Introduction
The morality of purchasing a kidney from an individual who prefers to have a nephrectomy in exchange for cash is one that remains questionable and overly controversial. Even if it were legal and controlled, it is open to an argument that the kidney trade would frequently be immoral under the current circumstances. Even while it might not only be voluntary but also save lives and alleviate suffering by expanding the kidney pool accessible for transplant, it would frequently be incorrect. Contrary to popular belief, kidney trade is fundamentally incorrect, that is, bad in every situation. As Satz has reported that “the idea of establishing a kidney market is now attracting unprecedented support among those involved in transplantation” (425). The present dedication to the idea of equitable opportunity on the waitlist for organs from dead donors is deteriorating into an equal chance to perish on the watchlist. In this regards, this paper assesses the morality of the kidneys’ market including reasons for its existence with a close analysis of concerns raised by Satz.
Why There Might Be a Demand for Market Kidneys
Human kidneys are thought to filter toxins from around 35 gallons of blood each day; this filtrate creates urine, which is rapidly expelled from the body every few hours. According to current estimates, seven million adult Americans—2.4 percent of the entire national adult population—have end-stage renal disease, rendering their kidneys completely inoperable (Levey et al. 1120). Their bodies thus start to amass an overwhelming amount of poisonous waste. These individuals would die within a few days if no action were taken. Fortunately, there is hemodialysis, a medical procedure in which a device cleanses blood outside the body. Although hemodialysis has the potential to save lives, it is pretty expensive. Patients must get hospital treatment three times a week because of how quickly the body collects these toxins, leaving a minimal opportunity for skipping therapy (Johansen et al. 1). The sufferers’ way of life is put under unnecessary stress. A United States Renal Data System report indicates that a patient’s projected lifetime after beginning hemodialysis therapies is only eight years for someone in their 40s to 44s and four and a half more years for someone in their 60s to 64s (Johansen et al. 1). These are overwhelming statistics by any standards and are the starting for the growing demand for kidneys.
The present dedication to the idea of equitable opportunity on the waitlist for organs from dead donors is deteriorating into an equal chance to perish on the watchlist. Even though the number of individuals in need of kidney transplants has risen, the number of live donors has yet to keep up, and it will not meet the demand shortly (Johansen et al. 1). This has increased interest in creative methods to expand the number of organs accessible, such as commercial solutions. One of the few organs for which live donation is practical is the kidney: Many people are in good enough health to get along with one kidney. Currently, live donors account for around one-third of kidney transplants (Johansen et al. 1). Such kidneys have superior health outcomes and last almost twice as long as those obtained from dead donors.
The quantity of kidneys accessible for transplant is the main limiting issue, even though kidney transplants are a miracle of contemporary medicine. Although deceased-donor transplants, in which the cadaveric organs of an otherwise healthy person are implanted into the patient with ESRD, are increasing in frequency, there are still noticeable logistical obstacles, ethical dilemmas, and technical challenges that will prevent a sharp rise in deceased-donor transplants. For example, over 116,000 individuals were on the kidney transplant standby list, yet only 19,060 organ transplants were carried out in 2016 (Saran et al. 2). Of this number, 13,431 came from deceased donors, while 5,629 came from live ones (Saran et al. 2). This shows the great deficit with a growing need for the organs.
By compensating donors, the illicit organ trade would end, and the safety of people who might otherwise sell their organs would increase. Currently, kidneys are sold on a booming underground market, and individuals who decide to do so are frequently duped and taken advantage of. 10% of individuals who require transplants get one, and 10% of these people obtain their transplants illegally (Saran et al. 3). By making this technique legal, the United States will bring this illicit, risky, exploitative market out of the shadows and into a more controlled, secure environment. A potential donor might securely get the remuneration they want while safeguarding the health of both the donor and the receiver instead of looking for illegal means of payment for their organs.
The idea of compensating these donors is not new to the ears as well as it has existed before and under the consideration of many governments. Iran is the only nation that allows individuals to legally market their kidneys. Sellers and buyers are registered with a government foundation, which matches them and establishes a predetermined price of $4,600 on that particular organ. Over 30,000 kidney transplants have been carried out in Iran by medical professionals since 1993 (Saran et al. 4). It is much easier since it hinders the illegal means of acquiring these organs, supposed it was against the law to sell them. The restrictions in place give rise to the illicit harvesting of kidneys from people. Therefore, opening the market door closes some of these activities.
Ethical Reasons Counting in Favor and Against Kidney Markets
There are moral restrictions on voluntary exchanges of goods and services. For instance, even if the other person agrees to the sale and the purchase would be better for society than any alternative course of action the buyer might take, it may still be immoral. Under the current circumstances, the market trade of kidneys would frequently go against morally objectionable standards (Koplin et al. 44). One concept prohibits disrespecting people’s inherent worth, while the other prevents using people as means. It is logical to look for an alternate method of reducing the current organ scarcity because the market exchange is probably at odds with the idea that others are not to be used only as means. This objective could be achieved through cadaveric organ donation opt-out systems.
Participants in an adequately regulated kidney marketplace would probably go against a second rule that would qualify as a moral restriction, prohibiting people from using others only as means. The need for a single buyer, presumably the government, is a transparent approach to ensure that a market is effectively controlled (MacDougall 2). Other purchasers may be less motivated and able to ensure that organ donors have provided their informed permission and get appropriate postoperative care. There is a benefit of the doubt as to whether even the governments of significantly underdeveloped nations or areas that would likely serve as the supply of kidneys would do a decent job of ensuring compliance with laws.
People whose region is characterized by extensive kidney sales may see their autonomy more curtailed. People try ineffectively to pay off the debt by selling their kidneys. That has been the case in grey markets, which probably would be in regulated ones (Koplin et al. 44). Moneylenders, however, could become more forceful in their debt collection if they learn that people in a particular region are ready and able to trade their organs for money. It is realistic to expect that one’s autonomy may be compromised if they are the target of aggressive debt collection. One may find themselves with less chance to advance goals they regard to be of utmost significance, such as starting one’s enterprise, if one is obliged to acquire money more rapidly and in larger quantities than one would have been. Therefore, a controlled market may have repercussions that reduce autonomy for those living where kidneys are sold.
Granted, affluent countries that purchase organs may adopt regulations stating that, for example, kidneys may only be bought from states that have accepted a specific international standard for handling vendors (Koplin et al. 44). However, even if a nation adopts such a norm in good faith and not just as a showpiece, it might need to have the means to ensure its inhabitants uphold it. Kidneys would move from developing to developed nations if kidney markets were widely established. However, impoverished countries frequently have inefficient regulatory infrastructures that are cash-starved. Assuming that a call in a place with extreme poverty would be efficiently controlled seems unrealistic (MacDougall 2). Vendors may encounter the same autonomy-restraining impacts they do on the black market in a market with weak regulations.
One of the significant ethical reasons for kidney markets is that they will provide full access to the kidney market and help save lives due to easy access to the kidney (Sterri 33). People’s lives can be easily saved as a result. It has been noted that acquiring a kidney will require double coincidence. Still, the availability of kidneys in the market will increase the chances of matching with a potential donor and reduce the waiting list. It is ethical to save lives and getting paid while doing so can motivate more people to engage in the act of selling their kidneys. Through this, the number of deaths caused by kidney failures and other related illnesses will be massively reduced. Similarly, it could lead to a massive cut in the amount of money some individuals were to pay to undergo machine dialysis due to lacking organ donors.
Two Objections to A Legally Permitted Market in Kidneys Discussed by Satz
Equal Status Consideration
Kidney black marketplaces nowadays undoubtedly represent the various market conditions for customers and vendors. Most purchasers are at least moderately wealthy, whereas most sellers are abjectly impoverished “buyers and sellers for procurement and distribution would have the consequence that poor people would disproportionately be the organ sellers” (Satz 430). International organ markets have drawn significant attention to the transfer of organs from the poor to the wealthy, from developing countries to developed countries, women to men, and non-whites to whites. Indeed, it may be argued that the demand to permit the sale and purchase of kidneys reflects the reality that individuals looking to do so typically have the money to do so. Compare this to the predicament of the underprivileged, whose health requirements are now underserved. Although millions in extreme poverty share critical health requirements, the poor have little money (Satz 430). As a result, their health needs typically receive far less consideration than those of the relatively rich.
In a system where kidney distribution and procurement depended on individual sellers and buyers, impoverished people would be socially disadvantaged by the world’s organ vendors, and affluent individuals would be the most likely beneficiaries (Satz 430). In contrast, a donation-based procurement system is significantly more likely to include vendors from all socioeconomic strata. There is a legitimate worry that kidney markets might exacerbate already-existing class disparities (Satz 430). Such markets might widen inequalities by including bodily parts in the range of resources that money grants and exposing the individual to them. There are individuals on kidney transplant waitlists who presently have insufficient funds. The choice of the recipient of a kidney for transplant is made mostly irrespective of that person’s financial situation (Satz 430). On the contrary, a kidney market may entail the kidneys being distributed to the most interested parties.
Weak Agency
Surgery is involved in kidney transplantation, and all surgical procedures include risks. A thorough investigation of India’s kidney dealers revealed that 86% of those surveyed said their health had significantly declined after the nephrectomy (Satz 429). Kidney extraction exposes the person to future issues if the surviving kidney suffers injury or if its capacity to filter the blood decreases, even though one kidney can cleanse the blood if it works correctly. The impoverished people in underdeveloped countries who trade their kidneys have no access to health care or a right to a replacement kidney if their surviving kidney stops working correctly. As Satz (429) puts it, “the poor in the developing world who sell their kidneys have no health insurance and no claim on an additional kidney if their remaining one fails to function properly.” The likelihood of health concerns is higher in areas where individuals have less access to drinking water, inadequate diet, and frequent hard manual labor.
A supporter of organ markets may respond that improving sellers’ knowledge of the anticipated outcomes of their transactions is the best way to address their decreased agency. For instance, it might be necessary for organ brokers to attend classes on the dangers of live organ donation and to show that they are aware of the potential repercussions of donating or selling a kidney. It is unknown, though, how much they will forego the deal out of pure risk aversion, given the extreme destitution many vendors experience and their lack of educational attainment. Furthermore, less developed nations can see inadequate and underfunded supervisory institutions.
When the weak agency is linked to severe harm, it poses a serious challenge for those who want to center their protection of the organ market on the individual’s freedom to make their own decisions regarding their internal organs. If prospective kidney donors were highly educated about the results of their trade, it would seem that they would be less inclined to endorse the procedure, given that most organ buyers would not. It could be hard to comprehend renal loss before one goes through it. The argument for permitting a kidney market is thus compromised when we combine the informational issues with the absence of advantages.
Regulation of Kidney Markets Addressing the Ethical Issues Raised by Objections
Since kidney marketplaces are unlikely to be perfect, they are more likely to market with extensive market failures. These include poor agency, large pockets of monopolistic power, and human destitution that results in exploitation and low price (Satz 430). Based on this reasoning, people’s dislike of kidney markets is primarily rooted in the dangers that may result from the vendors’ poverty, lack of access to primary healthcare, lack of clean water, and arduous labor. Addressing issues that revolve around weak agency and equal status consideration requires a policy umbrellaing them.
Besides, market regulation is unlikely to solve the issue of a hopeless world and poverty, as the policy may help to some extent to minimize the problems related to weak agencies. Satz (432) thus says, “Properly regulated, an organ market might be structured to discourage sales from extremely poor donors.” It is also feasible to handle any potential risks associated with kidney donation by requiring sufficient follow-up treatment, guaranteeing access to a transplanted organ in case one is necessary, and maybe outlawing the international traffic in kidneys. Nevertheless, once more, this could be challenging to enforce in some countries around the globe. One option to reduce the likelihood of negative consequences for sellers is to create an organ futures market where acquired organs are only used after the seller passes away.
People in need are still inclined to turn to the black market, despite the prohibition on kidney marketplaces and minimal to no follow-up or treatment. Satz (432) argues that the black organ markets will flourish, as they do in some areas of Pakistan, Brazil, and India, if the nation is unable or unwilling to enforce the ban. In the developing world, mainly as improved medical technology proliferates, selling kidneys on the black market has grown to alarming proportions (Satz 432). Concerns regarding exploitation and unfair sale conditions might be alleviated to some extent by monitoring the licensed kidney marketplace rather than depending on the black market. An organ market may be designed to prevent sales from poor donors if it is adequately managed.
In this regard, the marketplace will be more allowable and the issues highlighted along the multiple aspects may be solved. The concern is whether methods can be discovered to help stop kidney sales from attempting to enter into other types of transactions. Satz (432) describes them as “changing the terms of trade for those who do not want to participate in such markets.” These include some that use them as security for repayment or as a way to qualify for social services. Even for those who are concerned about the economic effects of such marketplaces, this would change the trading terms for those who would not like to play an active role in such marketplaces.
Conclusion
This essay has examined the kidney market by examining potential market kidney demand, some ethical arguments opposing and supporting kidney markets, two counterarguments to a legally recognized market in kidneys that Satz discussed, and how government oversight of kidney markets could perhaps resolve the ethical concerns brought up by this disapproval. The present dedication to the idea of equitable opportunity on the waitlist for organs from dead donors is deteriorating into an equal chance to perish on the watchlist. Even though the number of individuals in need of kidney transplants has risen, the number of live donors has yet to keep up, and it will not meet the demand shortly. People in need are still inclined to turn to the black market, despite the prohibition on kidney marketplaces and minimal to no follow-up or treatment. Adequate oversight of the kidney market could help address most of the concerns.
Works Cited
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