There’s an old urban legend about a traveler in a third world country whom the locals take out for drinks. Sometime before dawn, someone slips a roofie among the ice cubes in his liquor, and he blacks out. He wakes up in a bathtub of ice water with searing pain digging into both sides of his back. According to some versions, there’s also a tube emerging from near his spine. Struggling for consciousness, he finds a cell phone and an oddly polite note telling him to call the paramedics immediately—his kidneys have been “harvested” for a wealthy, mercenary, desperate dialysis patient.
I had never thought of that as anything more than a spooky tale, but after discovering a podcast by a debating group called Intelligence Squared, I saw the story in a new light. In the past few years, lawyers, doctors, ethicists, and economists have been discussing a radical idea: whether the United States should open up a market to buy and sell human organs, especially kidneys, to make up for shortfalls with the current organ-donation system (which consists largerly of putting people on a long list and praying).
People for and against organ markets probably would have been equally disgusted by the urban legend but would have also found different morals in it. Those for organ trading might see proof of how far people will go to get an organ transplant, and argue that buying organs must be brought out of back alleys, bars, and bathtubs and regulated by law. Those against it would likely find a contradictory message—how markets and money corrode morals, making even human bodies a commodity. Same facts, wildly different conclusions.
In theory, an organ market is simple economics. Pay me $50,000 and I give you a kidney. You live; I can get by just fine with one kidney, and I get money for college or a down payment on a house (or a lot more, if I live in a third-world country). And the motivation for opening a market is clear. The current system, based on altruism, doesn’t provide enough incentive. A stem-cell miracle notwithstanding, most sick patients will die waiting for replacement parts. Those are facts. What the yeas and nays bicker about is whether a market to buy and sell organs is fair or exploitative, and whether it will eliminate shortages or make them worse.
That’s why Intelligence Squared, in conjunction with National Public Radio, recently held an old-fashioned oral debate in New York on the issue, which was the raw material for the podcast. (After a summer break, the debates start up again this month; see sidebar for details.) The debate mimicked a high-school forensics competition, where six speakers got six minutes each to argue for or against organ markets. The moderator, Ira Flatow of NPR’s “Science Friday,” then opened up the floor for general discussion. In a nice twist, the audience voted on whether they supported organ markets before and after the debate, a rough measure of which side “won” the scrum. It gave the night the feeling of an old Athenian or Roman oratorical showcase, with speakers trying to win over peers.
Unfortunately, the same flaw that Plato and Cicero condemned thousands of years ago—that flashy, polarizing rhetoric often swayed the crowds before reason could sink in—somewhat marred the organ debate as well. With votes on the line, panelists accused the other side of everything from perpetrating a “disgraceful assault on human dignity” and “literally causing sick patients to die” to “market fundamentalism” and opening an “organ bazaar” to haggle over kidneys like oriental rugs.
Still, sophistry aside, the debate was valuable. For one, it provided a census of all the confusing legal and medical issues at play, since each panelist had one or two unique points to drive home. The comments by Sally Satel, a psychiatrist and scholar at the American Enterprise Institute, had the most emotional weight—she herself had to go online and beg for a kidney a few years ago. (A kind friend eventually donated one, or Satel would have died.) Satel described how people like her rented billboards asking for kidneys or traveled to China for organs from freshly executed prisoners—a practice another panelist condemned as “medical tourism.”
Satel and her two comrades in support of organ markets also asked, quite reasonably, why the antis wouldn’t tolerate even a trial run of organ sales to see if their doomsday prediction (such as poor people being be exploited and insurance companies owning people’s body parts) actually occurred. But David Rothman, a professor of social medicine at Columbia University who opposes organ markets, offered a clever rebuttal to trial runs. He described another psychological experiment where a daycare, instead of just demanding that parents not be late after 5 p.m., began to charge by the minute. Surprisingly, the staff found that parents became tardier when they had to pay. Being late, they realized, was no longer a social stigma, just a tax. In another surprise, when the daycare scrapped the pricing program, tardiness remained high. “Their bottom line,” Rothman concluded, “and they weren’t thinking of this in our context [of kidney markets], but it’s gorgeous, is once a commodity, always a commodity.”
Another panelist, who nominally supported a living-donor organ market, spent most of his allotted minutes arguing for something else entirely. In fact, the plan proposed by Lloyd Cohen, a law professor at George Mason University, paradoxically resembled an organ life-insurance policy. Under Cohen’s plan, living people would sign a contract stating that, when they died, a hospital had the right to harvest their organs for other patients. After the transplants, the dead person’s beneficiaries would receive a cash reward. This system sidesteps the potential health problems of living long-term with one kidney and allows people to also donate hearts and livers. Of course, as the antis pointed out, if people already fear that signing up for organ donation programs will convince calculating, utilitarian doctors to withhold treatment for one patient to harvest his organs and save four more (polls show that people believe this), throwing money into the mix probably won’t reassure people.
Specific plans aside, much of the debate revolved around an unspoken tenet—the difference between pragmatic and absolute morals. For instance, a Harvard University doctor argued that the United States opening a market would give other countries—countries with much looser ethical standards, like China or the Philippines—implicit approval to globalize the organ trade. But Satel, who admitted that she considered buying a black-market kidney, countered that this was a moot point because those countries already trade organs, like it or not. Added one of Satel’s supporters, “Efforts to shut this market have been as unsuccessful as Prohibition was in inducing an end to the use of alcohol.”
In the end, pleas like that carried the flag, and the pro-market side ended up convincing more audience members to support them. Before the debate, 44 percent of people supported human organ markets (with 29 percent undecided), whereas after the debate 60 percent of people approved (with 9 percent still unsure). There likely won’t be organ markets in the United States any time soon, unless the political climate changes. But as bodies continue to pile up and perfectly good organs get buried, the pressure to do something—even to let people sell their flesh for silver—will only increase.
The organ debate was just one in a series of debates that Intelligence Squared has sponsored in the past few years. Other topics include “Is Islam Dominated by Radicals?” and “Is Russia Becoming Our Enemy Again?” Podcasts of the debates are available online at http://www.iq2us.org/ and videos are available on YouTube. A fall debate series kicks off September 16 in New York.
Sam Kean is the associate editor of Search.