Adverse effects of a controlled living-unrelated donor renal transplant program on living-related and cadaveric kidney donation

The Body as Gift, Commodity, or Something in Between: Ethical Implications of Advanced Kidney Donation

An innovative program recently initiated at the University of California, Los Angeles (UCLA) Medical Center allows people to donate a kidney in exchange for a voucher that a loved one can redeem for a kidney if and when needed. As a relatively new practice, the ethical implications of advanced kidney donation have not yet been widely discussed. This paper reflects on some of the bioethical issues at stake in this new donation program, as well as some broader philosophical issues related to the meaning and moral salience of commodification. I first consider whether the literature on commercial markets in organs--a longstanding topic of bioethical debate--can meaningfully inform ethical analysis of kidney voucher programs. Specifically, I consider whether and to what extent common objections to the exchange of kidneys for cash also apply to the exchange of kidneys for "kidney vouchers." Second, I argue that the contrast between the ethical issues raised by these two practices highlights the need to understand commodification as existing on a continuum, with different degrees of commodification giving rise to different ethical issues. Doing so can help sharpen our understanding of commodification as a moral concept, as well as its relevance to broader debates about the moral limits of markets.

Kidney Sales and Market Regulation: A Reply to Semrau

Luke Semrau argues that the documented harms of existing organ markets do not undermine the case for establishing regulated systems of paid kidney donation. He offers two arguments in support of this conclusion. First, Semrau argues that the harms of kidney selling are straightforwardly amenable to regulatory solution. Second, Semrau argues that even in existing black markets, sellers would likely have experienced greater harm if the option of selling a kidney were not available. This commentary challenges both of Semrau's claims. I argue that there is no reason to believe that kidney sellers benefit from the current black market trade in organs, and highlight a number of potential issues regarding the effectiveness and feasibility of Semrau's proposed market regulations.

From blood donation to kidney sales: the gift relationship and transplant commercialism

In The Gift Relationship, Richard Titmuss argued that the practice of altruistic blood donation fosters social solidarity while markets in blood erode it. This paper considers the implications of this line of argument for the organ market debate. I defend Titmuss' arguments against a number of criticisms and respond to claims that Titmuss' work is not relevant to the context of live donor organ transplantation. I conclude that Titmuss' arguments are more resilient than many advocates of organ markets suggest, and more relevant to the debate than is commonly appreciated.

Assessing the likely harms to kidney vendors in regulated organ markets

Advocates of paid living kidney donation frequently argue that kidney sellers would benefit from paid donation under a properly regulated kidney market. The poor outcomes experienced by participants in existing markets are often entirely attributed to harmful black-market practices. This article reviews the medical and anthropological literature on the physical, psychological, social, and financial harms experienced by vendors under Iran's regulated system of donor compensation and black markets throughout the world and argues that this body of research not only documents significant harms to vendors, but also provides reasons to believe that such harms would persist under a regulated system. This does not settle the question of whether or not a regulated market should be introduced, but it does strengthen the case against markets in kidneys while suggesting that those advocating such a system cannot appeal to the purported benefits to vendors to support their case.

Paid donation: a global view

Paying for kidney or other organ donation has lead to heated debates about donor and recipient welfare. Many have argued that paying for donation leads to coercion and exploitation of the poor, and, in the end, produces more harm than good. Others have said that payment helps the poor, and we should all have sovereignty over our bodies and, thus, should be allowed to donate for remuneration. Although World Health Organizations and governments in many countries have now banned the process of paying for donation, there is still ongoing payment legally and illegally. Thus, this timely set of three articles from Iran, Pakistan, and the Philippines, where paid donation has been extensively performed, will allow the reader to decide for themselves whether the benefits and/or harms of this practice are now clear.

Some sociocultural aspects of cadaver organ donation: Recent rulings from Iran

Cultural and social factors strongly influence cadaveric organ donation and removal. In Muslim countries such as Iran, there is general public resistance to removal of organs despite clear rulings from religious leaders. Recently, some religious authorities have waived family permission and allowed cadaver organ removal even if the deceased person had not made a declaration for organ donation. Scholars have also exempted physicians from paying a legal penalty for removing organs in such cases. Cadaver organ donation is also allowed if the deceased person has made a declaration that money obtained from the recipient be spent to pay his debts or for public welfare and that the organ be used to save a life. There is no restriction on organ donation between people of different religions in normal circumstances. We conclude that these rulings should positively influence present sociocultural cadaver organ donation trends in Iran.

Ethical and legal aspects of organ transplantation in Iran

The great advances in the technology of organ preservation, immunosuppression, and surgical procedures have resulted in success in saving lives. However, these advantages have raised major ethical, policy, and religious problems in organ transplantation. Extensive efforts have been made to address these problems in different communities. In this study the transplantation program and implementation of legislation in Iran is reviewed. The history of the organ transplantation "Act of Organ Transplantation and Brain Death," which allows controlled living unrelated donors access to renal transplantation, is discussed as the main subject.