). Therefore, trafficking in human organs can lead to the state, in which the bodies of poor people are of great value after their death. In other words, the value of life of low-income group representatives becomes lower than the value of their bodies, which can be used for prolonging the lives of the rich and privileged people. The prohibitive principle towards the commercial relations in organ donation is in accordance with the basic law of moral relations between people, which claims that a person cannot be regarded as a means of achieving the goal of another individual. “The commodification critique holds that the human body has inestimable intrinsic value and allowing someone to sell the body, or part of it, degrades that person’s dignity” (Allen and Reese 2031). The ethical understanding of a human as an individual who possesses dignity, will, and freedom opposes the offer of compensation to organ donors.
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Giving compensation to organ donors leads to financial exploitation of a person who do not want to become a donor. It is difficult to understand why donation of organs for money is inherently incompetent especially if one uses this money for education or medical care for a close relative. The main elements of altruism, among which are motive, care, and attention to others, play the key role here (Shaikh & Bruce 109). In this case, the sale of organs serves as the transfer of money from those who have them to those who do not. Nevertheless, this argumentation will hardly convince anyone. It far from simple ethical issues especially in the world where inequality in wealth and access to healthcare exists. Allen and Reese state that the introduction of payment for organ donation will destroy the principles of altruism since every donor will start demanding money (2031). At the same time, it is not possible to harvest all potential donor organs from corpses. One of the factors in this dispute, which are not acceptable from the ethical point of view, is exploitation. It can be emotional exploitation by family members, financial exploitation by relatives or persuasion of someone who does not want to be a donor (Shaikh and Bruce 110). Allen and Reese argue that people of low socioeconomic status are particularly vulnerable to such coercion and have no choice but to sell their organs (2031). This danger exists in any form of commercial intermediation especially if the monetary rates are high. Therefore, it is not surprising that financial transactions on the sale of organs almost inevitably mean that it is money, not medical necessity, decides which patient will receive a particular organ.
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The issue of the legal status of transplants closely relates to these ethical provisions. The ban on buying and selling a person expands to his/her tissues and organs. Turning into biological materials and representing a means of transplantation, individual’s organs should not become a tool of commercialization of life due to their belonging to human body (Delmonico et al. 1188). Since the organs and tissues of a person are the parts of the human body, they do not correspond with the concept of things. Consequently, person’s organs should not have a market equivalent or become the subject of a sale-purchase transaction. The given situation concerning the organs and tissues of a person has its inevitable consequences. It leads to the recognition of the possibility of their purchase and sale as well as erases the differences between the material and personal sides of human existence (Ravitsky 380). It is not difficult to determine the existing degree of danger of ignoring the fundamental ethical foundations for the society.
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The application of market rules to the sphere of organ donation contributes to spreading criminal organ trade. In the world, a person, his/her life, health, and honor must be the main social values. According to Shaikh and Bruce, “the purchase or sale of human organs is not allowed, according to the National Organ Transplant Act (NOTA) and the Uniform Anatomical Gift Act” (109). Unfortunately, recent events showed that illegal human trafficking began to demonstrate rapid development around the globe. It is possible to obtain organs from defenseless people due to fraudulent or even criminal means as well as organize organ trade. Today, buying and selling of organs are gaining popularity. To prevent illegal trade of organs, laws should prohibit trafficking in organs and other human anatomical materials.
Provision of compensation to organ donors has negative moral consequences not only for donors but also for buyers. The sale of person’s organs for transplantation is a quick way to get a significant sum of money. People who urgently need a donor for a dying relative are ready to give everything they have in return for a chance to extend life of a loved one. Swindlers use this fact to take the last money from these individuals and then simply disappear.
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A certain guarantee of fairness in the distribution of donor organs is the inclusion of recipients to the transplant program, which forms on the basis of a waiting list at the regional or interregional level. The question of price does not play any role here. Recipients gain equal rights to meet their appropriate donors within the frameworks of these programs. The latter also provides the exchange of donor transplants between transplantation associations. The provision of equal rights is realized through a mechanism of choice where purely medical reasons, severity of the condition of a patient-recipient, and parameters of the immunological or genotypic characteristics of a donor matter. In this system of distribution of organs, which must be a guarantee of eliminating all possible abuses, the recommendation to create a tool for the procurement of donor organs at the regional or national levels becomes one of the common ethical rules. Therefore, there is a need for the comprehensive solution of transplant issues through improving and compiling an adequate legal framework that is consistent with international legal acts as well as creating favorable moral and political climate in the society.
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Transplantology had brought crucial changes into medicine through contributing to the possibilities of prolonging people’s lives. However, there is significant organ shortage that leads to the formation of ethical question of whether offering compensation to organ donors is a moral solution to the problem. Ethical problems that are associated with the commercialization of transplantology exist due to the fact that human organs become commodities. What is more, in the conditions of universal deficiency of donor organs, they transform into very expensive commodities. It leads to unlawful removal of human organs for the purpose of enrichment. Therefore, paying compensation to organ donors cannot become a moral solution to the organ shortage problem because it opposes human rights and principle of equality.