If the Price is Right: The Ethics and Efficiency of Market Solutions to the Organ Shortage
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ORIGINAL RESEARCH
If the Price is Right: The Ethics and Efficiency of Market Solutions to the Organ Shortage Andreas Albertsen
Received: 20 August 2019 / Accepted: 23 April 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide.
Keywords Organ markets . Future markets . Exploitation . Coercion . Organ trade
A. Albertsen (*) Department of Political Science, School of Business and Social Sciences, Aarhus University, Bartholins Alle 7, 8000 Aarhus C, Denmark e-mail: [email protected]
Introduction Organ transplantation holds the promise of improving and prolonging life for a growing number of people. There is, however, a chronic shortage of available organs, and people are dying on the organ-transplant waiting list (Cook and Krawiec 2014; Council of Europe and Organización Nacional de and Trasplantes 2016). This has sparked a lively debate as to how this problem should be addressed. One family of proposals suggests that we provide valuable considerations for those who contribute an organ and thus proposes financial incentives to end the organ shortage. This implies that we reward sellers for their organs rather than compensate them for inability to work or other inconveniences associated with a donation. This article contributes to the rich literature on organ markets in the following way. First, it identifies and describes four kinds of organ markets, each of which is prominent in the existing literature. The four models are the unregulated current market, the regulated current market, the payment-forconsent futures market, and the family-reward futures market. Second, the article explores how prominent ethical concerns—crowding out, invalid consent, harm, exploitation, and commodification of human relationships—apply to the four models. This approach sets aside objections that these arguments are weak, wrong, or not legitimate. The systematic analysis of how the four models fare should be considered a supplement to existing discussions of which regulatory measures connect to specific concerns (Cohen 2014a)
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