The Ethics of Free-Market Kidneys, Part 2

February 11, 2014

In some countries selling one's organs is perfectly legal. In the United States, it is against the law, although many people have suggested that legalizing the trade would save lives and offer real social benefits. Others find it an ethically dubious proposition.

Organ Trade Exploitation

Some believe that organ commerce is inherently exploitative. One researcher noted that in South Africa, "Township residents are quick to note the inequality of exchanges in which organs and tissues were routinely taken from young black bodies, without the knowledge of family members, and transplanted into the ailing bodies of mostly white male patients.... Before 1983, transplant surgeons in South Africa were not obligated by law to ask a family for its consent before harvesting organs and tissues from cadavers" (Scheper-Hughes 1998, 51).

One of the main proponents of banning organ sales, Director of Organs Watch Nancy Scheper-Hughes, acknowledges that "the arguments for ‘regulation' as opposed to prohibition have some merit," but claims that they are "out of touch with the social and medical realities in many developing countries. Often institutions in these countries created to ‘monitor' organ harvesting and distribution are weak, dysfunctional, corrupt, or compromised by the impunity of the organ brokers, and by outlaw surgeons" (Bakdash & Scheper-Hughes 2006).

In this view, it is not the sale of organs per se that is the problem, but instead the potential for corruption. Scheper-Hughes (1998) notes that "In the end, organ transplantation depends on a social contract and on social trust. The ethics of transplant surgery also require reasonably democratic states in which basic human rights, especially bodily integrity, are protected and guaranteed."

Harvesting Organs from the Dead

The issue is no clearer when it comes to taking organs from the dead. According to Scheper-Hughes, "Various human rights organizations... opened a debate on Chinese organs, basing their reports primarily on informant interviews and first-person accounts charging the Chinese government with sponsoring an official policy of systematically removing organs from executed prisoners for transplantation. These body parts, they claimed, are sometimes given to reward politically well-connected Chinese, or more often, sold to people from Hong Kong, Taiwan, Singapore, or other pacific rim nations, who pay as much as $30,000 for an organ" (Scheper-Hughes 1998, 51). According to Chinese-born activist Harry Wu, at least 2,000 executed Chinese prisoners each year are subjected to organ removal. A Human Rights Watch/Asia (1994) report that some condemned prisoners are killed quickly and their organs taken from them immediately after the execution.

Clearly one serious issue with using prisoner of any kind is that of consent. Can a condemned person truly give consent? One might think that a person in such a situation would have nothing to lose-after all, the threat of death is hardly a deterrent. However it may be that the prisoners are tortured into signing certificates, or possibly promised that a small payment would be made to their families. And in any event, an unethical government would likely have few qualms about forging a consent form anyway.

The rich exploit the bodies of the poor. The direction of benefit always moves up the social strata-that was the case with the pauper bodies in 1800s England, and it remains the case today with the sale of kidneys from residents in poor regions to rich Westerners. No one denies that socioeconomic inequalities plague the issue of organ trade. As Tarif Bakdash notes, "Of course we must address the underlying root causes of poverty, so that people are never forced to have to sell their bodily organs. But until we solve the problems of social, political, educational, and economical underdevelopment we need to face reality by legalizing and regulating organ sales in the developing world" (Bakdash & Scheper-Hughes 2006).

In other words, if socioeconomic equality between potential organ donors and recipients are the only conditions under which organ trade is ethically acceptable, then tens of millions of people will die waiting.





Bakdash, T., Scheper-Hughes, N. (2006). Is It Ethical for Patients with Renal Disease to Purchase Kidneys from the World's Poor? PLoS Med 3(10): e349. doi:10.1371/journal.pmed.0030349

Becker, G. & J. Elías. (2007). Introducing incentives in the market for live and cadaveric organ donations. Available at

Bhattacharjee, Y. (2010). The organ dealer. Discover, April, 65-96.

Gorman, C. (2000). Spare a kidney? Time. March 13, 98.

Human Rights Watch/Asia. (1994). Organ procurement and judicial execution in China. Human Rights Watch report, August, Vol. 6, No. 9. Retrieved from

Kaserman, D. (2002). The U.S. Organ Procurement System: A Prescription for Reform. New York: Aei Press.

Kristoff, N. (2002). Psst! Sell your kidney? The New York Times, November 12. Available at

Radford, B. (2008, February 19). The truth about sensational kidney thefts., available at

Scheper-Hughes, N. (1998). Truth and rumor on the organ trail. Natural History 107(8), 48-56.

Tsai, M. (2007). Organs for sale. Wired, April, p. 48.