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Organs for sale?

Kee Hyun Kim's picture

Book commentary

Kee Hyun (Andy) Kim              


During the semester, we have covered a very wide rang of topics in the area of biology. We began by explaining the origins of life, preceded to cell structures and by the end, were covering complex multicultural organisms such as humans. Despite such wide range of topics, there was one thing that has stayed constant from the first day of class to the very last day; science is a story, not an academia of absolute truth. At first, I was a little bit startled by the fact that science is not about truth but is merely a measurement of how good a story is. As class progressed, however, I became comfortable with the notion of storytelling and even began to enjoy listening to different stories and expressing my opinion about it.


This was why I chose Biomedical ethics, opposite viewpoints, which is essentially a collection of contrasting stories in controversial areas of biology such as ethics of generic research to the question whether reproductive technologies is ethical at all. The book is organized in a very similar manner to the way our class discussions were handled both online and off line. The editor of the book brings in a controversial question in biology, than chooses writings by academics from opposite sides of the argument and present it to the reader to decide. It resembles our class discussions in that the editors do not attempt to define what is right or wrong, they merely ask the question and present us with contrasting stories, allowing us to choose the best story among ourselves.            


Although all chapters of the book had interesting stories, the second chapter, which deals with ethics regarding organ donation was the chapter that caught my attention. The reason I chose this chapter is because of my personal experience when I was in middle school. My best friend’s father had seriously damaged his liver by excessive drinking. Only 30% of his liver was working and He desperately needed a transplant. However, he was placed on a long waited list with an expected wait time of over 18month. It seemed very clear that he was not going to survive that long and to this day, I still remember how dark his face turned within a few month time period. As his family were preparing for the worst, a miracle happened, a young women was recently killed in a car accident and had livers that matched his tissue. Miraculously he was able to get the transplant in time to save his life. Since than, the issue of organ donation has meant more to me than other biological issues and that is why I chose this part of the chapter among others.             


After reading the stories presented, I realized that the shortage of organs is certainly not limited to Korea. The shortage of Organs is a huge problem in the untied States also. There are more than 98,000 men, women and children who are waiting for their turn in the organ transplant waiting list.[1] Every 90minutes, a person dies simply because he or she wasn’t able to receive the necessary transplant.[2] If an individual sings up on the waitlist today, it is expected that he or she will have to wait between five to eight years.[3] If the current organ shortage continues, by 2010, it is expected that individuals would have to wait between ten to sixteen years to get an organ transplant.[4] Clearly, there seems to be a problem and in this book, two different individuals propose a completely opposite solution.            


 The first story is told by Andy H, Barnett, Roger D Blair and David L. Kaserman. The three essentially argue that financial incentives should be given to organ donors. The shortage is created because the government is essentially putting a price ceiling of 0 for a good that has an extremely inelastic demand, a classic case of a price ceiling that ends up harming everybody and creates a massive dead weight loss. As a result, lives that could otherwise be saved and organs that could otherwise be used are wasted. They argue it is not immoral to pay the donors and that it would actually be immoral to not pay the donors who make the biggest sacrifice anything while huge sums are paid to the hospitals, surgeons and nurses.[5]           


 The idea of financially rewarding organ donors, however, does not go unchallenged. Alasdair Palmer, attempts to convince the readers with his story about why it is unethical to involve money in organ donations. Although he agrees that there aren’t enough organs to meet the demand, he disagrees with the idea of involving money into the equation. He gives the example of a young woman in India, where a very lively black market for organs exists. The Indian woman was forced by her husband to give up one of her kidneys; her husband got her an alarm clock and a battery for her radio and spent the rest of the money in gambling.[6] He argues that this problem of organ shortage should be dealt through in ethically acceptable ways: increasing the budget for educating the people, increasing investment in keeping brain dead bodies ventilated and increasing the coordination between the organ donors and the transplant surgeons.              


Although Mr. Palmer makes a excellent argument, I believe that the stories told by Mr. Barnett, Mr. Blair and Mr. Kaserman is a better story to solve the organ shortage problem we face today. Problems such as the Indian woman being forced by her husband occurred precisely because the transplant operation was undertaken in a black market. If there was an open legal market and a regulatory body, such stories would decrease dramatically. When we look at the example of prohibition, we can see how simply denying and outlying it can actually make the situation worse. I do agree that more investment should be made in education and improving the logistics of the transplant operation, however, these are minor changes and will not be able to bring  the major change necessary to stave off the imminent organ crisis that we are about to face. No matter how efficient we make it to be, a 0 price ceiling on a good with a very inelastic demand simply cannot work because we are human.       


David L. Bender, Biomedical ethics, Greenhave press, San Diego, 1998Sally, Satel, Death’s waiting list, New York Times,    

1.         [1] Sally, Satel, Death’s waiting list, New York Times,
2.         [2] Sally, Satel, Death’s waiting list, New York Times,
3.         [3] Sally, Satel, Death’s waiting list, New York Times,
4.       [4] Sally, Satel, Death’s waiting list, New York Times,
[5] David L. Bender, Biomedical ethics, p.60 
[6] David L. Bender, Biomedical ethics, p.63