Organ Exchange--Ethical Concerns

A large emphasis in the engineering program has been placed on engineering ethics. One thing of particular interest when studying the organ exchange model is the ethical questions that come up. Many of these ideas were mentioned in class. The ideas that an organ market would exploit the poor, the ideas that people in an exchange could back out after their "partner" received his or her organ, and the even more fundamental idea that it is important to preserve the lives of those dying each year because of failure to have a kidney transplanlt. Some of the ethical aspects are considered in the following article: http://www.scu.edu/ethics/publications/iie/v1n2/kidneys.html This article clearly outlines some of the strong points behind the idea that an organ market will lead to exploitation of the poor, desperate, and ill-informed. Yet this article http://healthcare-economist.com/2008/02/15/should-people-be-allowed-to-sell-kidneys-for-money/ claims that a bartering system (such as the kidney exchange) would not be as effective at saving lives as a pure monetary market. With lives at stake where does one find the balance? In a "Decision Making" class I took earlier this year, as well as at the end of the second article, the idea of making organ donation about death an "opt-out" instead of an "opt-in" decision could make organs more readily available. One of the key reasons behind this is because people are less likely to mess with the status quo, if the status quo means you are not donating organs and have to "CHOOSE" to do so, even if its relatively easy and you believe in it you may continually put it off and never make the switch. However if its an opt-out option, it would still be easy for those who are opposed to the idea to make the change, but a larger number would most likely donate. There are a lot of ethical concerns that come up with multiple approaches to the problem. What is the best and most effective way to fairly provide kidneys for those who need it?

Considering both articles and what was said in class, I think in terms of ethically meeting the need for kidneys the exchange system is the best. However, in terms of efficiency, it can't beat the traditional money-based market for kidneys. Since a money market involves the entire world and traditional laws of demand and supply, it will naturally be efficient as long as laws don't intervene. However, one advantage that the exchange system does have over the money market is that you know exactly what you're getting.

Similar to the market for lemons vs. good cars we examined in class, if people sold kidneys for money, the buyers sometimes have little knowledge (if any) of the seller's medical history. This is especially the case if kidneys are purchased in impoverished countries like China/India through a "middle man" -- usually a doctor. A kidney might get rejected or have a disease attached to it that the buyer does not want. In the case of lemon cars, the consequence is not deadly, so this is a much bigger issue in the market for kidneys. The middle men oftentimes don't care who gets what kidney and how well it'll match him/her. However, in the exchange systems outlined in class, doctors determine which kidneys are good matches for which patients, and this problem is eliminated.

So, overall, it's a tough decision between efficiency and safety/ethics. However, I'd say the exchange system has much more promise because even though it might not be as efficient, countries are still willing to adopt exchange programs and that means at least some kidneys will get to the people that need them.