Pub Date: 19/01/2007 Pub: ST Page: 26Day: FridayEdition: FIRSTHeadline: Legalising organ sale the lesser of two evilsBy: SALMA KHALIKPage Heading: REVIEWSubject: POLITICAL/GENERAL NEWS^HEALTH^MEDICAL TREATMENTS/PROCEDURES^ORGAN/TISSUE TRANSPLANT POLITICAL/GENERAL NEWS^HEALTH^MEDICAL ETHICSSource: SPH
BY SALMA KHALIKHEALTH CORRESPONDENTWHEN the subject of organ sale came up some years ago, I was aghast that such asuggestion could even be made. Now, I’m not so sure.Having met patients who have died for lack of a donor organ, having seen howblack markets have emerged to meet this need, I now think there may be a strongcase to be made to legalise the sale of human organs.Let’s look at the arguments against the sale of organs:It degrades the value of human life, to treat the body as you would any otherobject.It exploits the poor, who will be the only sellers.No surgery is free of risk.It is morally wrong.What about arguments for the sale of organs?First, let me say that I support the sale only of kidneys from live donors.People can continue to lead healthy lives with one kidney, and the risk ofdeath from donating a kidney is less than one in 1,000.Selling the heart is obviously out; liver transplant carries a 1 to 3 per centrisk of death, which is too high; and to ask someone to give up an eye isridiculous.But there are now about 3,000 people with kidney failure in Singapore. At leasta third would have better and longer lives – and at a much cheaper cost – witha transplant.Basically, dialysis doesn’t stop the ravages to the body from a non-functioningkidney. So people on dialysis live shorter lives.Even with the expanded Human Organ Transplant Act which allows organs to betaken from brain-dead people, and not just those who died in an accident, thewaiting list continues to grow every year.Is it an acceptable option to obtain kidneys for transplant through commercialdeals with people who need the money?An editorial in the British Medical Journal in 2002, entitled “An ethicallydefensible market in organs”, suggested a monopsony, with the state as the solepurchaser.This would prevent exploitation of the poor by the rich, it argued.The state should ensure that sellers know the risk, are healthy, are givenfollow-up treatment if necessary, and as far as is possible, ensure that thereis no coercion.The state then allocates the kidneys to patients on a need basis, not just tothe rich who can afford to pay.Does it degrade the value of human life? Perhaps. But so does prostitution. Yetthere is no outcry against prostitution, which goes on in many developedcountries.The sale of a woman’s body in prostitution is to gratify. The sale of a kidneyis to save a life. A prostitute risks getting sexually transmitted diseases,including the deadly Aids.Are the poor being exploited if organ sale is allowed?Perhaps. But life is not fair. The poor, by definition, are getting a rawerdeal. If a poor person feels that the money he gets from the sale of a kidneycould make a difference in his life, and that of his family, who are we to denyhim that chance?We should not encourage him to sell his kidney. But the final decision is histo make.Professor Alastair Campbell of the biomedical ethics committee at the NationalUniversity of Singapore is right to say that no matter how hard we try, wecannot expect a perfectly ethical market to exist.Would people sell a kidney to buy a Gucci bag? Not if there were propercounselling. Would some loan shark suggest repayment of a loan through the saleof a kidney? Hopefully not.But take the analogy of cars. Every year, people die from road accidents.Should cars be banned?It is all a matter of weighing the risks against the benefits. And putting inas many safeguards as we can to protect sellers from being exploited.A final argument: Organ trading already exists.Over the past 20 years, more than 600 Singaporeans have gone abroad, mainly toChina or India, for organ transplants. They very obviously paid for the organ.Singaporeans are not the only people buying organs from poorer countries. TheAmericans do it, the Europeans do it, the Israelis do it – lots of people doit.The fact that it goes on doesn’t make it right.But if it cannot be stopped, then it may be better to legalise it, to protectboth buyer and seller. It would be the lesser of two evils.
BY SALMA KHALIKHEALTH CORRESPONDENTWHEN the subject of organ sale came up some years ago, I was aghast that such asuggestion could even be made. Now, I’m not so sure.Having met patients who have died for lack of a donor organ, having seen howblack markets have emerged to meet this need, I now think there may be a strongcase to be made to legalise the sale of human organs.Let’s look at the arguments against the sale of organs:It degrades the value of human life, to treat the body as you would any otherobject.It exploits the poor, who will be the only sellers.No surgery is free of risk.It is morally wrong.What about arguments for the sale of organs?First, let me say that I support the sale only of kidneys from live donors.People can continue to lead healthy lives with one kidney, and the risk ofdeath from donating a kidney is less than one in 1,000.Selling the heart is obviously out; liver transplant carries a 1 to 3 per centrisk of death, which is too high; and to ask someone to give up an eye isridiculous.But there are now about 3,000 people with kidney failure in Singapore. At leasta third would have better and longer lives – and at a much cheaper cost – witha transplant.Basically, dialysis doesn’t stop the ravages to the body from a non-functioningkidney. So people on dialysis live shorter lives.Even with the expanded Human Organ Transplant Act which allows organs to betaken from brain-dead people, and not just those who died in an accident, thewaiting list continues to grow every year.Is it an acceptable option to obtain kidneys for transplant through commercialdeals with people who need the money?An editorial in the British Medical Journal in 2002, entitled “An ethicallydefensible market in organs”, suggested a monopsony, with the state as the solepurchaser.This would prevent exploitation of the poor by the rich, it argued.The state should ensure that sellers know the risk, are healthy, are givenfollow-up treatment if necessary, and as far as is possible, ensure that thereis no coercion.The state then allocates the kidneys to patients on a need basis, not just tothe rich who can afford to pay.Does it degrade the value of human life? Perhaps. But so does prostitution. Yetthere is no outcry against prostitution, which goes on in many developedcountries.The sale of a woman’s body in prostitution is to gratify. The sale of a kidneyis to save a life. A prostitute risks getting sexually transmitted diseases,including the deadly Aids.Are the poor being exploited if organ sale is allowed?Perhaps. But life is not fair. The poor, by definition, are getting a rawerdeal. If a poor person feels that the money he gets from the sale of a kidneycould make a difference in his life, and that of his family, who are we to denyhim that chance?We should not encourage him to sell his kidney. But the final decision is histo make.Professor Alastair Campbell of the biomedical ethics committee at the NationalUniversity of Singapore is right to say that no matter how hard we try, wecannot expect a perfectly ethical market to exist.Would people sell a kidney to buy a Gucci bag? Not if there were propercounselling. Would some loan shark suggest repayment of a loan through the saleof a kidney? Hopefully not.But take the analogy of cars. Every year, people die from road accidents.Should cars be banned?It is all a matter of weighing the risks against the benefits. And putting inas many safeguards as we can to protect sellers from being exploited.A final argument: Organ trading already exists.Over the past 20 years, more than 600 Singaporeans have gone abroad, mainly toChina or India, for organ transplants. They very obviously paid for the organ.Singaporeans are not the only people buying organs from poorer countries. TheAmericans do it, the Europeans do it, the Israelis do it – lots of people doit.The fact that it goes on doesn’t make it right.But if it cannot be stopped, then it may be better to legalise it, to protectboth buyer and seller. It would be the lesser of two evils.
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