Problematizing Organ Sales

Gabriel Pleasants

Abstract—This paper critically explores the global sale of organs from two perspectives. The first belongs to those who argue that the phenomenon is beneficial to both the rich and the poor; it is a “life for life” transaction. The second is the medical human rights position that argues against organ sales because they exploit and destroy the health of the poor. It is found that the latter view is much stronger because it is based on rigorous ethnographies that demonstrate that organ sales in fact only benefit the economically privileged. It is suggested that the sale of organs is merely one symptom of larger global ills.

The discourse surrounding the international movement of organs to sick bodies can be illuminated by looking at the words used to describe the phenomenon: “trade” and “traffic.” Those who argue for sales of organs refer to the “organ trade,” a term that calls to mind a legitimate market. They argue from a philosophical/rational perspective that reveres individual autonomy and holds aloft the right of the poor to sell bodily tissue in order to secure a better economic future. They argue that it is doubly beneficial because that bodily tissue also secures the health of the buyer. Proponents of an organ trade argue on the grounds of “life for life” (Radcliffe-Richards et. al. 1950-1952, Cherry 20). The school that opposes the sale of organs describes it as “organ trafficking,” which calls to mind the “human trafficking” of the slave trade. This camp argues from a medical human rights perspective based on years of fieldwork examining organ trafficking among the vulnerable (Scheper-Hughes 1645-1648, Cohen 135-165). The biopolitical discourse is focused on the opposition of the perspective of individual autonomy versus that of medical human rights. Yet the discourse is situated within a cosmology that leaves the foundation of those arguing for an organ trade unquestioned. The ethical argument assumes that the body parts of the poor are assets in a world of globalized capitalism; it also assumes that the poor are autonomous in the same way as those who are not economically constrained. This essay will critically examine the unquestioned foundation of those advocating an organ trade by looking at the devastating repercussions that such a perspective has on the health of the poor as cataloged by those who resist organ trafficking.

To undercut the foundation of the argument for organ sales, it is necessary to first examine the structure that has been built upon it. “The Case for Allowing Kidney Sales,” by Janet Radcliffe-Richards and coauthors takes the standpoint of a philosopher, soundly rational and ethical (supposedly). The article is an attempt to rationally overcome the “feelings of outrage and disgust that led to an outright ban on kidney sales” (Radcliffe-Richards et. al. 1950). The argument of the article, very briefly outlined is this:

There is a shortage of kidneys for transplantation throughout the world that is leading to the “suffering and death” of many. Living vendors are available to meet this need, to the benefit of those who are sick and dying. It is objected that the living vendors are poor and are being exploited by the rich; however, the economic privilege of the buyers can be used to compensate the sellers, who will also come out with a positive result (“life for life”). Those who argue against the exploitation of the poor are in fact harming the poor through paternalism; the poor are “anxious to sell.” The poor are autonomous individuals with a valuable asset that they should be allowed to sell; they can be protected from exploitation through regulation.

The argument for organ sales is based on “financial aid to supplement altruistic sacrifice” (Frati 2433-2435). It puts faith in the strength of a regulated market: “People would be free to negotiate a bargain in which both parties win: on the one side a life is saved, on the other a family is lifted from poverty” (Cherry 20). Yet the “life for life” argument is essentially founded on the premise that the parts of the body can be commoditized and capitalized and that they fit within a global capitalist system. Furthermore, the argument assumes the perfection and naturalness of that system in using institutions like the state to regulate the “trade.”

The medical human rights perspective that fights the trafficking of human organs implicitly resists the foundation of the “life for life” argument, which I will refer to as a global capitalist cosmology. Nancy Scheper-Hughes explains that, “the kidney as a commodity has emerged as the gold standard in the new body trade, representing the poor person’s ultimate collateral against hunger, debt, and penury” (1645). Scheper-Hughes’s perspective is grounded in years of work gathering ethnographic accounts of “the global traffic in human organs,” rather than in a theoretical perspective. It has led her to equate the “circulation of kidneys” with “established routes of capital from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones, and from female to male or from poor, low status men to more affluent men” (Ibid 1645). Rather than a positive, “life for life” choice, Scheper-Hughes and her colleague, Lawrence Cohen, have found that instead of raising organ sellers up out of their conditions of poverty and marginalization, the sale of their organs was in fact a nonchoice produced by those conditions; it almost always marginalized them further.

Cohen’s interviews with women who sold their kidneys in India at first reveal what the “life for life” camp expects: “Yes, I would do it again if I had another to give.” But it is their next words that capture the reality of the organ “trade”: “I would have to” (Cohen 138). Both Scheper-Hughes and Cohen explain how the primary transaction is certainly not beneficial to the organ seller: “Bioethical arguments about the right to buy or sell an organ or other body part are based on Euro-American notions of contract and individual choice. But these create the semblance of ethical choice in an intrinsically unethical context” (148). Unlike those who argue from the rational perspective, those who argue for medical human rights take their argument against organ “trafficking” further, beyond the primary transaction.

“The problem with an ethical argument of this sort is the unrelenting presumption that ethics can be reduced to a primary transaction” (148). By examining the “second-order phenomena” that result when a poor, marginalized person sells an organ to one of the world’s affluent minority, the reality of organ transactions on the ground crushes the theoretical argument of ethics and philosophy. Scheper-Hughes and Cohen again provide the soundest foundation because they have compiled years of ethnographic research in a way that few others have. Both anthropologists found that the crucial factors when investigating organ sales were well beyond the limited scope of the primary transaction. In India, Cohen explains that debt plays an instrumental role in kidney sales before and after the primary transaction. In “kidney belts,” moneylenders push more aggressively for debts to be paid knowing that the extremely poor there have at least one asset. The kidney takes a straight path from the poor seller to the affluent buyer, but the other side of the “life for life” equation, the money meant to pull the seller out of poverty, is usually diverted to pay off debts already accrued. South Africa’s Sunday Times tells the story of what happened to Alberty Da Silva’s money:

Then, Da Silva’s cash evaporated. His two former girlfriends, the mothers of his children, made off with a large chunk of it and, with what remained, Da Silva bought a used car to look for work. When he couldn’t meet the monthly payments, he downgraded to an old jalopy. When the jalopy broke down almost immediately, he traded it for a second-hand bicycle. The bicycle and a pair of running shoes are all he has left to show for the sale of his kidney—that, and a huge, disfiguring, sabre-like scar across his midsection (8).

The experiences of “sellers” before and after they sell an organ demonstrate that it is not simply the first-order phenomenon of the financial transaction, the most important part of the equation for global capitalism (goods for money), that must be considered.

Nancy Scheper-Hughes worked with a group of Moldovan kidney sellers and documented the ostracism and stigmatization of that group. One young seller in his late twenties said: “They call us prostitutes….Actually, we are worse than prostitutes because we have sold something we can never get back. We are a disgrace to our families and to our country” (Scheper-Hughes 1647). Lawrence Cohen’s poignant evidence of the consequences for the poor of selling an organ cannot be ignored, either. He tells of a woman who sold her kidney and was beaten by her husband on her scar when she no longer had any of the money that was supposed to get her out of poverty; Cohen calls it, “a postoperative complication of a painful scar that began to hurt when the money ran out” (Cohen 162). The distressing examples of stigma provided by Scheper-Hughes and Cohen have no place in the rational/philosophical argument for kidney sales; that line of argument is only interested in the first-order phenomenon of the financial transaction. It is not surprising, though, because actual ethnographic evidence from organ sellers had no place in it either. When confronted with the second-order phenomena, the ethical argument dodged it by advocating regulation: “The best way to address such problems would be by regulation and perhaps a central purchasing system, to provide screening, counselling, reliable payment, insurance, and financial advice” (Radcliffe-Richards et. al. 1951).

Besides ignoring that global capitalism has created the need for the poor to sell their “organ of last resort,” the “life for life” argument presumes that mechanisms, such as regulation by states and other institutional bodies, will be able to resolve the devastating second-order phenomena that result from the extraordinarily harsh conditions that those at the bottom of the world economic system live in. This faith in global capitalism is a result of being enveloped by the dominant paradigm and not being able to see oneself within an unnatural frame. Proponents of a philosophical/rational/ethical argument for organ sales treat their Western epistemology as the only epistemology, and inherently natural. So, too, do they regard global capitalism as the only economic system and biomedicine and its advances as moving toward what it is to be human. Organ transplantation reveals the resistance of the world’s poor and marginalized to the global capitalism of the West, which has been presumed legitimate and natural when it is actually unnatural. We are left with no easy answers like the neat and rational arguments for the sale of organs, however. By finding what isn’t, we are left with the question, What is?

Works cited

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