I'm in the process of looking for work. In the meantime, I'm a bit low on cash. A friend of mine recently joked that I could always sell a kidney. Well, I'm not that desperate (yet), but the fact remains that I can't sell a kidney, at least not legally. This got me thinking: should I be able to do so?
Most people have intuitions about what it's okay and what it's not okay to do for money. Harvard philosopher Michael Sandel has articulated some of those intuitions in What Money Can't Buy: The Moral Limits of Markets. Although I haven't read the book, I know he takes up the issue of selling organs and rejects it on ethical grounds. The gist of his argument can be found here. I understand these intuitions, but I'm not sure I agree with Sandel entirely. Admittedly, I haven't thought about the issue as long as he has, and my thoughts are still nascent, but I'm going to try to craft an alternative argument and you can judge it for yourself.
To return to our moral intuitions, however, our society tends to frown on people who sell their bodies. This is usually a euphemism for prostitution (which I think should be legal anyways) but we could take it more literally to include the sale of body parts. When it comes to the reproductive system, however, we don't seem to have a problem with it. Men can sell their sperm and women can sell their eggs. A woman can even lease out her uterus as a surrogate mother. But when it comes to the renal system, we as a society draw the line. Why? Granted, there are practical moral issues involved with the sale of organs as Sandel points out. The sellers tend to be poor and the buyers tend to be rich; the movement of organs is usually from the third to the first world. But that might be because these are black market transactions. If they were legal and above ground, a fair market price might emerge. But Sandel is right: the key issue is autonomy. The decision would have to voluntary, not coerced, and determining that in practice isn't easy. Nevertheless, it isn't easy to determine in the case of surrogate mothers or people who are paid to take experimental drugs, yet many of us accept the moral permissibility of these practices.
Perhaps part of our resistance to the sale of organs comes from the fact that we consider it noble to donate organs freely. It is better to give them away than receive compensation for them. Again, most of us acknowledge the difference between giving something freely and exchanging it for monetary gain. Maybe our adherence to that principle is why we consider organ donations good and selling organs bad. But I'm not convinced that principle will work here. The reason being that in the case of most organs, the donation is posthumous. When you think about it, posthumous donation requires no real sacrifice on the part of the donor. (This is why I find it surprising that so few people fill out their organ donor card. I'm even in favor of donation being the default position, i.e. you have to opt out of the program.) After all, the donor is deceased and would remain so with or without their organs. But in the case of a live donor, as is possible in kidney transplants, there is a real sacrifice. The person is actually giving up something. Isn't such a person entitled to some compensation?
To make this a little more clear, let's take a relatively uncontroversial scenario. Let's say that my brother needed a kidney. I would certainly be allowed legally to donate one of mine and I would also feel a sense of moral obligation to do so. But it wouldn't entirely be a selfless act. Yes, I would be making a sacrifice, but I would also be gaining something, namely having my brother around longer, enjoying a better quality of life which, in turn, has implications for my quality of life. So it's not entirely a selfless gesture on my part. In other words, I receive compensation of a kind. In the case of a stranger, with whom I have no familial bond nor have any expectation will improve the quality of my life, is it unreasonable to expect that the compensation be monetary?
Needless to say, this issue is complicated. I haven't even addressed the question of whether or not such compensation would solve the shortage problem and increase the net well-being of patients awaiting transplants. I don't claim to have worked out a full-fledged position on this issue. I've just tried to provide some food for thought and push our moral intuitions in new directions. What do you think?