The United States Federal Government should amend the National Organ Transplant
Act to permit regulated sale of human organs. A government agency should be
established to purchase organs from those living in the United States, with payment in
vouchers with a cash value set at an adjusted market-clearing price. Organs should be
placed in the Organ Procurement and Transplantation Network.
Advantage 1 – US transplants will be better
The federal government established the organ transplant system and contracts with
non-governmental organizations to operate it.
Schwark 11 DAVID SCHWARK, J.D. expected 2011, Cleveland State University, Cleveland-Marshall College of
Law. Journal of Law and Health 2011 24 J.L. & Health 323 NOTE: ORGAN CONSCRIPTION: HOW THE DEAD
CAN SAVE THE LIVING lexis
The National Organ Transplantation Act In 1984, Congress passed the National Organ Transplantation
Act amid fears of a commercial market in kidneys. n58 Congress also hoped the legislation would
alleviate the shortage of transplantable organs. n59 NOTA is an important piece of transplant
legislation for several reasons. First, it firmly rejected the idea of an organ market by forbidding the
sale of human organs in interstate commerce. n60 Lawmakers were worried that a market system
would prey upon the poor as a source for organs. n61 Another important part of NOTA was the
creation of the Task Force on Organ Transplantation ("Task Force"), which was charged with
"conduct[ing] comprehensive examinations of the medical, legal, ethical, economic, and social issues
presented by human organ procurement and transplantation." n62 The Task Force recommended
that hospitals "adopt routine inquiry/required request policies and procedures for identifying
potential organ and tissue donors and for providing next-of-kin with appropriate opportunities for
donation." n63 Congress adopted the [*331] recommendation, and as a result, hospitals can forfeit
Medicaid and Medicare funding if they fail to establish "written protocols for the identification of
potential organ donors." n64 NOTA also established the system of organ procurement and
distribution that currently operates in the United States. NOTA delegated power to the Secretary of
the Department of Health and Human Services to provide for the establishment and operation of the
Organ Procurement and Transplantation Network ("OPTN"), which oversees and coordinates the
allocation of organs throughout the country. n65 Some of the OPTN's other duties include:
maintaining a national list of individuals who need organs; n66 maintaining a national system to
match people on the waiting list with available organs; n67 establishing a nationwide procurement
and allocation system; n68 working actively on ways to "increase the supply of organs;" n69 and
coordinating for the transportation of organs from organ procurement organizations ("OPOs") to
transplant centers. n70 NOTA allows the Secretary to make grants for the planning of qualified OPOs.
n71 The duties of the OPOs include arranging the acquisition and preservation of all donated organs,
identifying potential donors, providing or arranging for the [*332] transportation of donated organs
to transplant centers that participate in the OPTN, and determining the quality standards for the
acquisition of organs. n72 The nation is divided into sixty-three areas composed of eleven regions
under the current system, with huge disparities in waiting times from region to region. n73 In 2006
alone, 7,191 candidates died while waiting for an organ. n74 This figure demonstrates that almost
twenty people on the national waiting list die each day while waiting for an organ. Congress chose
the United Network for Organ Sharing ("UNOS"), an existing central registry of potential kidney
recipients, to administer the OPTN. n75 The U.S. Department of Health and Human Services ("HHS")
contracted with UNOS in 1986 and has renewed the contract four times. n76 In 1998, the HHS
released what it called the "Final Rule," which established that "human organs donated for
transplantation are a public trust." n77 The Final Rule's stated purpose is "encouraging organ
donation; developing an organ allocation system that functions as much as technologically feasible
on a nationwide basis; providing the bases for effective Federal oversight of the OPTN . . . and,
providing better information about transplantation to patients, families and health care providers."
n78 The three main performance goals of the Final Rule are "objective and measurable medical
criteria to be used by all transplant centers" to ensure that patients within similar states of illness are
listed at the same time; standardized "medical status" categories to group transplant candidates by
medical urgency; and allocation policies that ensure equitable "organ distribution to those with the
greatest medical urgency, in accordance with sound medical judgment," without regard to their
geographic location. n79 Though these goals appear noble, they have unfortunately been unable to
cure the most pressing issue - a lack of transplantable organs.
While more could be done, this system has saved hundreds of thousands of lives
Fry-Revere 14 Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014
The Kidney Sellers: A Journey of Discovery in Iran p 3
When we say “organ shortage,” we must be clear that this is one of those problems we would have
wished for half a century ago. We face an organ shortage because modern medicine makes it
possible to transplant organs from one human body to another, meaning hundreds of thousands of
people who a few years ago had no hope of survival now have a new lease on life. Until the 1950s,
little could be done to save damaged organs. If diseases were caught early enough, potential
deterioration could be slowed or curtailed by treating the underlying illness, but if a vital organ was
damaged beyond repair, the patient would inevitably die—sooner rather than later. The one
exception was kidneys. Because dialysis machines simulate, to some extent, the work of kidneys by
filtering the blood, death could be forestalled for a few years, but not indefinitely Even now, the
average lifespan on dialysis in the United States is only four years. Also, by most accounts, life on
dialysis is not much of a life at all. The majority of dialysis patients leave their jobs within a few
months of starting dialysis. Fewer than 10 percent of patients are still employed after six months on
dialysis. They are too tired, too weak, too stiff, have too many medical appointments, and have to
spend too much time watching their diets and getting dialyzed (usually three times a week, for three
to four hours each session).'
Many more are denied the benefits of this system. The ban on organ sales for
transplant has created a large and growing shortage of organs for transplant
Williams 14 Kristy L. Williams, University of Houston Law Center, Health Law & Policy Institute; University of
Texas Medical Branch, Institute of Medical Humanities.; Marisa Finley, Baylor Scott & White Health Center for
Health Care Policy; J. James Rohack, Baylor Scott & White Health March 31, 2014 American Journal of Law and
Medicine, Forthcoming Just Say No to NOTA: Why the Prohibition of Compensation for Human Transplant Organs
in NOTA Should Be Repealed and a Regulated Market for Cadaver
Organs Instituted http://ssrn.com/abstract=2418514
Organ transplantation saves thousands of lives every year. However, many individuals die waiting for
transplants due to an insufficiency of organs.1 Currently, more than 122,000 individuals are waitlisted
for organs in the United States.2 Due to financial and other barriers to becoming waitlisted, the actual
number of Americans requiring organs is likely higher.3 This gap between available organs and the need
for organs continues to widen.4 The supply of organs is limited as only a small number of individuals
die in circumstances medically eligible for organ donation, and less than sixty-eight percent of eligible individuals
donate.5 As a result of those long waitlists and limited supply there is a substantial need to increase organ donations. This paper will focus
on increasing consent rates for cadaveric organ donation in the Unites States by repealing current law prohibiting cadaveric donors and
their estates from being financially compensated.6 The
current organ donation system in the United States relies
on the altruism of donors. The National Organ Transplantation Act (NOTA) prohibits the receipt of any form of
valuable consideration in exchange for organs to be used for transplantation.7 State statutes also prohibit the
sale of certain organs and tissue for transplantation; however, state laws vary widely as to what body parts are covered.8 As paying for
organs is prohibited, other methods
have been employed in attempts to increase donations.9 Despite the
implementation of these strategies, a severe organ shortage remains.
The shortage means many die and suffer
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics, Auburn
University
Winter 2008 Regulation
The Failure of US 'Organ Procurement Policy
http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
WAITING LISTS YET TO COME The consequences of our
failure to adapt our cadaveric organ procurement policy to the
changed technological realities of the transplant industry have been unconscionable. Figure 2, above, suggests that more than
80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. In addition, the
unnecessary pain and suffering of those who have been forced to wait while undergoing dialysis,
unemployment, and declining health must also be reckoned along with the growing despair of family
members who must witness all of this. Nonetheless, the pain, suffering, and death imposed on the
innocents thus far pales in comparison to what lies ahead if more fundamental change is not
forthcoming. In order to illustrate the severe consequences of a continuation of the altruistic system, we use the data presented in
Figures 1 and 2 above to generate forecasts of future waiting lists and deaths. The forecasts represent our best guess of what the future
holds if fundamental change continues to be postponed. The results should serve as a wake-up call for those who argue that we should
continue tinkering with the existing procurement system while further postponing the implementation of financial incentives. The costs of
such a “wait and see” approach are rapidly becoming intolerable. CHANGING VARIABLE To produce reasonable forecasts of future waiting
lists and deaths, we must first confront an apparent anomaly in the reported data that could cast doubt on the accuracy of some of the
more recent figures. Specifically, the reported number of deaths of patients on the waiting list (plus those too sick to receive a transplant)
follows a consistently upward trend that is very close to a constant proportion of the size of the waiting list over most of the sample period.
Beginning in 2002, however, the number of deaths levels off and even starts to decline, despite continued growth of the waiting list. It is
not clear why there is an abrupt change in the observed trend in this variable. Our investigation of this issue yielded several plausible
explanations but no definitive answer. For example, it may be the case that recent advances in medical care, such as the left ventricular
assist device, have extended some patients’ lives and, thereby, reduced the number of deaths on the list. Alternatively, it may be the case
that because of rising criticism of the current system, unos has taken steps to remove some of the relatively higher-risk patients from the
list before they die. For example, the meld/peld program, which was introduced in February 2002, removed a number of liver patients
(who have a comparatively high death rate) from the waiting list. Additionally, the increasing use of so-called “extended criteria” donor
organs may have a similar effect, getting the most critically ill patients off the list prior to their deaths. Clearly, the implications of these
alternative explanations for reliance on the data are not the same. For example, if patients are, in fact, simply living longer and the data
accurately reflect that reality, then our analysis should incorporate the observations. But if the more recent figures are, instead, a
manifestation of strategic actions taken by the reporting agency, then they should be excluded. Because we have been unable to identify a
single, convincing explanation for the observed phenomenon, we elected to perform our analysis both ways — including and excluding the
post-2002 observations on the number of deaths. ESTIMATES Given the two alternative sample periods, the methodology we employ to
generate our forecasts is as follows: First, because the number of deaths appears to be causally driven by the number of patients on the
waiting list, we begin by estimating a simple linear regression model of the former as a function of the latter. The results of that estimation
are reported in Table 1 for the two sample periods described above. Next, we estimate a second linear model with the number of patients
on the waiting list regressed against time, again using the two alternative sample periods. Those results are reported in Table 2. From the
results, we
are able to produce forecasts of the expected size of future waiting lists for each of our sample
periods. We run the forecasts out 10 years from the end of our longer sample period, to 2015. Given the forecasted waiting
list values, we are then able to use the regression results in Table 1 to generate our forecasts of the number of deaths over the same
period. The two alternative sets of forecasts are shown graphically in Figures 3 and 4. Depending upon the sample period chosen, the
results show the waiting list reaching 145,691 to 152,400 patients by 2015. Of the patients listed at that time, between 10,547 and 13,642
are expected to die that year. Even more tragically, over the entire period of both actual and predicted values, a
cumulative total of
196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing
shortage. Figure 5 illustrates the results. In that figure, we incorporate several historical reference points in order to put the numbers in
perspective. No one directly involved in the transplant industry is likely to be surprised by our results. Thirty years of experience
consistently point to a continuation of the current, long-standing trends. There is nothing on the horizon that should lead anyone to expect
a sudden reversal. But our purpose is not to surprise the parties who are already knowledgeable about this increasingly severe problem.
Rather, our intent is to awaken the sleeping policymakers whose continuing inaction will inevitably lead to these results. They can no
longer continue to postpone meaningful reform of the U.S. organ transplant system in the futile hope that, somehow, things will improve.
They will not.
The impact of the shortage falls heaviest on blacks, who have a greater need for
transplants
Pollack 14 MARTIN POLLAK and MARK ZEIDEL, respectively, chief of the Division of Nephrology and chairman of
the department of medicine at Beth Israel Deaconess Medical Center. Sept. 2, 2014
New York Times The Opinion Pages | Letters Ideas to Relieve a Kidney Shortage
http://www.nytimes.com/2014/09/05/opinion/ideas-to-relieve-a-kidney-shortage.html?_r=0
End-stage kidney failure is the cause of tremendous mortality as well as great cost: About 6 percent of the
Medicare budget — more than $30 billion — is spent yearly on end-stage kidney disease care. The growing obesity
epidemic and the consequent increase in Type 2 diabetes are major contributors to the rates and costs of kidney
failure. Kidney disease also disproportionately affects minority populations. Blacks develop kidney failure at three
to five times the rate of nonblacks, largely the effect of recently identified genetic factors.
Additionally, altruistic donations are biased against the poor
Fry-Revere 14 Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014
The Kidney Sellers: A Journey of Discovery in Iran p 201
But there is another tragic consequence inherent in the American system of altruistic organ donation
that many people are not aware of, an insidious injustice so profound one might question whether
our current policy is any less barbaric than the exploitation it sought to eliminate. By mandating
altruistic living kidney donations, the United States has inadvertently relegated some very specific
groups of Americans to die on dialysis while creating opportunities for others to get kidneys for free.
Someone well-to-do or well-connected. or even someone who is a middle-class. white~collar worker
is far more likely to have friends or relatives who qualify to donate than someone who is poor.
unemployed, or a blue-collar worker. Listed here are some of the qualifications for being a living
kidney donor: Donors must be healthy and insured. They can’t have diabetes, hypertension, or heart
problems; can’t be more than a little overweight: and preferably don't have a history of diabetes or
heart disease in their immediate families. These are prevalent illnesses among Americans—an
estimated 8.3 percent of Americans suffer from diabetes, and heart disease caused nearly 25 percent
of American deaths in 2OO8—but the problem is especially acute among the poor and minorities. A
growing body of evidence points to strong links between socioeconomic status and the prevalence of
diabetes, hypertension (a risk factor for heart disease), and end stage renal disease. On top of this,
donors need health insurance which practically speaking means that donors or their_spouses must
be full-time employees in a business large enough to provide insurance, must be making enough to
purchase their own insurance, or must be under 26 and covered by their parents’ health insurance.
Donors must have time to spare. First, they need to make 3 to 10 week-day trips to a hospital, clinic,
or lab for pre-op meetings and testing with lab technicians, doctors, social workers, and
psychologists. Then after the operation, they need ‘two to seven days to recover in the hospital and
at least two weeks to recover at home. Even after three weeks, however, it remains unwise to do any
heavy lifting. The period to limit heavy lift- ing might last anywhere from 2 to 6 months or longer
depending on ‘the age and general health of the donor, whether there were any complications
during surgery or afterwards, and how quickly the donor is healing. This means taking a good deal of
time away from work or other responsibilities, particularly if the donor has to do more than is
generally required of someone with a desk job. Donors must have a support group with time to
spare. They need help during the donation and recovery period. Donors can’t drive themselves home
from the hospital after the operation. They need people who can take care of them for at least the
first week or two after surgery. And of course, someone must take on the responsibilities donors are
unable to fulfill during recovery: any job-related duties as well as home responsibilities, such as
caring for children, older relatives, the household, pets, and the yard. Donors must have money. The
actual nephrectomy is covered through the recipients insurance or federal and state health
programs like Medicare and Medicaid, but there are donation related costs that are not covered.
Donors may have travel-related expenses like gas, flights, hotels and food while getting pre—
operative testing done and before and after surgery. If a donor’s friends and family can't take off
time to help the donor (or can’t take off weeks or months), the donor might have to hire someone to
help with non-work related obligations: for example, a babtsitter, a pet sitter, and someone to clean
the house and/or mow the lawn It is also quite possible that donors may need to take off more time
from work than they have paid leave. (Recipients are legally permitted to reimburse donors for lost
wages, but not all recipients, and particularly not impoverished ones, have the financial means to
cover lost wages. Furthermore reimbursing the self-employed is prohibited because there is no clear
measure, such as a salary, to value their work. State and federal programs provide some financial
assistance for donors, but most of those programs only provide need-based support for travel
expenses or only compensate donors a small percentage of their costs after the fact") The up-front
costs associated with kidney donation are simply too great for many potential donors, particularly if
they are members of an underprivileged socioeconomic class. The costs of donating are not limited
to the out-of-pocket expenses that might not be reimbursed. Taking too many days off work can
jeopardize a donor’s job status: A donor may lose his or her position altogether. fall behind in work
responsibilities, or lose seniority when it comes to promotions or other benefits. There are also
secondary costs such as the financial and emotional strain donation puts on family members and
friends when they contribute financially or take time off work to help the donor during recovery.
Given these restrictions. how many people do you know who would qua]- ify to be kidney donors?
W'hite-collar workers might be able to “afford” to donate if they have enough vacation time. enough
money saved to pay for donation-related expenses up front. friends and family who can take time off
work to help with everyday responsibilities, and a job to return to that doesn’t require heavy lifting.
Blue-collar workers are far less likely to have the resources needed to be living donors. They might
not have sufficient, if any, paid leave, may not have friends and family who have enough free time to
help with children and household responsibilities, and are more likely than white-collar workers to
have jobs that require heavy lifting. Now consider the self-employed, people like family farmers and
small business owners. How can they find the time or money to donate? And even if the selfemployed qualify to donate, who would run their businesses in their absence, and how many of them
have jobs that won't require at least some heavy lifting? And what about homemakers or people who
care for children or elderly relatives? Who would take on their responsibilities while they arrange for
and recover from a kidney donation, let alone the risks of heavy lifting too soon after surgery? _ _
Finally, poor and minority communities are harder hit with problems of obesity, diabetes, and
hypertension, making it less likely that a potential recipient’s friends and family will even qualify
medically as donors, let alone have the financial resources necessary to donate. And what about the
unemployed? They don’t qualify because they don’t have insurance. So the unemployed, or even
friends or relatives who work part-time, might not qualify to donate because they don’t have
adequate insurance coverage. As a result, the United States has a kidney donation system that, in the
name of altruism, makes it possible for the well-to-do, leisure class, and upper middle-class to get
living donor kidneys for free, while the average working class laborer, the poor, and the unemployed
have to watch their friends and family die on dialysis, waiting for second-best cadaver organs that
rarely come.
Thus, the shortage disproportionately impacts Blacks
Jefferson-Jones 13 Jamila Jefferson-Jones, J.D., Harvard Law School, Assistant Professor of Law at Barry
University's Dwayne O. Andreas School of Law in Orlando The Journal of Gender, Race & Justice Winter, 2013
16 J. Gender Race & Just. 105 ARTICLE: The Exchange of Inmate Organs for Liberty: Diminishing the "Yuck
Factor" in the Bioethics Repugnance Debate lexis
The statistics for Black ESRD patients are even more alarming than the overall national data. Blacks
represent only thirteen percent of the United States population, n38 but, disproportionately,
represent approximately thirty percent of those on the kidney waiting list. n39 The number of Black
patients who have been hoping for a kidney for two years or more and three years or more are fiftythree percent and thirty-six percent respectively. n40 Blacks who are on the kidney waiting list also
die at a rate averaging approximately 1,500 people per year - a number that represents thirty-eight
percent of all kidney waiting list deaths. n41
governemtnal purchasing is good for organ sales-only way to ensure fair
distribution—african americans are disproportionately effected
Goodwin 07
THE BODY MARKET: RACE POLITICS &
PRIVATE ORDERING
Michele Goodwin*
Visiting Professor, University of Chicago Law School. Everett Fraser
Professor of Law and Professor of Medicine, University of Minnesota.
Racial exploitation is now the powerful, conventional challenge to emerging discourses on
alternative methodologies of procuring organs, especially markets. Yet, to what effect? Those
committed to providing equitable opportunities to suffering patients must ask whether
challenges to organ markets benefit patients, especially racial minorities? Reduced waitlists?
Resolved racial disparities in organ allocation? These questions are relevant to any discussion about equity, access,
and class in organ procurement and allocation in the United States. The evidence, including growing waitlists and
thousands of deaths each year, informs us that altruistic organ procurement remains an
ineffective approach to meet the growing demand for organs. Race becomes the dominant cover
or proxy to justify exclusive reliance on altruism in organ procurement. The problem here is that
race-based claims against organ markets serve to destabilize any discourse that might involve
racial minorities contributing in non-altruistic ways to organ pools. Race plays as an expedient trope here,
masking concerns that may be driven by other interests far removed from minority status, class, and access. To be sure, there is a
tremendous demand for organs in America, and the situation is worsening. As of August 15, 2007, there were 96,928
patients on the United Network for Organ Sharing (UNOS) waitlist. 4 That number represents an increase
of 400 patients in less than three months. Over 6000 of these patients will die before receiving an organ, and thousands of others
will be unceremoniously removed from the waitlist because they are no longer attractive candidates, being too sick, weak, or old
according to those who set the rationing priorities. Disproportionately, these individuals are African
Americans, stuck in a strange quagmire, where policymakers expect strangers to donate organs
and rescue them. This normative approach is utilitarian in theory, and although intended to equalize transplantation
opportunities, it provides verylittle relief to vulnerable patients. One significant complication in the utilitarian
ordering of transplantation is the reliance on blind compassion. Another complication with that normative approach is that it
refuses to consider the pragmatic or realistic ordering of collectives, including competing value systems and group biases. In essence
it demands the surrendering of lives or organs, in this case with a promise for later returns. Yet, those goals must be understood as
aspirational, with very little hope of imminent achievement. If more Americans believed that communal sacrifice is returned in equal
measure they would readily surrender their organs at procurement sites throughout the United States. But they do not. This Article
does not argue against the value of aspirational thinking. To the contrary, the creation of just rules and
regulations and the testing of those rules through a reliable, fair, and unbiased judicial system
form an ideal that we strive for in our legal system.
There is an inherent value to life- death destroys it
Bernstein ‘2 (Richard J., Vera List Prof. Phil. – New School for Social Research, “Radical Evil: A
Philosophical Interrogation”, p. 188-192)
Jonas does in The Phenomenon of Life, his rethinking of the meaning of organic life. He tealizes that his philosophical project goes against many of the deeply embedded prejudices and dogmas of
contemporary philosophy. He challenges two well-entrenched dogmas: that there is no metaphysical truth, and that
there is no path from the "is" to the "ought". To escape from ethical nihilism, we must show that there is
a metaphysical ground of ethics, an objective basis for valueand purpose in being itself. These are strong claims; and, needless to say, they are extremely
This is precisely what
controversial. In defense of Jonas, it should be said that he approaches this task with both boldness and intellectual modesty. He frequently acknowledges that he cannot "prove" his claims, but he certainly believes that his
"premises" do "more justice to the total phenomenon of man and Being in general" than the prevailing dualist or reductionist alternatives. "But in the last analysis my argument can do no more than give a rational grounding to an
option it presents as a choice for a thoughtful person — an option that of course has its own inner power of persuasion. Unfortunately I have nothing better to offer. Perhaps a future metaphysics will be able to do more." 8 To
appreciate how Jonas's philosophical project unfolds, we need to examine his philosophical interpretation of life. This is the starting point of his grounding of a new imperative of responsibility. It also provides the context for his
speculations concerning evil. In the foreword to The Phenomenon of Life, Jonas gives a succinct statement of his aim. Put at its briefest, this volume offers an "existential" interpretation of biological facts. Contemporary
existentialism, obsessed with man alone, is in the habit of claiming as his unique privilege and predicament much of what is rooted in organic existence as such: in so doing, it withholds from the organic world the insights to be
learned from the awareness of self. On its part, scientific biology, by its rules confined to the physical, outward facts, must ignore the dimension of inwardness that belongs to life: in so doing, it submerges the distinction of
"animate" and "inanimate." A new reading of the biological record may recover the inner dimension — that which we know best -- for the understanding of things organic and so reclaim for psycho-physical unity of life that place in
Jonas, in his existential interpretation of bios, pursues "this underlying
theme of all of life in its development through the ascending order of organic powers and functions: metabolism, moving
and desiring, sensing and perceiving, imagination, art, and mind — a progressive scale of freedom and peril, culminating in man, who may understand
the theoretical scheme which it had lost through the divorce of the material and the mental since Descartes. p. ix)
his uniqueness anew when he no longer sees himself in metaphysical isolation" (PL, p. ix). The way in which Jonas phrases this theme recalls the Aristotelian approach to bios, and it is clear that Aristotle is a major influence on
Jonas. There is an even closer affinity with the philosophy of nature that Schelling sought to elaborate in the nineteenth century. Schelling (like many post- Kantian German thinkers) was troubled by the same fundamental
dichotomy that underlies the problem for Jonas. The dichotomy that Kant introduced between the realm of "disenchanted" nature and the realm of freedom leads to untenable antinomies. Jonas differs from both Aristotle and
Schelling in taking into account Darwin and contemporary scientific biology. A proper philosophical understanding of biology must always be compatible with the scientific facts. But at the same time, it must also root out misguided
materialistic and reductionist interpretations of those biological facts. In this respect, Jonas's naturalism bears a strong affinity with the evolutionary naturalism of Peirce and Dewey. At the same time, Jonas is deeply skeptical of
any theory of evolutionary biology that introduces mysterious "vital forces" or neglects the contingencies and perils of evolutionary development.' Jonas seeks to show "that it is in the dark stirrings of primeval organic substance
that a principle of freedom shines forth for the first time within the vast necessity of the physical universe" (PL 3). Freedom, in this broad sense, is not identified exclusively with human freedom; it reaches down to the first
glimmerings of organic life, and up to the type of freedom manifested by human beings
. " 'Freedom' must denote an objectively discernible mode of
being, i.e., a manner of executing existence, distinctive of the organic per se and thus shared by all members but by no nonmembers of the class: an ontologically descriptive term which can apply to mere physical evidence
at first" (PL 3). This coming into being of freedom is not just a success story. "The privilege of freedom carries the burden of need and means precarious being" (PL 4). It is with biological metabolism that this principle of freedom
. Jonas goes "so far as to maintain that metabolism, the basic stratum of all organic existence, already displays freedom — indeed that it is the first
form freedom takes." 1 ° With "metabolism — its power and its need — not-being made its appearance in the world as an alternative embodied in being itself; and thereby being itself first assumes an
first arises
emphatic sense: intrinsically qualified by the threat of its negative it must affirm itself, and existence affirmed is existence as a concern" (PL 4). This broad, ontological understanding of freedom as a characteristic of all organic life
serves Jonas as "an Ariadne's thread through the interpretation of Life" (PL 3). The way in which Jonas enlarges our understanding of freedom is indicative of his primary argumentative strategy. He expands and reinterprets
categories that are normally applied exclusively to human beings so that we can see that they identify objectively discernible modes of being characteristic of everything animate. Even inwardness, and incipient forms of self; reach
down to the simplest forms of organic life. 11 Now it may seem as if Jonas is guilty of anthropomorphism, of projecting what is distinctively human onto the entire domain of living beings. He is acutely aware of this sort of
objection, but he argues that even the idea of anthropomorphism must be rethought. 12 We distort Jonas's philosophy of life if we think that he is projecting human characteristics onto the nonhuman animate world. Earlier I
quoted the passage in which Jonas speaks of a "third way" — "one by which the dualistic rift can be avoided and yet enough of the dualistic insight saved to uphold the humanity of man" (GEN 234). We avoid the "dualistic rift" by
showing that there is genuine continuity of organic life, and that such categories as freedom, inwardness, and selfhood apply to everything that is animate. These categories designate objective modes of being. But we preserve
"enough dualistic insight" when we recognize that
freedom, inwardness, and selfhood manifest themselves in human beings in a
distinctive manner. I do not want to suggest that Jonas is successful in carrying out this ambitious program. He is aware of the tentativeness and fallibility of his claims, but he presents us with an
understanding of animate beings such that we can discern both continuity and difference.' 3 It should now be clear that Jonas is not limiting himself to a regional philosophy of the organism or a new "existential" interpretation of
biological facts. His goal is nothing less than to provide a new metaphysical understanding of being, a new ontology. And he is quite explicit about this. Our reflections [are] intended to show in what sense the problem of life, and
with it that of the body, ought to stand in the center of ontology and, to some extent, also of epistemology. . . The central position of the problem of life means not only that it must be accorded a decisive voice in judging any given
ontology but also that any treatment of itself must summon the whole of ontology. (PL 25) The philosophical divide between Levinas and Jonas appears to be enormous. For Levinas, as long as we restrict ourselves to the horizon of
Being and to ontology (no matter how broadly these are conceived), there is no place for ethics, and no answer to ethical nihilism. For Jonas, by contrast, unless we can enlarge our understanding of ontology in such a manner as
would provide an objective grounding for value and purpose within nature, there is no way to answer the challenge of ethical nihilism. But despite this initial appearance of extreme opposition, there is a way of interpreting Jonas
and Levinas that lessens the gap between them. In Levinasian terminology, we can say that Jonas shows that there is a way of understanding ontology and the living body that does justice to the nonreducible alterity of the other
(l'autrui). 14 Still, we might ask how Jonas's "existential" interpretation of biological facts and the new ontology he is proposing can provide a metaphysical grounding for a new ethics. Jonas criticizes the philosophical prejudice that
freedom, inwardness, and selfhood are objective modes of
being, so he argues that values and ends are objective modes of being. There is a basic value inherent in
organic being, a basic affirmation, "The Yes' of Life" (IR 81). 15 "The self-affirmation of being becomes
emphatic in the opposition of life to death. Life is the explicit confrontation of being with not-being. . .
. The 'yes' of all striving is here sharpened by the active `no' to not-being" (IR 81-2). Furthermore — and this is the crucial point for Jonas
— this affirmation of life that is in all organic being has a binding obligatory force upon human beings.
This blindly self-enacting "yes" gains obligating force in the seeing freedom of man, who as the supreme outcome of nature's
purposive labor is no longer its automatic executor but, with the power obtained from knowledge, can become its destroyer as well. He must adopt the "yes" into his will and
impose the "no" to not-being on his power. But precisely this transition from willing to obligation is the critical point of moral theory at which attempts at laying a foundation for
there is no place in nature for values, purposes, and ends. Just as he maintains that
it come so easily to grief. Why does now, in man, that become a duty which hitherto "being" itself took care of through all individual willings? (IR 82). We discover here the transition from is to "ought" — from the self-affirmation of
life to the binding obligation of human beings to preserve life not only for the present but also for the future. But why do we need a new ethics? The subtitle of The Imperative of Responsibility — In Search of an Ethics for the
.Modern technology has transformed the nature and consequences of human
ac-tion so radically that the underlying premises of traditional ethics are no longer valid. For the first time in history human
Technological Age — indicates why we need a new ethics
Not only is there the new possibility of total nuclear
disaster; there are the even more invidious and threatening possibilities that result from the unconstrained use of technologies that can destroy the
environment required for life. The major transformation brought about by modern technology is that the consequences of our actions frequently exceed by far anything we can envision. Jonas was
beings possess the knowledge and the power to destroy life on this planet, including human life.
one of the first philosophers to warn us about the unprecedented ethical and political problems that arise with the rapid development of biotechnology. He claimed that this was happening at a time when there was an "ethical
vacuum," when there did not seem to be any effective ethical principles to limit ot guide our ethical decisions. In the name of scientific and technological "progress," there is a relentless pressure to adopt a stance where virtually
We need, Jonas argued, a new categorical imperative that
might be formulated as follows: "Act so that the effects of your action are compatible with the
permanence of genuine human life"; or expressed negatively: "Act so that the effects of your action are not
destructive of the future possibility of such a life"; or simply: "Do not compromise the conditions for an
indefinite continuation of humanity on earth"; or again turned positive: "In your present choices, include the future wholeness of Man among the objects of your will." (IR 11)
anything is permissible, includ-ing transforming the genetic structure of human beings, as long as it is "freely chosen."
The plan with sales would provide an adequate supply of organs.
Becker and Elias 14
Gary S. Becker, Nobel Prize-winning professor of economics at the University of Chicago and a senior fellow at the
Hoover Institution; and Julio J. Elias, economics professor at the Universidad del CEMA in Argentina. Updated Jan.
18, 2014 Wall Street Journal Cash for Kidneys: The Case for a Market for Organs
http://online.wsj.com/news/articles/SB10001424052702304149404579322560004817176?mod=WSJ_hpp_MIDDL
ENexttoWhatsNewsFifth
Finding a way to increase the supply of organs would reduce wait times and deaths, and it would
greatly ease the suffering that many sick individuals now endure while they hope for a transplant.
The most effective change, we believe, would be to provide compensation to people who give their
organs—that is, we recommend establishing a market for organs. Organ transplants are one of the extraordinary
developments of modern science. They began in 1954 with a kidney transplant performed at Brigham & Women's hospital in Boston. But
the practice only took off in the 1970s with the development of immunosuppressive drugs that could prevent the rejection of transplanted
organs. Since then, the number of kidney and other organ transplants has grown rapidly, but not nearly as rapidly as the growth in the
number of people with defective organs who need transplants. The result has been longer and longer delays to receive organs. Many of
those waiting for kidneys are on dialysis, and life expectancy while on dialysis isn't long. For example, people age 45 to 49 live, on average,
eight additional years if they remain on dialysis, but they live an additional 23 years if they get a kidney transplant. That is why in 2012,
almost 4,500 persons died while waiting for kidney transplants. Although some of those waiting would have died anyway, the great
majority died because they were unable to replace their defective kidneys quickly enough. Enlarge Image The toll on those waiting for
kidneys and on their families is enormous, from both greatly reduced life expectancy and the many hardships of being on dialysis. Most of
those on dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost over the average 4.5-year waiting
period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of the transplant itself. Individuals can
live a normal life with only one kidney, so about 34% of all kidneys used in transplants come from live donors. The majority of transplant
kidneys come from parents, children, siblings and other relatives of those who need transplants. The rest come from individuals who want
to help those in need of transplants. In recent years, kidney exchanges—in which pairs of living would-be donors and recipients who prove
incompatible look for another pair or pairs of donors and recipients who would be compatible for transplants, cutting their wait time—
have become more widespread. Although these exchanges have grown rapidly in the U.S. since 2005, they still account for only 9% of live
donations and just 3% of all kidney donations, including after-death donations. The relatively minor role of exchanges in total donations
isn't an accident, because exchanges are really a form of barter, and barter is always an inefficient way to arrange transactions.
Exhortations and other efforts to encourage more organ donations have failed to significantly close the large gap between supply and
demand. For example, some countries use an implied consent approach, in which organs from cadavers are assumed to be available for
transplant unless, before death, individuals indicate that they don't want their organs to be used. (The U.S. continues to use informed
consent, requiring people to make an active declaration of their wish to donate.) In our own highly preliminary study of a few countries—
Argentina, Austria, Brazil, Chile and Denmark—that have made the shift to implied consent from informed consent or vice versa, we found
that the switch didn't lead to consistent changes in the number of transplant surgeries. Other studies have found more positive effects
from switching to implied consent, but none of the effects would be large enough to eliminate the sizable shortfall in the supply of organs
in the U.S. That shortfall isn't just an American problem. It exists in most other countries as well, even when they use different methods to
procure organs and have different cultures and traditions. Paying
donors for their organs would finally eliminate the
supply-demand gap. In particular, sufficient payment to kidney donors would increase the supply of
kidneys by a large percentage, without greatly increasing the total cost of a kidney transplant. We
have estimated how much individuals would need to be paid for kidneys to be willing to sell them for
transplants. These estimates take account of the slight risk to donors from transplant surgery, the number of weeks of work lost
during the surgery and recovery periods, and the small risk of reduction in the quality of life. Our conclusion is that a very large
number of both live and cadaveric kidney donations would be available by paying about $15,000 for
each kidney. That estimate isn't exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate
wouldn't increase the total cost of kidney transplants by a large percentage. Few countries have ever allowed the open purchase and sale
of organs, but Iran
permits the sale of kidneys by living donors. Scattered and incomplete evidence from Iran indicates
that the price of kidneys there is about $4,000 and that waiting times to get kidneys have been largely eliminated.
Since Iran's per capita income is one-quarter of that of the U.S., this evidence supports our $15,000 estimate. Other countries are also
starting to think along these lines: Singapore and Australia have recently introduced limited payments to live donors that compensate
mainly for time lost from work. Since
the number of kidneys available at a reasonable price would be far more
than needed to close the gap between the demand and supply of kidneys, there would no longer be
any significant waiting time to get a kidney transplant. The number of people on dialysis would
decline dramatically, and deaths due to long waits for a transplant would essentially disappear. Today,
finding a compatible kidney isn't easy. There are four basic blood types, and tissue matching is complex and involves the combination of six
proteins. Blood and tissue type determine the chance that a kidney will help a recipient in the long run. But the sale of organs would result
in a large supply of most kidney types, and with large numbers of kidneys available, transplant surgeries could be arranged to suit the
health of recipients (and donors) because surgeons would be confident that compatible kidneys would be available. The system that we're
proposing would include payment to individuals who agree that their organs can be used after they die. This is important because
transplants for heart and lungs and most liver transplants only use organs from the deceased. Under a new system, individuals would sell
their organs "forward" (that is, for future use), with payment going to their heirs after their organs are harvested. Relatives sometimes
refuse to have organs used even when a deceased family member has explicitly requested it, and they would be more inclined to honor
such wishes if they received substantial compensation for their assent. The idea of paying organ donors has met with strong opposition
from some (but not all) transplant surgeons and other doctors, as well as various academics, political leaders and others. Critics have
claimed that paying for organs would be ineffective, that payment would be immoral because it involves the sale of body parts and that the
main donors would be the desperate poor, who could come to regret their decision. In short, critics believe that monetary payments for
organs would be repugnant. But the
claim that payments would be ineffective in eliminating the shortage of
organs isn't consistent with what we know about the supply of other parts of the body for medical
use. For example, the U.S. allows market-determined payments to surrogate mothers—and surrogacy takes time, involves great
discomfort and is somewhat risky. Yet in the U.S., the average payment to a surrogate mother is only about $20,000. Another illuminating
example is the all-volunteer U.S. military. Critics once asserted that it wouldn't be possible to get enough capable volunteers by offering
them only reasonable pay, especially in wartime. But the all-volunteer force has worked well in the U.S., even during wars, and the cost of
these recruits hasn't been excessive. Whether paying donors is immoral because it involves the sale of organs is a much more subjective
matter, but we question this assertion, given the very serious problems with the present system. Any claim about the supposed immorality
of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving the quality of life of
those waiting for organs. How can paying for organs to increase their supply be more immoral than the injustice of the present system?
Under the type of system we propose, safeguards could be created against impulsive behavior or exploitation. For example, to reduce the
likelihood of rash donations, a period of three months or longer could be required before someone would be allowed to donate their
kidneys or other organs. This would give donors a chance to re-evaluate their decisions, and they could change their minds at any time
before the surgery. They could also receive guidance from counselors on the wisdom of these decisions. Though the poor would be more
likely to sell their kidneys and other organs, they also suffer more than others from the current scarcity. Today, the rich often don't wait as
long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground
medical sector, and others (such as the late Steve Jobs ) manage to jump the queue by having residence in several states or other means.
The sale of organs would make them more available to the poor, and Medicaid could help pay for the added cost of transplant surgery. The
altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative, friend or anyone else would
be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to those in need of organs could
increase to help them pay for the cost of organ transplants. Paying
for organs would lead to more transplants—and thereby,
save the cost of dialysis for people
waiting for kidney transplants and other costs to individuals waiting for other organs. More
important, it would prevent thousands of deaths and improve the quality of life among those who
now must wait years before getting the organs they need.
perhaps, to a large increase in the overall medical costs of transplantation. But it would
The government purchasing approach of the plan would end the current
discrimination in transplant availability
Berger 11 Alexander Berger is a research analyst for GiveWell, a nonprofit that researches charities to help
donors decide where to give. The New York Times December 6, 2011 Why Selling Kidneys Should Be Legal
SECTION: Section ; Column 0; National Desk; OP-ED CONTRIBUTOR; Pg. lexis
It has been illegal to compensate kidney donors in any way since 1984. The fear behind the law -that a rich tycoon could take advantage of someone desperately poor and persuade that person to
sell an organ for a pittance -- is understandable. But the truth is that the victims of the current ban
are disproportionately African-American and poor. When wealthy white people find their way onto
the kidney waiting list, they are much more likely to get off it early by finding a donor among their
friends and family (or, as Steve Jobs did for a liver transplant in 2009, by traveling to a region with a
shorter list). Worst of all, the ban encourages an international black market, where desperate people
do end up selling their organs, without protection, fair compensation or proper medical care. A wellregulated legal market for kidneys would not have any of these problems. It could ensure that donors
were compensated fairly -- most experts say somewhere in the ballpark of $50,000 would make
sense. Only the government or a chosen nonprofit would be allowed to purchase the kidneys, and
they would allocate them on the basis of need rather than wealth, the same way that posthumously
donated organs are currently distributed. The kidneys would be paid for by whoever covers the
patient, whether that is their insurance company or Medicare. Ideally, so many donors would come
forward that no patient would be left on the waiting list.
The legalization of sales to the government, rather than purchases in a open market
would mean equitable distribution of organs -- and avoid crowd out
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
First, we are arguing for the claim that it ought to be legal for a person to be paid for one of his or her
kidneys. We are not arguing that it ought to be legal for a potential recipient to buy a kidney in an
open market. We propose that the buyers of kidneys be the agencies in charge of kidney
procurement or transplantation; that is, we propose that such agencies should be allowed to use
financial incentives to acquire kidneys. We assume that allocation of kidneys will be based on
medical criteria, as in the existing allocation system for cadaveric organs. Kidneys will not be traded
in an unregulated market. 2 A similar system is currently in place for blood products: a person can
receive money for providing blood products, but one's chances of receiving blood are distinct from
one's financial status. We further note that transplant recipients or their agents—e.g., insurance
companies, Medicaid—pay for organs now, compensating the organ procurement organization that
organizes the organ retrieval, the surgeon who removes the organ, the hospital where the organ is
procured, and so forth. The only component of the organ procurement process not currently paid is
the most critical component, the possessor of the kidney, who is sine qua non for organ availability.
Second, we believe the legalization of kidney sales will increase the number of kidneys that are
transplanted each year and thus save the lives of people who would otherwise die. We base this
belief on two views that seem to us very plausible: first, that financial incentives will induce some
people to give up a kidney for transplantation who would otherwise not have done so; and second,
that the existence of financial incentives will not decrease significantly the current level of live kidney
donations. The first view seems to us to follow from the basic idea that people are more likely to do
something if they are going to get paid for it. The second view seems to us to follow from the fact
that a very large majority of live kidney donations occur between family members and the idea that
the motivation of a sister who donates a kidney to a brother, or a parent who donates a kidney to a
child, will not be altered by the existence of financial incentives. Although we think these views are
plausible, we acknowledge that there is no clear evidence that they are true. If subsequent research
were to establish that the legalization of kidney sales would lead to a decrease in the number of
kidneys that are transplanted each year, some of the arguments we make would be substantially
weakened. 3 Third, we are arguing for allowing payment to living kidney donors, but many of the
kidneys available for transplantation come from cadavers. [End Page 19] We believe that payment
for cadaveric organs also ought to be legalized, but we will not discuss that issue here. If we
successfully make the case for allowing payment to living donors, the case for payment for cadaveric
kidneys should follow easily. The Prima Facie Case for Kidney Sales With these preliminary points in
mind, we will proceed to the initial argument for permitting payment for kidneys. 4 This argument is
based on two claims: the "good donor claim" and the "sale of tissue claim." The good donor claim
contends that it is and ought to be legal for a living person to donate one of his or her kidneys to
someone else who needs a kidney in order to survive. These donations typically consist of someone
giving a kidney to a sibling, spouse, or child, but there are also cases of individuals donating to
strangers. Such donations account for about half of all kidney transplants. 5 Our society, moreover,
does not simply allow such live kidney donations. Rather, we actively praise and encourage them. 6
We typically take them to be morally unproblematic cases of saving a human life. The sale of tissue
claim contends that it is and ought to be legal for living persons to sell parts of their bodies. We can
sell such tissues as hair, sperm, and eggs, but the body parts we focus on here are blood products. A
kidney is more like blood products than other tissues because both are physical necessities: people
need them in order to survive. Our proposed kidney sales are more like the sale of blood products in
that both involve the market only in acquisition and not in allocation: the current system pays people
for plasma while continuing to distribute blood products without regard to patients' economic status,
just as we propose for kidneys. We do not typically praise people who sell their plasma as we do
people who donate a kidney to save the life of a sibling. At the same time, most people do not brand
commercial blood banks as moral abominations. We generally take them to be an acceptable means
of acquiring a resource that is needed to save lives. 7 It is doubtful, for instance, that there would be
widespread support for the abolition of payment for plasma if the result were a reduction in supply
so severe that thousands of people died every year for lack of blood products. If both the good donor
claim and the sale of tissue claim are true, we have at least an initial argument, or prima facie
grounds, for holding that payment for kidneys ought to be legal. The good donor claim implies that it
ought to be legal for a living person to decide to transfer one of his or [End Page 20] her kidneys to
someone else, while the sale of tissue claim implies that it ought to be legal for a living person to
decide to transfer part of his or her body to someone else for money. It thus seems initially plausible
to hold that the two claims together imply that it ought to be legal for a living person to decide to
transfer one of his or her kidneys to someone else for money. Of course, there seems to be an
obvious difference between donating a kidney and selling one: motive. Those who donate typically
are motivated by benevolence or altruism, while those who sell typically are motivated by monetary
self-interest. 8 The sale of tissue claim suggests, however, that this difference on its own is irrelevant
to the question of whether kidney sales ought to be legal, because the sale of tissue claim establishes
that it ought to be legal to transfer a body part in order to make money. If donating a kidney ought to
be legal (the good donor claim), and if the only difference between donating a kidney and selling one
is the motive of monetary self-interest, and if the motive of monetary self-interest does not on its
own warrant legal prohibition (the sale of tissue claim), then the morally relevant part of the analogy
between donating and selling should still obtain and we still have grounds for holding that selling
kidneys ought to be legal. There is also an obvious difference between selling a kidney and selling
plasma: the invasiveness of the procedure. Phlebotomy for sale of plasma is simple and quick, with
no lasting side effects, while parting with a kidney involves major surgery and living with only one
kidney thereafter. It is very unlikely, however, that there will be any long-term ill effects from the
surgery itself or from life with a single kidney. 9 Indeed, the laws allowing live kidney donations
presuppose that the risk to donors is very small and thus morally acceptable. The good donor claim
implies, then, that the invasiveness of the procedure of transferring a kidney is not in and of itself a
sufficient reason to legally prohibit live kidney transfer. If the only difference between selling plasma
and selling a kidney is the risk of the procedure, and if that risk does not constitute grounds for
prohibiting live kidney transfers, then the morally relevant part of the analogy between selling
plasma and selling a kidney still should obtain and we still have grounds for holding that kidney sales
ought to be legal. The point of the preceding two paragraphs is this: if we oppose the sale of kidneys
because we think it is too dangerous, then we also should oppose live kidney donations. But we do
not oppose live kidney donations because we realize that the risks are acceptably low and worth
taking [End Page 21] in order to save lives. So, it is inconsistent to oppose selling kidneys because of
the possible dangers while at the same time endorsing the good donor claim. Similarly, if we oppose
kidney sales because we think people should not sell body parts, then we should also oppose
commercial blood banks. But most people do not oppose blood banks because they realize that the
banks play an important role in saving lives. So, it is inconsistent to oppose selling kidneys because it
involves payment while at the same time endorsing the sale of tissue claim. 10 The considerable
emotional resistance to permitting kidney sales may be based on a combination of distaste for
payment and worry about risk. But if neither of these concerns on its own constitutes defensible
grounds for opposing payment, then it seems unlikely that the two of them together will do so. This
initial argument does not imply that we should legalize the sale of hearts and livers. The initial
argument holds only that, if it is medically safe for living people to donate an organ, then people
should also be allowed to sell that organ. But it is not medically safe for a living person to donate his
or her heart or liver. Our reliance on the good donor claim does, however, commit us to the idea that
if it is morally correct to allow someone to donate an organ or part of an organ, then it is morally
correct to allow someone to sell that organ or organ part. If, therefore, it is morally correct to allow
people to donate liver lobes and parts of lungs, then, according to our initial argument, it ought to be
legal for a person to sell a liver lobe or part of a lung as well. Our proposal does not address the
purchase of kidneys, which is a separate question. Many of the arguments against legalizing the
purchase of kidneys do not apply to the sale of kidneys. For example, one argument against
permitting the buying of kidneys is that it will lead to fewer kidneys for transplantation overall.
Another argument is that while allowing individuals to purchase kidneys might not reduce the overall
number of kidneys available for transplantation, it will reduce the number of donated kidneys and
harm the poor who will not be able to afford to buy a kidney. Both arguments rest on empirical
claims that are often stated as fact, yet have no supporting evidence. Even if the empirical claims
were accurate, moreover, their moral importance could be disputed. Perhaps there are powerful
moral reasons to legalize the buying of organs even if doing so leads to fewer organs overall or
reduces the chances of a poor person's receiving a kidney transplant. Then again, perhaps a negative
effect on the overall supply of kidneys or on the transplantation prospects [End Page 22] for the poor
will turn out to be a conclusive reason not to legalize the buying of kidneys. The important point is
that our proposal will not be affected either way. As already noted in our preliminary points, our
proposal can be reasonably expected both to increase the overall number of kidneys for
transplantation and to increase the chances that a poor person who needs a kidney will receive one.
Therefore, in arguing for the legalization of kidney sales, we put aside the separate question of
whether buying kidneys ought to be legal as well.
Government purchaser also avoids exploitation of poor donors
Erin and Harris 3 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of Law,
University of Manchester, J Med Ethics 2003;29:137-138 An ethical market in human organs
http://jme.bmj.com/content/29/3/137.full
While people’s lives continue to be put at risk by the dearth of organs available for transplantation,
we must give urgent consideration to any option that may make up the shortfall. A market in organs from
living donors is one such option. The market should be ethically supportable, and have built into it, for
example, safeguards against wrongful exploitation. This can be accomplished by establishing a single
purchaser system within a confined marketplace.
Coercion of the poor does not apply to central purchasing – experience with egg
donations proves
Sobota 4 Margaret R. Sobota, J.D. Candidate (2005), Washington University School of Law. Washington
University Law Quarterly Fall, 2004 82 Wash. U. L. Q. 1225 NOTE: THE PRICE OF LIFE: $ 50,000 FOR AN EGG, WHY NOT
$ 1,500 FOR A KIDNEY? AN ARGUMENT TO ESTABLISH A MARKET FOR ORGAN PROCUREMENT SIMILAR TO THE CURRENT
MARKET FOR HUMAN EGG PROCUREMENT lexis
A. Arguments Opposing a Market for Organ Procurement
The main argument against establishing a market for organ procurement is economic coercion. n141
Market opponents insist that poor, destitute people from around the world will be forced into selling
their organs without making an in-formed decision. n142 There are several flaws with this argument.
n143 First, the economic coercion argument is based on the false premise that the prices donors will
be paid for their organs will be high enough to override their doubts and ethical concerns about
becoming a donor. n144 In the proposed market system for organ procurement, either OPOs or the
state will be paying the donors; thus preventing potential wealthy recipients from driving up the
prices paid for organs. n145 With only moderate prices being paid to organ donors, economic
incentives would likely not outweigh a donor's moral objections to donation, and thus no economic
coercion would occur. n146 Additionally, the current market system for egg donation suggests that
economic coercion would not be a problem in a market for organ procurement. n147 A majority of
egg donors are not poor or minority women, and the amounts paid to them for their donations are
usually not an "undue inducement to undergo the medical [*1246] risks involved." n148 These facts
suggest that if a system of financial compensation for organ donation were established, comparable
to the system already in place for egg donation, there would similarly be no economic coercion of
donors.
With sales limited to government purchasing transplants under the plan would be
based on medical need
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
The international black market in kidneys is worthy of moral condemnation, and the popular press
has been right to expose it. But the horrible stories do not constitute justification for a blanket
rejection of payment for kidneys in this country because there are two crucial differences between
the international black market and the legal domestic program we propose.
First, in our proposal the medical setting in which legal kidney transfer would take place is that of
contemporary transplantation, safe and medically sophisticated. Screening would select only
potential kidney sellers whose kidneys are suitable for transfer and whose medical condition predicts
minimal risk. Follow-up care would be scrupulous. Sellers would receive exactly the same medical
attention and treatment that living kidney donors now receive in this country. The people to whom
the kidneys are transferred will also receive the same medical attention and treatment that kidney
recipients currently receive.
Second, the domestic program we propose involves money only in the acquisition of kidneys, unlike
the international black market. Allocation of kidneys would be based on medical criteria, as it is
today. No private individual would be able to buy a kidney outside the system. Poor individuals will
have just as much chance of receiving one of the kidneys.
Advantage 2 Worldwide transplants will be better
The US ban on sales has created an international illegal market
Hughes 9 J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School, May 2009.
Vanderbilt Journal of Transnational Law January, 2009 42 Vand. J. Transnat'l L. 351
Note: You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models
U.S. organ procurement policy has consequences beyond a domestic organ shortage. A thriving
global black market in human organs has resulted from U.S. policy banning organ sales. n78 While nearly all
developed nations have banned the sale and purchase of human organs, many countries do not strictly enforce these laws. n79 The
illegality of the organ trade is insufficient to discourage many of those faced with the possibility of
dying on an organ waiting list, and "transplant tourism" has become its own industry. n80 In Bombay in
2001, nearly US$ 10 million were exchanged for kidney transplants. n81 Patients use kidney brokers to locate sellers, who circumvent a ban
on kidney sales by signing an affidavit swearing that they are not being paid. n82 Before the U.S. invaded Iraq in 2003, that country was
known as "one of [the] world's best black marketplaces for human organs." n83 The lack of effective prosecution of these transactions
extends beyond Asia and the Middle East to Europe, as recent cases in Estonia and Germany suggest. n84 U.S.
doctors perform
illegal transplants, too, often under hospitals' "don't ask, don't tell" policy regarding transplants
involving foreigners who claim to be related. n85 U.S. hospitals set their own rules for who can be a live organ donor, and
organ brokers can locate hospitals that do not question a purported familial relationship between "donors" and "donees." n86 The lack
of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor throughout the
world. n87 Organ sellers often face debt, unemployment, and serious health problems; as such, they are easy targets for abuse. n88
Prisoners and the homeless are among those exploited. n89 Sellers of organs on the black market are often paid less than what they were
initially promised, while their financial situations and health often grow worse after the transplants. n90 Data from the Indian black market
trade in kidneys [*363] support the concern about sellers' lack of adequate information about the risks involved. In one study, 86% of the
sellers there reported that their health had "deteriorated substantially" after their organ sales, and "four out of five sellers would not
recommend that others follow their lead in selling organs." n91 In
short, U.S. policy and its ban on organ sales have
produced some of the same immoral and unethical consequences the ban was designed to avoid. n92
Economically desperate people are coerced into selling their organs in the hope of
bettering their situation. As a result of the actions of unscrupulous organ brokers and
inadequate medical care, they are actually made worse off.
Jaycox 12 Michael P. Jaycox, teaching fellow and Ph.D. candidate in theological ethics at Boston College,
COERCION, AUTONOMY, AND THE PREFERENTIAL
OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00327.x/pdf
Developing World Bioethics Volume 12 Number 3 2012 pp 135–147
Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study in which he
interviewed thirty-two farm laborers in Pakistan, each of whom had sold a kidney within the past three years. 14 He found that
almost all of these organ vendors were in significant debt to wealthy landlords at the time they
sold their kidneys; the average debt of each was 130,000 rupees at the time of sale. Although the vendors were
promised by third-party brokers an average price of 160,000 rupees per kidney, the amount
actually received by the vendors was an average of 103,000 rupees. As a result, a majority (17) of
them were ‘either still in debt or had accumulated new debts’ at the time of their interviews. 15 Moreover, a
majority of the vendors experienced long-term physical and psychological malady as a result of
their nephrectomies, and a majority also expressed regret or shame for their decision because
they were not freed from their debts and/or felt they had committed a morally wrong act. When
asked why they had made the decision, ‘the most common [Urdu] words they used were majboori (a word that arises from the root
jabr, which means a state that is beyond one’s control) and ghurbat (extreme poverty).’16, Moazam
summarizes his
findings with the conclusion that the sale of kidneys functions to reinforce the poverty of
those who sell them: In the words of the vendors, they sell a kidney...in order to fulfill what they see as obligations toward
immediate and extended families in which they are inextricably embedded, and within systems of social and economic inequalities
which they can neither control nor escape. They sell kidneys in hopes of paying off loans taken to cover their families’ medical
expenses or to meet the responsibilities for arranging marriages and burying their dead. These are recurring expenses, and for most
the debts rapidly accumulate again, even if they have been partially or completely paid back with the money from selling a kidney.
17 4 F. Moazam, R.M. Zaman & A.M. Jafarey. Conversations with Kidney Vendors in Pakistan: An Ethnographic Study.Hastings Cent
Rep 2009; 39: 29–44. Due to recent legislation (18 March 2010), the sale of human organs is now illegal in Pakistan, although the
social effects of this new legislation remain to be studied; see T.M. Pope. Legal Briefing: Organ Donation and Allocation. J Clin Ethics
2010; 21: 243–263: 254.
For many, the coercion is more violent
Bowden 13 Jackie Bowden, 2013 J.D. graduate from St. Thomas University School of Law. Intercultural Human
Rights Law Review 2013 8 Intercultural Hum. Rts. L. Rev. 451
& TRADE: THE BLACK MARKET FOR HUMAN ORGANS lexis
[*452] Introduction
ARTICLE: FEELING EMPTY? ORGAN TRAFFICKING
[*452] Introduction Organ
trafficking has been depriving innocent people of their fundamental right to life
for decades. n1 Imagine living in a poor country, where you wake up in the morning and set out to find work and food for
the day. As you walk peacefully to your home at the end of the day, you are grabbed and thrown into the back of
an unmarked truck. n2 You wake up, screaming from excruciating pain, as a surgeon slices through your flesh to
remove your kidney. Due to the costs associated with such a procedure, no anesthesia is administered and no
medication is given to prevent infection. n3 In the event that the surgery does not go as planned, no forms of emergency
assistance are available. Your body is then dumped on a side street, and you are extremely lucky if you live.
Should you report the incident to government officials? What if the government is actually involved in this inhumane activity? n4 [*453]
There are conflicting views on whether people are actually kidnapped for their organs. n5 In fact, many believe these stories are just myths.
n6 However,
there are reported accounts suggesting that abduction of organs is a harsh reality of organ
trafficking. n7 Reports indicate organ trafficking is so prevalent that there is a surplus of organs available for transplantation. n8
Furthermore, there is evidence of governmental involvement, which contributes to and exacerbates
the problem. n9 Fortunately, most countries have enacted laws to prevent and prohibit organ trafficking from occurring. n10
And that market is widespread and expanding—desperation and profit ensures
expansion and exploitation
Samadi 2012 – Vice Chairman of the Department of Urology and Chief of Robotics and
Minimally Invasive Surgery at the Mount Sinai School of Medicine (David, May 30, 2012,
“Consequences of the rise in illegal organ trafficking,” Fox News,
http://www.foxnews.com/health/2012/05/30/consequences-rise-in-illegal-organ-trafficking/,)
Earlier this week, the World Health Organization (WHO) released a report demonstrating a rise in the
number of human organs being sold on the black market. According to the paper, in 2010 over 10,000
organs were sold, translating to more than one organ sold every hour. Organ transplantation is a
necessary treatment for many individuals whose organs have failed and has been in practice in the United States since the 1950s. In
the U.S. organ donations are regulated by an independent non-for-profit organization, United Network for Organ Sharing (UNOS).
Organs are given to those whose need is the greatest, regardless of wealth or position. Unfortunately, the need for
organs greatly outweighs the current supply. As of March 2012 over 113,115 patients are currently waiting for an
organ to become available. An illegal market has capitalized on these individuals’ desperation, and the
prospects of large profits are creating unfortunate incentives, with patients willing to pay up to
$200,000 for a kidney. According to the WHO report, 76 percent of organs sold were kidneys, reflecting the growing
demand secondary to complications of high blood pressure and diabetes. There are many ethical and health
concerns surrounding the trafficking of human organs. In the majority of situations, those
selling their organs represent members of vulnerable populations . In countries like Pakistan,
China or India, a person can sell a kidney for $5,000, while those handling the transaction make
a substantial profit. Prior reports have also demonstrated that the recipients of illegal organs tend
to fair worse than those who have received one legally. A recent meta-analysis involving 39 original publications
revealed that those obtaining organs abroad are at a higher risk of contracting transmissible
diseases, such as hepatitis B or HIV. Furthermore the patient and organ survival rates abroad are
significantly lower. These statistics might even underestimate the risk as the data is vulnerable to
survivor bias; those who do not survive the procedure and return home are often not included in
studies. Additionally, given the duplicitous nature of illegal organ trade, there are many scams. In
2010, a former psychiatrist was sentenced to more than 15 years in prison for offering false promises of organ transplants in the
Philippines, while taking over $400,000 dollars from patients. Over five patients actually travelled to the Philippines only to find out
that there was no organ awaiting them. One of these patients died in the Philippines. Regretfully, the number of
individuals needing organs continues to grow while the number of donors remains stable
The illicit market exploits in a way like slavery
Delmonico 3 Francis L. Delmonico, Director of the Renal Transplantation Unit at Massachusetts
General Hospital, the medical director at the New England Organ Bank, and Professor of
Surgery at Harvard Medical School; and Nancy Scheper-Hughes.Director of Organs Watch and Professor of Medical
Anthropology at the University of California at Berkeley Zygon, vol. 38, no. 3 (September 2003)
WHY WE SHOULD NOT PAY FOR HUMAN ORGANS
Ebsco
Although class distinctions are an almost naturalized part of social life in all complex societies, in this
particular instance the exploitation of organ sellers veers dangerously close to human slavery, as
argued by Giovanni Berlinguer (Berlinguer and Garrafa 1996). The pressures put by organ brokers
upon the desperation of the world’s dislocated, refugee, and poorest populations to provide the
scarce commodities reveals the limits of argu- ments based solely on individual autonomy. Yes, even
the poorest people of the world “make choices,” but they do not make these freely or under social or
economic conditions of their own making. Further, the pressure of organ brokers upon the poor
makes their decision to sell an organ anything but a free and autonomous choice. These secular
arguments reach a conclusion similar to one derived from Christian morality—that the sale of human
organs is unethical. The most disturbing issue of organ sales to both Christian and secular ethicists is
the formation of an economic underclass of organ donors throughout the world to serve the wealthy.
This is not to suggest that proponents of organ sales are in favor of exploiting the poor but, rather,
that they are indifferent to the social and individual pathologies that markets in kidneys and other
body parts produce, such as the documented evidence of postsurgery medical complications, chronic
pain, psychological problems, unemployment, decreased earning power, social ostracism, and social
stigma faced by kidney sellers in many parts of the world (see Zargooshi 2002; Jimenez and ScheperHughes 2002a; Ram 2002).
The illicit organ market is colonial in nature
Delmonico 3 Francis L. Delmonico, Director of the Renal Transplantation Unit at Massachusetts
General Hospital, the medical director at the New England Organ Bank, and Professor of
Surgery at Harvard Medical School; and Nancy Scheper-Hughes.Director of Organs Watch and Professor of Medical
Anthropology at the University of California at Berkeley Zygon, vol. 38, no. 3 (September 2003)
WHY WE SHOULD NOT PAY FOR HUMAN ORGANS
Ebsco
For several years, one of us (Nancy Scheper-Hughes [2003]) has been actively involved in multi-sited,
ethnographic field research in nine countries on the global traffic in human organs. The pattern of
organ distribu- tion follows established routes of capital: from South to North, from Third to First
World, from poor to rich, from black and brown to white, and from female to male recipients.
Residents of Japan, the Gulf States in the Middle East (Kuwait, Saudi Arabia, and Oman), Israel,
Western Europe, and North America now travel in individually tailored or in organized group
packages to medical centers in India, China, the Philippines, South America, Turkey, and Eastern
Europe to purchase kidneys that are not available locally or legally. They are aided in their quest by a
new class of organ brokers, some of whom operate on the Internet.
The illicit market is apartheid medicine
SCHEPER-HUGHES 3 Nancy Scheper-Hughes, Professor of Medical Anthropology at the University of California,
Berkeley, where she directs the doctoral program in Critical Studies in Medicine, Science, and the Body. JOURNAL
OF HUMAN RIGHTS, VOL . 2, NO. 2 (JUNE2003), 197–226 Rotten trade: millennial capitalism, human values and
global justice in organs trafficking http://web.b.ebscohost.com/ehost/ pdfviewer/pdfviewer?sid =97cebe61-93154e5e-b8db-f7372c8a971e%40sessionmgr115&vid=1&hid=117
This paper continues my discussion (Scheper-Hughes 2000b, 2001a, 2001b, 2002) of the darker side
of transplant practice. In all, three crucial points about the organs trade have emerged. The first is
about invented scarcities and artificial needs within a new context of highly fetishized ‘fresh’ organs.
The scarcity of cadaver organs has evolved into an active trade in ‘surplus’ organs from living ‘
suppliers’ as well as in new forms of ‘biopiracy’. The second point concerns the transplant rhetoric of
altruism masking real demands for human sacrifice. The third point concerns surplus empathy and
the relative visibility of two distinct populations – excluded and invisible organ givers and included
and highly visible organ receivers. We have found almost everywhere a new form of globalized
‘apartheid medicine’ that privileges one class of patients, organ recipients, over another class of
invisible and unrecognized ‘non-patients’, about whom almost nothing is known – an excellent place
for a critical medical anthropologist (Scheper-Hughes 1990) to begin.
Plan solves 2 internal links-First, It dries up the demand for illegal organs
Upchurch 12 Ryan Upchurch, Seton Hall Law 1-1-12 Seton Hall Law eRepository "The Man who
Removes a Mountain Begins by Carrying Away Small Stones: Flynn v. Holder and a Re-Examination of
The National Organ Transplantation Act of 1984" (2012).
http://erepository.law.shu.edu/student_scholarship/18
By increasing the supply of available organs in the United States through compensation, American citizens
would have less reason to travel elsewhere to pay for an organ. For example, Aadil Hospital in Lahore, Pakistan
advertises two transplant packages catered towards foreign patients: $14,000 for the first transplant and $16,000 for the second if the first
organ fails.118 If
demand dried up from foreign citizens, transplant tourism in these countries would take a
major hit because brokers would fetch lower sums for organs they procure. Statistical information is difficult to come by for obvious
reasons, but presumably American citizens make up a substantial percentage of the tourist patients
seeking a new organ they cannot attain domestically. As one report about impoverished Bangladeshi villagers
taken advantage of for their organs succinctly stated, “Most of those organs ended up transplanted into
American citizens.”119 The black market for organs in other countries is not fueled by local patients. Rather, it is driven upwards
and out of control by those American as well as European citizens who cannot acquire what they need domestically.120 One estimate is
that the black market accounts for as high as twenty percent of all kidney transplants worldwide.121 Nadley Hakim, transplant surgeon for
St. Mary’s Hospital in London, offered an interesting take on this problem of the black market when he said, “this trade is going on anyway,
why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done
safely, the donor will not suffer.”122 Within the past month, an indigent Chinese teenager sold his kidney so that he could purchase an
iPad and iPhone.123 The unnamed teenager now suffers from renal deficiency.124 Sadly, the boy received roughly ten percent of what the
buyer paid, with the rest going to the surgeon and others involved in coordinating the operation.125 If
those American citizens
with the means to purchase were not forced abroad to find an organ, it is very possible that stories
like this would become much less commonplace.
Second, Legalizing organ sales in the US spills over globally
Calandrillo 4 Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D.,
Harvard Law School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall,
2004 13 Geo. Mason L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's
Organ Shortage lexis
Moreover, if we cannot prevent the black markets in human organs that continue to thrive worldwide
today, a thoughtful and responsible regulatory solution in America might be the best response. Many
scholars have chronicled the reality that today's black markets lead to a host of abuses, provide for no follow-up health care, and generally
exploit the poor to the wealthy's advantage. n180 Stephen Spurr details the potential for misrepresentation and fraud against both buyers
and sellers today, as prices spiral out of control for organs that are of dubious quality. n181 Gloria Banks decries the exploitation of
society's most vulnerable individuals in the organ sale trade, and urges legal and ethical safeguards for their protection. n182 Susan Hankin
Denise adds that a properly regulated organ market may therefore be a better solution to the problem of scarcity than the outright ban we
witness today. n183 FOOTNOTE ATTACHED n183 See Denise, supra note 72, at 1035-36 (arguing that regulated markets are superior to the
existing ban on organ sales in the U.S.). Of course, even a
well-regulated legalized market in the U.S. may not
completely eliminate black markets worldwide if patients can still find organs more cheaply abroad. However, it is
reasonable to suspect that an American market would significantly reduce the demand for black
market organs, especially given the ability of a regulated market to better ensure the quality of its
product. Furthermore, a legalized market in the U.S. (with appropriate safeguards to prevent abuse
of sellers) may lead to similar structures abroad. On the other hand, one might argue that competing markets might
lead to a "race to the bottom" in terms of regulatory standards, as each country tries to gain more market share.
Illegal market abuses are not an indication of what legal sales would be like – just the
opposite
Kaserman, 7 Dr. David Kaserman is currently Torchmark Professor of Economics at Auburn University.
Issues in Law & Medicine Summer, 2007 23 Issues L. & Med. 45
Successes and The Failures lexis
ARTICLE: Fifty Years of Organ Transplants: The
In a truly ironic twist of logic, some opponents of the use of financial incentives for cadaveric organ
donors have cited various human rights abuses and extraordinarily high prices associated with such
black market activities as har-bingers of the sorts of outcomes likely to accompany legalized organ
markets. n32 This line of "reasoning" is equivalent to arguing that legalization of liquor sales would lead
to the sorts of mafia-related activities that arose during prohibi-tion. This argument stands accepted
economic theory on its head. The truth is that the types of behavior and price levels that frequently
accompany black market sales tend to disappear when trade is legalized. Legalized trade allows the
market price to fall as legitimate businesses enter the market and increase supply. Moreover, costs
decrease as the risks of both prosecution and violent actions by rival producers are eliminated. The
outcome is lower prices, an increase in the volume of trade, and a cessation of criminal activities. Thus,
the types of conduct associated with illegal suppliers involved in black market trade and the prices at
which such trade takes place do not accurately reflect the behavior and prices likely to result from
legalized sales. In fact, it has long been recognized that the most effective remedy for undesirable black
market activity is to eliminate restrictions on trade. Stated succinctly, the cure for black market abuses is
legalized trade. That conclusion holds a fortiori, in the case at hand. Eliminating the shortage of
cadaveric organs through legalization of financial incentives would greatly reduce, if not eliminate, the
demand for living donor kidneys obtained through black markets. Therefore, if one is opposed to current
black market activities, then one should favor financial incentives for cadaveric organ donors.
Specifically, debate over organ sales is necessary given shortages
Smith 11 Lewis Smith 05 January 2011 The Independent Sale of human organs should be legalised,
say surgeons
http://www.independent.co.uk/life-style/health-and-families/health-news/sale-ofhuman-organs-should-be-legalised-say-surgeons-2176110.html
Professor John Harris, an ethicist at the University of Manchester, believes a debate and the
introduction of an organ market are long overdue. "Morality demands it," he said. "It's time to
consider it because this country, to its eternal shame, has allowed a completely unnecessary
shortage for 30 years. Thousands of people die each year [internationally] for want of organs. That's
the measure of the urgency of the problem. "Being paid doesn't nullify altruism – doctors aren't less caring because they
are paid. With the current system, everyone gets paid except for the donor." Professor Harris has developed proposals for an ethical
market in organs in which donors would be paid as part of a regulated system. Such a system, he said, would have to be controlled within a
strictly defined community, probably the UK but possibly extended to the EU, so every organ could be accounted for. No imports would be
allowed. The NHS would be the sole supplier and would distribute organs as it does other treatments – ability to pay would not be a factor.
Consent would be required for every donation and would have to be rigorously carried out to ensure no donor was subjected to untoward
pressure. Professor
Sir Peter Bell, former vice-president of the Royal College of Surgeons but now
retired from practice, wants a public debate because there is such a shortage of organs for
transplantation: "It is time to debate it again.[…] There is a great shortage of organs." There
remains stiff opposition to liberalising the market, not least from the British Transplantation Society
(BTS). Opponents agree there should be a public debate about the merits and flaws of a
market in organs. "The British Transplantation Society opposes this view, however it is
prepared to debate this issue as the theoretical and empirical literature evolves," said a
spokesman. Keith Rigg, the transplant surgeon and BTS president, said: "I'm happy to debate
it. There are pros and cons. I think the trouble is it would require a huge change in public opinion
and legislation. One argument against a regulated market is if you are paying some people, what
would be the impact on the existing deceased donor programme and living donor programme?"
Debate on effective implementation is a moral responsibility
Taub et al 3 Sara Taub, Andrew H. Maixner, Karine Morin, Robert M. Sade, For The Council On Ethical
And Judicial Affairs, American Medical Association. "Cadaveric Organ Donation: Encouraging The Study
Of Motivation." Transplantation Forum. Vol. 76, 748–751, No. 4, August 27, 2003.
https://www.musc.edu/humanvalues/pdf/Cadaveric-organ-donation.pdf
A thorough discussion of this matter also must include an examination of the costs of foregoing such
studies. Currently, about 16 patients die each day waiting for an available organ (15). If policymakers,
ethicists, or legislators prohibit the implementation of programs that could be shown to increase the
number of available organs and reduce the number of deaths, then they must bear some moral
responsibility for the patients who die from lack of an organ transplant. Therefore, a better informed
debate is necessary, one that can occur only after the effectiveness of various incentive models has
been measured.
Role-playing allows us to critique the state from with in.
Stark, ’96 (Tennessee Associate Law Professor, Winter 32 Stan J Int’L L 91)
Role-playing exercises, in which students assume the roles of various states, replicate the diffusion of normative authority and the need for
role-playing enables students to explore
state identity from the "inside." What shapes state identity? The case studies contained in Volume II allow students to explore a
consensus which characterize the law on the use of force. 68 In addition, [*102]
wide range of political, geo-political and historical factors which have produced various hot-spots throughout the world, as well as to
distinguish state identity from "American" identity. Through
role-playing, students discover how self-interest shapes
state narratives. Which states want to strengthen the Charter paradigm and which seek to challenge it? Which state dominates the
conversation? Why do the others allow it to do so? Finally, as Stephanie Wildman has pointed out, role-playing allows students to
forget themselves and their anxieties about their performance in law school, freeing them to explore these
questions creatively . 69
Focusing on the details and inner-workings of government policy-making is productive
– critical approaches can’t resolve real world problems like poverty, racism and war
McClean, 01 – Adjunct Professor of Philosophy, Molloy College, New York
(David E., “The Cultural Left and the Limits of Social Hope,” Presented at the 2001 Annual Conference of the Society for the
Advancement of American Philosophy, www.americanphilosophy.org/archives/past_conference_programs/pc2001/Discussion%20papers/david_mcclean.htm, JMP)
There is a lot of philosophical prose on the general subject of social justice. Some of this is quite good, and some of it is quite bad. What
distinguishes the good from the bad is not merely the level of erudition. Displays
of high erudition are gratuitously reflected
in much of the writing by those, for example, still clinging to Marxian ontology and is often just a useful
smokescreen which shrouds a near total disconnect from empirical reality. This kind of political writing likes to
make a lot of references to other obscure, jargon-laden essays and tedious books written by other true believers - the crowd that takes the
fusion of Marxian and Freudian private fantasies seriously. Nor is it the lack of scholarship that makes this prose bad. Much of it is well
"supported" by footnotes referencing a lode of other works, some of which are actually quite good. Rather, what
makes this prose
bad is its utter lack of relevance to extant and critical policy debates, the passage of actual laws, and the
amendment of existing regulations that might actually do some good for someone else. The writers of this bad
prose are too interested in our arrival at some social place wherein we will finally emerge from our "inauthentic" state into something called
"reality." Most of this stuff, of course, comes from those steeped in the Continental tradition (particularly post-Kant). While that tradition has
much to offer and has helped shape my own philosophical sensibilities, it is anything but useful when it comes to truly relevant philosophical
analysis, and no self-respecting Pragmatist can really take seriously the strong poetry of formations like "authenticity looming on the ever
remote horizons of fetishization." What
Pragmatists see instead is the hope that we can fix some of the social ills
that face us if we treat policy and reform as more important than Spirit and Utopia. Like light rain released from
pretty clouds too high in the atmosphere, the substance of this prose dissipates before it can reach the ground and
be a useful component in a discussion of medicare reform or how to better regulate a pharmaceutical industry that bankrupts
senior citizens and condemns to death HIV patients unfortunate enough to have been born in Burkina Faso - and a regulatory regime that
permits this. It
is often too drenched in abstractions and references to a narrow and not so merry band of
other intellectuals (Nietzsche, Bataille, Foucault, Lukács, Benjamin) to be of much use to those who are the supposed subject matter of
this preternatural social justice literature. Since I have no particular allegiance to these other intellectuals, no particular impulse to carry their
water or defend their reputations, I
try and forget as much as I can about their writings in order to make space for some new
approaches and fresh thinking about that important question that always faces us - "What is to be
done?" I am, I think, lucky to have taken this decision before it had become too late. One might argue with me that these other intellectuals
are not looking to be taken seriously in the construction of solutions to specific socio-political problems. They are, after all, philosophers
engaged in something called philosophizing. They are, after all, just trying to be good culture critics. Of course, that isn't quite true, for they
often write with specific reference to social issues and social justice in mind, even when they are fluttering about in the ether of high theory
(Lukács, for example, was a government officer, albeit a minister of culture, which to me says a lot), and social
justice is not a
Platonic form but parses into the specific quotidian acts of institutions and individuals. Social justice is
but the genus heading which may be described better with reference to its species iterations- the
various conditions of cruelty and sadism which we wittingly or unwittingly permit. If we wanted to, we could
reconcile the grand general theories of these thinkers to specific bureaucracies or social problems and
so try to increase their relevance. We could construct an account which acts as a bridge to relevant
policy considerations. But such attempts, usually performed in the reams of secondary literature
generated by their devotees, usually make things even more bizarre. In any event, I don't think we owe them that
amount of effort. After all, if they wanted to be relevant they could have said so by writing in such a way that made it clear that relevance was a
high priority. For Marxians in general, everything tends to get reduced to class. For Lukács everything tends to get reduced to "reification." But
society and its social ills are far too intricate to gloss in these ways, and the engines that drive competing interests are much more easily
explained with reference to animal drives and fears than by Absolute Spirit. That is to say, they are not easily explained at all.
Some instances of the state is necessary for true social reform
Chomsky, 1996 (Noam, quoted by Tom Lane, December 23, http://www.totse.com/en/politics/anarchism/161594.html)RC
Prospects for freedom and justice are limitless. The steps we should take depend on what we are trying
to achieve. There are, and can be, no general answers. The questions are wrongly put. I am reminded of a nice slogan of the rural workers'
movement in Brazil (from which I have just returned): they say that they must expand the floor of the cage, until the point
when they can break the bars. At times, that even requires defense of the cage against even worse
predators outside: defense of illegitimate state power against predatory private tyranny in the United
States today, for example, a point that should be obvious to any person committed to justice and freedom -anyone, for example, who thinks that children should have food to eat -- but that seems difficult for many people who regard themselves as
libertarians and anarchists to comprehend. That is one of the self-destructive and irrational impulses of decent people who consider themselves
to be on the left, in my opinion, separating them in practice from the lives and legitimate aspirations of suffering people.