Debating the legalization of organ trade in Canada

IRAN IS CURRENTLY the only nation that permits the sale of human organs. By legalizing organ trade, the country has found a way to reduce the number of sick citizens dying as a result of lack of donors. It has also set an ethical precedent for the free sale of organs. A professor at the Telfer School of Management and a third-year U of O economics and public policy student weigh in on the possibility of bringing the organ trade to Canada.

Point: Human organs should remain priceless

There is an endemic shortage of human organs for transplantation in Canada, as elsewhere. Should this shortage be alleviated, or even eliminated, by allowing the sale of organs and removing the current laws that prohibit such selling?

The public considers the commodification of organs to be intrinsically offensive. Even staunchly and famously free-market adherents like Margaret Thatcher likened the idea to “slavery in bits and pieces.”

Another argument against the selling of organs is the concern over the quality and safety of the thus acquired organs, though this problem can be mitigated by the use of testing and screening technologies and procedures.

The most potent argument against the commodification of organs is one of distributive justice. The poor will become the overwhelming source of organs. The globalization of the market for organs will be unavoidable, resulting in a virtual one-way flow of organs from poor to rich countries—much of it illegitimate.

There is a growing literature on the so-called “red-market” amply documenting the exploitation and horrific abuse of the destitute and children in many developing countries. A huge black market exists and the enforcement of laws prohibiting the sale of organs has proven ineffective and futile, a situation that will only get worse with commodification.

So how else can the shortages be addressed? Countries need to try using incentives to coax more donation of organs. Singapore and Israel, for example, are implementing a system that gives priority to transplantable organs to those who previously donated organs themselves. In the U.K., a bioethics committee proposed the government pay the funeral expenses of organ donors. Other ideas included payment for cadaver organs to a charity of the donor’s choice.

An increased supply of organs in Canada is eminently possible with reasonable changes in medical and hospital practices, specifically in the procurement and retrieval of organs.

Canadians should be careful what we wish for. Aiming for “no shortage” of organs is both unrealistic and, more importantly, unwise. Eventually it would result in grave shortages and unmet need will most surely occur in other areas of medicine. It is a question of priorities and it is far from obvious that organs for transplantation must consistently be the highest priority in medicine.

—Pran Manga

Counterpoint: Free the market, save lives

In Canada, the sale and purchase of kidneys—or any organ—for transplantation is illegal. This prohibition directly leads to quantifiable, uncompensated, third-party harm inflicted on innocent people by political decision-making.

According to the Canadian Institute for Health Information, there are currently about 3,000 Canadians on the waiting list for a kidney transplant, with close to 300 dying while waiting each year. In waiting for an available kidney for transplantation, most undergo some form of dialysis, a stop-gap measure that does not cure kidney disease or make kidneys well again and does not fully replace kidney function.

Typically patients are treated using hemodialysis at a cost of approximately $60,000 per patient, per year of treatment. This costs our overburdened, single-payer health-care system $2.2 billion annually, and these numbers will only increase over time with the aging of Canada’s population.

The simple reason for this costly, deadly predicament: The illegal status of organ trade in Canada. The illegality of the trade creates a price ceiling for kidneys at zero dollars, affecting supply and demand. The elimination of this price ceiling through a free market for organ trade would eliminate the shortage, as the price of a kidney would settle at a level that would eliminate excess demand. Those with the money to purchase organs could do so, and thus only those unable to pay for premium organs would be forced to rely on the health-care system to provide them.

Aside from an apparent general objection to the commodification of the body, the prohibition is vaguely defended on grounds that a market for kidneys would take advantage of, and negatively impact, those of lower income, who could benefit from selling their kidneys.

Otherwise worded, a policy that has led directly to thousands of deaths, untold hardships and heartache, and billions of dollars in unnecessary costs is primarily defended on the grounds that the state does not trust poor people to make decisions that would work in their own interest. This is insufficient as grounds for prohibition.

All organs should be allowed to trade freely between willing, consenting, informed adults, just like any other commodity. Freeing the market for organs would be a victory for personal choice over government prohibition and have the added benefit of saving money and lives.

—Chris Spoke