Mandatory organ recovery when an individual is announced dead would increase the opportunity for other patients to receive organs more efficiently; "Research shows that there would be an increase of between 16 percent to 50 percent in the availability of organs (Carney)." Carneys article, "The Case for Mandatory Organ Donation" argues that by making organ donation mandatory it would curb the illegal trade of valuable organs and make it more accessible to receive an organ. The illegal organ market will continue as long as organs are a limited resource and the profits attainable are high (Carney). Current trends indicate that there is a growing consideration that "harvesting from cadavers should be a routine procedure just like autopsies in murder investigations (Carney)." Some ethicists and doctors argue that it would be more effective to have a routine organ procurement procedure, Carney presents Aaron Spital's, Mount Sinai School of Medicine, and James Stacey Taylor's paper on Routine Recovery of Cadaveric Organs for Transplantation, "Routine recovery would be much simpler and cheaper to implement than proposals designed to stimulate consent because there would be no need for donor registries, no need to train requesters, no need for stringent government regulation, no need to consider paying for organs, and no need for permanent public education campaigns." This approach obviously presents ethical problems, especially in the United States where autonomy over the body is an innate human right, however it would reduce the extensive waiting list for organs such as liver. According to Carney "Roughly half a million people around the world suffer from kidney failure and many are willing to pay any price for a donor organ. They have two options: wait on impossibly long donation lists or pay someone for a live donor transplant (Carney)." Even though there are an extensive amount of people who opt to donate their organs when their are brain dead "even willing donors often end up not donating because families raise objections or there is a question about consent (Carney)."In addition to this the "bureaucratic shuffle" and hoops to jump through cause organs to lose their vitality. According to Carney and other medical professionals and ethicists implementing routine procedures would dramatically increase the organ supply and may serve as a domino effect to prevent illegal procurement or reduce the need for kin to donate their organs as a means to live longer.Kaufman, Russ and Shim's article "Aged Bodies and Kinship Matters: the ethical field of kidney transplant" discusses the relationship between life extension and kin obligation for organ donation. Procedures such as kidney transplants are now routine procedures because of their less invasive qualities, thus "when techniques become less invasive and associated with lower mortality risk, consumer demand for them and ethical pressure to make them available both increase (Kaufman, Russ, Shim 82)." The expectations for longer life expects medical to cure in for the means of life extension, thus organ transplantation offers a now morally acceptable procedure to be done in order to extend life. This expectation also leads to the expectation that family and friends will provide the means of life extension, thus "love is actualized often through the commitment to a longer life and by doing things to prolong life (Kaufman, Russ, Shim 83)." In relation to Carney's explanation for the need for more organs Kaufman, Russ and Shim also argue that the growing demand for organs "emerges from the broad expectation that end[stage kidney disesase need not be fatal and from acceptance of kidney transplantation as a standard medical treatment for end-stage disease (84). It is therefore evident that because of changing technologies in the medical field and ethical acceptance of body modification there comes a higher demand for kidneys and other organs. Technoligizing medicine has brought on new implications for doctors, patients and donors to participate in life-sustaining and extending technologies (84). However, it is also important to note that the affluent middle class and insured people have primary access to these legal kidney sources. In correlation, Carney presents Nancy Scheper Hughes argument that "the current system of organ donation breeds inequalities (Carney)." The inequality of organ donation and receival has encourage patients to ask kin members to offer their kidneys, for the elderly younger generations are expected to "unnaturally" offer the gift of a kidney (85). Kaufman, Russ and Shim argue that ultimately the moral implication is "a sacrifice of the wholeness of the body and a nonreciprocal bargain (85)." Carney argues that this wholeness of the body would also be sacrificed without question by medical practitioners that support routine recover of organs at death with or without consent. Furthermore, he argues that procuring organs as routine would eliminate "kin obligation" for the older generation (Kaufman, Russ and Shim 86). "The potentiality of offering, giving, accepting, and receiving a kidney puts pressure on parent-child, spousal, and other meaningful bonds. Within those bonds, offering is a sign of unconditional love, sacrifice, and the strength of the bond (Kaufman, Russ and Shim 87)." These social and familial obligations could potentially be eliminated if organ donations exceeded what was needed.
The commodification and increasing monetary value of organs in the market economy has increased the trade of organs and has given increased value to poorer populations. The exchange of goods between patients needing a new organ and poverty ridden populations who need money exemplifies the global market economy and supply and demand, "the uninhibited circulation of bought and sold kidneys exemplifies a neoliberal political discourse based on juridical concepts of the autonomous individual subject, equality, radical freedom, accumulation, and universalism, expressed in the expansion of medical rights and medical citizenship (Scheper-Hughes 148). The exploitation of the poor living bodies to supply organs to an affluent class creates a kin relationship between the buyer and seller, "new forms of 'social kinship' must be invented to link strangers, even at times political enemies from distant locations who are described by the operating surgeons as 'a perfect match--like brothers' (Scheper-Hughes 150)." The kin relationship is made evident by a seller who said, "the money I paid him was 'a gift of life' equal to what I received (Scheper-Hughes 151)." The necessity to seek the illegal organ trade is founded in the limited organ availability due to the "expansion of the organs waiting lists...to include patients from medical margins--those over 70 years, infants, those with hepatitis C and HIV seropositivity, and those proven to be immunologically prone to organ rejection (Scheper-Hughes 154)." If the medical field limited the expansion of the medical margins there may not be a need to require mandatory donation and consent that is presented by Carney. The organ trade and market illustrates a dyer need for more organs that are easily accessible by legal hospitals, however to do so would mean to initiate a mandatory organ donation that presents ethical problems for the dead, living and doctors.
The central issue that must be illustrated is the necessity to utilize kinship ties in "Aged Bodies and Kinship Matters" in order for the elderly generation to obtain organs from younger family and friends because of the extensive waitlist for organs from brain dead patients. "The Last Commodity" presents the give and take relationship between the seller of the organ and the person buying the organ for health purposes. In this situation a kin relationship is created in order to describe the give and take relationship and the "perfect match" described by the doctors regarding blood type and other factors. The kin relation and necessity for organs for the livelihood of patients is also illustrated in Carney's article on a possible transformation to mandatory organ donations, "curbing the illegal trade in humans just might mean scrapping the way we think about the rights of brain-dead donors (Carney)," for example. However the elimination of the illegal organ trade would have a profound effect on those selling their organs for monetary value in a global market economy.
Is mandatory organ donation feasible in the United States and what would this mean for the illegal trade of organs?
Portrait: A Land Ravaged by Tsunami and Kidney Brokers
This link will take you to Scott Carney's pictorial on kidney donors, and brokers in a poverty ridden area.
Organs for Sale: Where in the World Can I Buy a Heart?
This link shows the pricing and location options for buying organs.
Sources
Carney, Scott. "The Case for Mandatory Organ Donation." Wired, May 8, 2007. http://www.wired.com/medtech/health/news/2007/05/india_transplants_do`1norpolicy (accessed March 4, 2011).
Kaufman, Sharon R. , Ann J. Russ, and Janet K. Shim. "Age bodies and kinship matters: the ethical field of kidney transplant." American Ethnologist 33, no. 1 (2006): 81-99.
Scheper-Hughes, Nancy. "The Last Commodity: Post-Human Ethics and the Global Traffic in "Fresh" Organs." In Global assemblages: technology, politics, and ethics as anthropological problems. Malden, MA: Blackwell Pub., 2005. 145-167.
