Kidnap a kidney

Wayne Sumner

  • The Ethics of Transplants: Why Careless Thought Costs Lives by Janet Radcliffe Richards
    Oxford, 278 pp, £16.99, March 2012, ISBN 978 0 19 957555 8

Organ transplants save lives: 1107 of them in the UK between March 2011 and April 2012. But the demand for transplantable organs greatly exceeds supply. Currently, about ten thousand people in the UK are in need of a transplant and about a thousand die every year while on the waiting list. Some ways of increasing the number of available organs, such as urging people to sign up with the Organ Donor Register, are ethically unproblematic. But others raise ethical issues, or have been rejected on ethical grounds. These ethical objections are the subject of Janet Radcliffe Richards’s admirably lucid book. She believes that some widely accepted objections to organ procurement are based on mistakes in moral reasoning: the ‘careless thought’ that ‘costs lives’. Identifying and analysing these mistakes is one of her aims, but she has a broader purpose as well: to show that, as experts in moral reasoning, philosophers have a unique role in debates about public policy.

As medical technology advances it becomes possible to collect and transfer more and more parts of the body: organs, tissues, blood, gametes and so on. But Radcliffe Richards restricts her attention to the major organs – kidneys, liver, heart, lungs – whose transplantation is most likely to save lives. Her starting point is the proposition that saving someone’s life, or preserving someone’s health, by means of a transplant is an intrinsically good thing. This establishes a rebuttable presumption in favour of any method of procuring organs for transplant. The rebuttal may take the form of an argument against a particular method: against, for example, the suggestion that we should randomly kidnap people off the street to harvest their organs. But the burden of proof lies on the opponents to find some such argument; if those they advance do not survive critical scrutiny, then the initial presumption will stand.

This analytic procedure, Radcliffe Richards contends, enables us to identify the ethically salient factors concerning any proposed means of organ procurement. (She doesn’t deal, except in passing, with the allocation of organs.) She applies the procedure to two practices which have been widely condemned as unethical – allowing the purchase of kidneys from live donors and permitting those who sign up for posthumous donation to direct their organs to specific recipients – and argues that there is no good ethical reason to reject either.

Payment for kidney donation is currently prohibited in the UK, as it is in most of the world, and has been condemned by the World Health Organisation and in the 2008 Declaration of Istanbul on Organ Trafficking and Transplant Tourism. The main objections are well known: those who might be tempted to sell a kidney need to be protected against harming themselves; only the poor would be so tempted, but their consent would be invalid since it would be coerced by their poverty; any purchase of a kidney by the rich from the poor would inevitably be exploitative; payment for organs would foreclose opportunities for altruism; a market in organs would be an offence against human dignity. Radcliffe Richards works through each of these arguments with care and concludes that none of them is sufficient to rebut the initial presumption in favour of procurement.

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