An interesting discussion took place in a virtual trust and estate law group that I joined. Someone posted a link to the recent Wall Street Journal article about what you “lose” when you elect to donate your organs posthumously. I found the Journal’s article to be somewhat alarmist about the possibility of experiencing higher brain function and/or pain after being declared brain-dead, which is a legal form of death in all 50 states and a critical time for harvesting organs for transplant. Given the number of individuals who have few (legal) choices other than waiting on a transplant list, I think it would be unfortunate if the Wall Street Journal article were to dissuade individuals from signing donor cards. Many people are suffering for want of a transplant; and altruism alone does not incentivize enough healthy individuals to donate during life. Additionally, illegal markets for organs disproportionately exploit the poor and disadvantaged. After reading much of Sally Satel’s writing on transplant policy, I think the United States must commit to confronting the challenges of a limited organ supply and seriously consider implementing a system that compensates donors. As Dr. Satel explains in a 2010 debate printed in the New Internationalist magazine about the morality of buying and selling organs, donor compensation has the potential to mitigate the legal and moral harms of our current system:
I realize that most types of organs must come from deceased donors. But let’s be realistic about the extent to which deceased donation can help. You tell of Chinese prisoners who are shot for their organs. This horrific practice is precisely the kind of extreme situation that takes place when there is no legal alternative. If anything, it is an argument in favour of safe and legal means of rewarding donors. Developed countries must enlarge the pool of transplantable organs, by rewarding living and posthumous donors, if they are to keep some of their citizens from becoming reluctant participants in organ trafficking. Voluntary and compensated live donation for kidneys and deceased donation (compensated or not) can and should exist side by side.When discussing this issue with a friend of mine, she expressed her horror at the notion that organs would ever be “commoditized.” In my opinion, this misses the point entirely. Like it or not, organs are already a commodity—this is a case where demand will create a supply. Those with economic means will fly to far-flung corners of the globe to obtain a life-saving transplant. Some individuals will indeed become “reluctant participants in organ trafficking,” as Dr. Satel warns. Instead of bemoaning the commoditization of organs, we should pursue a deeper question; namely, to what extent do developed countries like the United States have a moral obligation to improve the current system of organ donation when the impact of a shortage in supply falls upon the world’s most vulnerable? Until we acknowledge the realities of the market for organs, the transplant waiting lists will remain long, and the trafficking will continue.