Kidney trouble

UNDER THE MICROSCOPE: WHY NOT SELL OUR ORGANS?

BIOETHICS and medical ethics are growth areas - I am rather suspicious of their practitioners as they have a vested interest in finding difficulties, for if they do not, they have no real role to play. But if I cannot beat them then I shall at least try to join them. So here is my stab at one ethical issue in medicine.

A cornerstone of medical ethics is patient autonomy. Considerable effort is made by ethical committees considering a clinical trial of a medical treatment to establish informed consent with patients. It is regarded as a patient's inalienable right to know they are being entered into a trial and exactly which different treatments and procedures are being carried out. They must have the right not to enter the trial and be allowed to withdraw at any stage. There must be no pressure for them to enter the trial - I have, however, argued that attention should also be given to patients' duties to enter trials as they are benefiting from others having done so, and it is only through trials that we can find out which is the best treatment.

Organs for transplantation are in very short supply, and in most countries demand greatly exceeds supply. In Austria and Spain, however, the situation is very much better as there is "presumed consent" in relation to organs that can be taken from someone who has died; that is, unless an individual has made an official deposition to the contrary, any organ can be taken for transplantation when they are dead. This seems to me to be an altruism- encouraging piece of legislation that other countries ought to copy.

It is also regarded as noble and altruistic to donate an organ to a friend or relative. Such transplants negate the idea that our bodies are somehow sacred and nothing should be taken from them.

So, given the acceptance of organ donation and the emphasis on patient autonomy, why is there horror and almost universal rejection of the possibility of a person selling their kidney for money? If patients have the rights over their own bodies, why should they not be allowed to do what they like with them? It does not harm anyone else. No one denies the right of people to take risks with their bodies as climbers, skiers and even urban cyclists, regularly do. Boxers are paid for us to see them suffer severe bodily damage. Soldiers protect us by risking their bodies.

The most common argument I hear is that rich people will be able to buy kidneys from poor people - to which my reply is that poor people will thus be able to get some money. I cannot see on what grounds one should not be allowed to sell parts of ones body apart from an almost instinctive distaste, but that is not in itself a good basis for making judgments. Imagine a situation where a desperately poor person - perhaps even in another country - could escape from debilitating poverty by sale of an organ. Such a sale, if the money were good, could transform the life of the seller's family. This could be open to abuse but could be subject to regulation in a manner analogous to the control there is over the way we sell our labour.

The sale of organs for money is not an attractive option, but neither is poverty nor the deaths due to lack of transplant organs. These are issues on which ethicists should enlighten us. And would I sell one of mine for, say, pounds 1m? I hope that is a decision I don't have to make.