Richard Epstein's Thinking The Unthinkable: Organ Sales

Richard A. Epstein’s “Thinking the Unthinkable: Organ Sales” (2005) is an argument trying to convince people that selling human organs is acceptable in order to increase the availability for those in need of an organ transplant. Epstein says money will motivate more people to donate their organs to those in need. He also looks at the argument from the point of the recipient of the organ and argues that the expense of buying an organ will not increase the price of getting an organ transplant.

Obviously, people who are rich already have an easier time getting an organ transplant. The rich can more easily afford the costs; the poor will not have any more of a cost disadvantage than they already have. Epstein gives these reasons to support his

idea that selling organs is not immoral. He does not accurately consider the immoral consequences of allowing organ sales by law. Compensating people for a good deed that is supposed to be selfless will completely change the nature of the action and the motivation behind it. Using money as motivation can be dangerous because of the manner in which harvesting the organ may occur and because of who may be reaping the benefit of the organ sale. Someone could use violence or could misuse their judgment to obtain the money from the organs of another person. Organs should only be allowed to be donated, not sold. Traditionally, donating organs is an act of giving in order to save someone else’s life; it allows a person to be a Good Samaritan. Willingly donating an organ keeps the focus on giving to others, instead of using a motivator that can corrupt, such as money.

The first important minor claim Epstein makes in support of organ sales is that we have relied on people to donate their organs for too long of a period of time, so now we have a shortage of organs. The reason for the shortage is many people do not donate. This shortage keeps people from getting the essential organs needed to save their lives. He says we must help out our fellow humans by selling much needed organs to those who cannot live without them. Few people would disagree with the fact that it is morally right to help save another’s life. Donating organs is a selfless act that can save another person’s life; Epstein wants to put less emphasis on donating organs as a selfless act and more emphasis receiving a reward for helping out another person. If a person is being compensated for the organ they are giving, then they are not actually donating it to someone else. The person is not making a sacrifice to help someone who is suffering. If the person who provides the organ receives money for the organ, that person is not showing compassion to the dying patient and the patient’s family. In many cases, the organ failure is not the patient’s fault, so why should the patient have to pay for an organ, especially if the donor is already dead and the organ will just be left to decay. The patient does not need any other costs; they already have enormous costs in order to be in the hospital and have the transplant surgery. The average cost of a transplant is already extremely high without the added cost of the actual organ. The average cost for the entire procedure of an organ transplant in 2002 could cost anywhere from $14,200 for a cornea to $814,500 for an intestine (Transplant, 2002). People who are giving an organ may be grieving from the loss of a loved one, but money will not stop the pain. Giving an organ may not stop the pain either, but at least it will give another human being a second chance. Just knowing that by donating an organ, a person and/or their family has helped someone else to survive should make them feel good about themselves. Donating an organ is simply the right choice to make.

Another minor claim made by Epstein is that people are being unfairly pressured into giving their organs, especially within families.

He says that “confusion and pressure in combination rarely justify banning a practice with lifesaving potential” (Epstein, 2005, p. 104). Epstein thinks that allowing people to sell their organs would be a better way of getting people to donate instead of pressuring them. Consider the illustration where an organ donor a match to give their family member a liver, but the organ donor was hesitating to give the organ up. If the organ donor was compensated with money, this compensation would be putting a price-tag on his family member’s human life. Suppose this same organ donor would only give up their organ if he or she was compensated with a certain dollar amount. This dollar amount would be the worth of the family member to the organ donor. This situation is an immoral one to put an organ donor of a family member in. Humans have never been given the right to put a price-tag on someone’s life. If price-tagging a human life was to occur and the patient knew about the dollar amount, the relationship between the donor and the patient would be ruined. How could anyone hesitate, if given the opportunity to save another’s life, especially that of a loved one? Donating an organ is the opportunity to make a difference in the world, not to decide someone’s

worth.

Epstein’s next minor claim is that by purchasing organs instead of receiving donated ones, the rich will not be favored over the poor anymore than they already are.

He wants to let people know he realizes that the rich are more able to afford good medical treatment immediately. He thinks selling organs will not change the unfairness in any way, so it really should not be taken into consideration. The fact of the matter is that the rich will be more able to obtain an organ than the poor if the organ costs money. According to the Donate Life website (2003), which is made available by the government, “the computerized matching system does not select recipients based on fame or wealth. Organs are matched by blood and tissue typing, organ size, medical urgency, waiting time, and geographic location.” This information about how a match is made between a donor’s organ and a patient is important because tissue type, organ size, and blood type will always be taken into consideration when finding an organ to give to another person because otherwise the recipient’s body could reject it. Other details taken into consideration when finding a match would diminish in importance though, if money was exchanged for an organ. For example, medical urgency would not be as important if someone who was in less need of a transplant had more money than someone who urgently needed the same organ. The wealthy person may have access to enough money on the spot or may be willing to pay more for the

organ because of their wealth. A fight over the organ could occur, or even bidding for the organ, once again allowing the person with more money to win and receive the organ. The entire system of how a person gets matched with an organ would be changed with the possibility of corruption in the system. People’s lives would be risked or lost because someone who is selfish and rich will focus priorities on the dollar amount spent on an organ, instead of the medical needs of a dying person.

Epstein also makes the claim that the people who are desperate and might sell their organs for cash are the people who “will not be sought over, let alone exploited, because they do not make ideal candidates for organ transfers” (2005, p. 104). Epstein does not think the poor will be able to make such rash decisions to sell their organs because they are not even candidates for it. What evidence does Epstein have to say that the poor are not candidates for organ transplants? No criterion exists that says that you cannot donate if you are poor. According to the Organ Procurement and Transplant Network website (2003), doctors take into consideration only the donor’s “past medical and social history, as well as present medical condition.” The doctors take into consider what kinds of diseases and damage a donor has done to particular organs. They also look at social aspects such as whether or not the donor was a smoker, but not whether or not they were poor or rich. A relationship between wealth and health for every donor does not exist. Therefore, poor donors will be candidates, which may lead them to making irrational decisions in order to get money from their organs or the organs of others. How are we assured that poor or greedy people who are desperate for money will not kill others for organs, steal organs from others, or even let a loved one die who could survive just to make money from their organs? Many people tend to go to the extremes when it comes to money. Therefore, the idea for organs to be sold instead of donated is not a good one. It puts the donor in a position to make irrational decisions.

Epstein has made his argument in favor of allowing people to sell their organs in order to increase the amount of organs available to those in need. The rebuttal argument showed why selling organs is not in the best interest of the donor, their family, and the recipient of the organ. Money is a dangerous motivation when it involves a human life because people will go to extremes to get money. Also people already cannot afford the extreme cost of an organ transplant, so adding another cost would make it more difficult for the poor to afford a transplant. If people would just continue donating organs for the good of those who are in pain, it would be better for all humans.