Thursday, May 29, 2014

Let Them Sell Kidneys!

Let us presume for a moment that a family member whom you love very much has been diagnosed with lymphoma, which requires a large amount of blood transfusions. On top of that, that family member has a rare blood type. And now let us also assume that there are generous donors who are more than willing to donate their blood and platelets to your loved one.

Now, however, let us assume that many of those donors were turned away. But they weren’t turned away because their blood types were not compatible or some other legitimate medical reason. They were turned away because they just did not have the proper paperwork.

As a result, that family member of yours dies.

Now, how do you think you would feel if you ever found yourself in such a situation?

For those of you who have been in Korea long enough, you might think that this story sounds familiar. That is because it actually happened in 2010 when a nineteen-year-old boy died after battling lymphoma for only a month. His blood type was B (Rh-), which, the Korea Times article says, is rare among Koreans. A Facebook campaign alerted the public about this and a large number of the expat community at the time volunteered to donate their blood.

However, many of them were turned away. One of the reasons was that they did not have valid Korean IDs.

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Blood is just one of the many things that thousands of people are waiting for but to no avail. They also need kidneys, livers, lungs, hearts, and corneas to name just a few. Although scientific discoveries might make the point that I am currently trying to make moot some day, it will not be at least another decade before human organs that have been developed from stem cells can even begin to be marketed. In the meantime, people die while waiting for a miracle that is not coming.

And things do not appear to be looking any better for those dying patients. According to a report in the Joongang Ilbo, in a survey of a thousand people, only 14.9 percent of the respondents said that they were registered donors. The report goes on to say:

The rest said they haven’t registered because they were afraid (42.4 percent) or didn’t know how to become a donor (41.4 percent).

Meanwhile, 52.3 percent said they didn’t want to have their organs removed after their deaths.

The most common reasons were fears (46.5 percent), a desire to be buried whole (39.2 percent) and the complexity of the registration process for becoming a donor (7.3 percent).

Because "taking it all with me to the afterlife" makes so much sense
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However, these were people who were talking about donating their organs after they died. There does not even seem to be a study about live organ transplants. Forget organs. Korea also suffers from a chronic shortage of blood.

However, it’s not like as though there is no demand for organs, despite the fact that the buying and selling of organs is illegal. Though not reported too regularly, there have been instances of people who had been arrested on charges of trafficking organs (as can be seen here, here, and here). If there were no demand, there would be no need for these traffickers’ “services.”

And organs are expensive. According to a blog post from the Marmot’s Hole from 2011, which in turn quoted the Journal of Korean Medical Science:

The mean operation fee to get a KT (kidney transplant) was US$21,000 (US$15,000-US$46,000), and another US$21,000 (US$15,000-US$32,000) was necessary for other expenses during the stay. The mean hospital stay was 18.5 days ranging from 14 to 90 days.

For LT (liver transplant) the needed expense was about twice of KT; the operation fee was US$47,000 (US$41,000-US$160,000), and extra expenses of US$16,000 (US$8,600-US$25,000) was necessary during the stay. The mean hospital stay was 43.4 days (range 7-84 days) which was also twice longer than KT.

So, this is what we know for sure so far:

  • The demand for blood and organs is there. And it is high.
  • The supply of blood and organs is far lower than the demand for them due to reasons such as personal fears and cultural norms. Yes, it’s the dreaded c-word. Confucianism states “The body, hair, and skin – all have been received from the parents; and so one doesn’t dare damage them.” This explains why 53.2 percent of Koreans desire to be buried whole.
  • People in financial trouble and those who see no other way out are desperate enough to sell their organs, despite the great dangers involved, both legally and procedurally.
  • There are unscrupulous criminals and back alley surgeons who have no problems with taking advantage of desperate people who see no other way of repaying their financial debts.

So is there a way to solve this problem? I certainly think there is. Legalize the buying and selling of organs, regardless of whether we are talking about post-mortem or live transplants.

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If one is pro-choice and holds those sets of beliefs (if not in their entirety, at least partially) as their own, it would be logically inconsistent to hold the opposing view, i.e. anti-choice, when it comes to individuals voluntarily choosing to sell their own organs. Just as much as the fate of a fetus can and ought to be decided by the pregnant woman (especially seeing that the woman owns her own body and is in charge of her own destiny), so too can any individual decide the fate of his ownself by choosing to sell his/her own organs.

A philosophical argument that is often used against the legalization of the selling of organs is the rhetorical question as to whether or not a person has the right to subjugate oneself to slavery. The answer to that is certainly “NO.” And there are moral reasons against the “right” to sell oneself into slavery. Even if an individual voluntarily chooses to sell oneself into slavery, and formulates an iron-clad contract to make it happen, it still does not change the fact that the right to contract is strictly derived from the right of private property.

Seeing that a person who sells himself into slavery will no longer own him/herself, that means that the right to self-ownership, the ultimate private property that each of us possesses, would be violated by default. Once a single party to a contract, no matter how mutual that contract may be, no longer adheres to the concept of private property or self-ownership, then that contract cannot, and must not, be enforced as it would have no moral leg to stand on.

In other words, an individual can give away his/her property (which is not the same as abandoning the concept of private property), but not his/her will.

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And that is the answer to that philosophical question. The philosophical question as to whether or not someone can legitimately sell oneself into slavery is, in this case, irrelevant. Call it the the slippery slope fallacy, the fallacy of composition, or an appeal to emotion. It has no bearing whatsoever in the debate about whether or not the buying and selling of human organs ought to be legalized.

Another argument against legalizing the buying and selling of organs is that it is unfair. To be specific, those who are most likely to sell their organs will be the poor whereas those who do the buying would be the rich.

However, those who make this argument are suffering from a bias against markets. The question that those who oppose the legalization of this market never ask or answer is: What is wrong with giving the poor an opportunity to make money?

If the argument against selling organs is that only the poor will sell their organs and the rich will do most of the buying, then how is it moral to keep the vast majority of all businesses legal? Those who are not well-off are the ones who are selling their services – in this case, their labor – in order to earn a living; and those who are well-off are the ones who are buying their services. Should we then make every single McDonald’s or Starbucks illegal?

Yes, it is true that the risks to their lives, as well as their own emotional well-being, that are associated with selling one’s kidney is much greater than getting a job that pays minimum wage where the most one has to typically sacrifice is a few hours out of a given day. However, the principle remains the same.

Therefore, the only real difference here is price. How much money would be enough for an individual to make the rational and voluntary choice to go under the knife to sell one’s kidney? I certainly have no answer for that. That is for market prices, aka the equilibrium price reached between suppliers and consumers, to decide.

It's not a bad thing to do.
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When all else fails, opponents argue by saying that it would be immoral to legalize such a trade because it just is. But that point is also entirely irrelevant. As those news stories that I linked to earlier clearly show, people already do sell their own organs. Basically, it is the same argument in regards to prostitution or abortion. They are illegal but they occur already, and there is no real way to prevent those who are willing to engage in voluntary and mutual transactions.

Finally, just as in the case of prostitution or abortion, legalizing the trade of organs would force out the criminal elements from the market. Or at the very least put a dent in their profit margins.

In 2012, a study that was released by the Mexican Competitiveness Institute found that Mexico’s drug cartels would lose up to US$1.425 billion if Colorado legalized marijuana.

When there is an increased level of competition, even the most entrenched businesses take a hit in their profits. This is even more true of organized crime. After all, how many people would really choose to go into business with criminals when there are plenty of legal alternatives to choose from?

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In a decade or so, when stem-cell research has borne lab-grown organs that can be successfully used on people are developed, and a decade after that when such lab-grown organs can become marketable for the majority of consumers to be able to purchase, then the very idea of selling one’s own organs would be relegated to the past for our future descendants to look upon with incredulity. What a glorious day that would be.

Until that day, however, it is long past time that people earnestly began to discuss the merits of legalizing the trade of human organs.