Philosophy of Economics - Report Example

Philosophy of Economics: Should there be a legal market for transplant kidneys from live donors? Philosophy of Economics: Should there be a legal market for transplant kidneys from live donors? Introduction The debate on the necessity to institutionalize a legal market for organ emanated from viewpoints upheld by professionals in the transplant community. Notably, the idea is currently attracting unprecedented support by most researchers, scholars, and professionals in the transplant community. It is noteworthy that the Altruistic donation system has had negligible success in addressing the shortage of kidneys in most countries (Larijani et al., 2007). Advocates of a legal market for organs present diverse viewpoints as justifications to their standpoint in the debate. Critics of a legal organ market, however, champion for the prohibition of the idea while citing unethical aspects of the trade. Different countries have diverse provisions on the sale of organs. The U.S., for instance, explicitly prohibits the practice under the 1984 the National Organ Transplant Act (Satel, 2008). That is contrary to countries such as Iran and the Philippines that have developed a model of sale of organs (Clark, 2013). It is justified to institute a legal kidney transplant market to address the ever-increasing demand for kidney transferred against a low level of supply from donors. The Need to Meet High Demand for Kidneys There is a high demand for organs such as kidneys. According to Barger (2011), there were 34, 000 patients on the waiting list in the U.S. In 2010, for instance, nearly 170, 000 people in need of an organ missed to get one. In essence, they die because of the high of patients in demand of organs against a low population of willing donors. The Scientific Registry of Transplant Recipients reports that only 40,000 Americans demanded kidney by 1999. In 2009, the record escalated to 83, 000 (Ogilvie, 2011). That represents 100% increase in the number over ten years period. In the European Union, a population of 49 477 individuals were awaiting renal transplantation in 2011, according to a survey by Lennerling et al. (2012). Concerns of an Emerging Black Market Advocates of a legal market for organs highlight concerns that a ban contributes to a rise in black market for the sale of the organs according to a study by Kelly (2013). Furthermore, black markets encourage exploitation of disparate donors who do not receive fair compensation from beneficiaries of organ transplant. It is evident that the current ban of compensation for live kidney donors encourages exploitation of the poor who are persuaded to donate an organ to the economically well-off individuals for a pittance (Berger, 2011). The contrary rarely happens; well-off individuals, in most instances, do not donate to the poor. That is tantamount to exploitation of poor donors (Becker & Elias, 2007). Mutual benefits Proponents of the debate argue that a well-regulated kidney market would ensure all parties in the trade have full consent and information. Placing a ban on compensation for kidney donations contravenes Articles 3 and 29 as outlined under the Universal Declaration of Human Rights. Related to the concept of mutual benefits is the notion of market-inalienability. It is a concept that would express freedom of a willing individual or donor based on the standpoint that they have the liberty to execute their independent decisions. Concerns of the need to save lives Major (2008) notes a high demand for kidneys that far exceeds their supply. Becker and Elias (2014) attributed the condition to the failure of conventional initiatives including exhortations and other strategies to promote organ donations. People who desperately need kidneys and are on the waiting list continue to die unnecessarily. Other solutions to increase supply of organs have been unsuccessful. That is a compelling justification to adopt a viable solution to the ever-increasing population of potential recipients who demand kidney donations to save their lives. In support of a financial model to address the challenge, Hippen, Ross, and Sade (2009) assert that the mission of saving a life far supersedes other concerns. There is a significant difference between the cost of maintaining an individual on dialysis and performing a transplant. In 2007, for instance, the gross expenditure on individuals with dialysis was nearly $28 billion. The expenditure is exceedingly high, compared to $2.2 billion spent on kidney transplant in America in the same year, 2007 (Ogilvie, 2011). It, therefore, saves many lives to perform a kidney transplant that maintaining an individual on dialysis. Furthermore, a high percentage of people who undergo transplant can go back to job compared to individuals suffering from dialysis. Promoting kidney transplant by increasing supply of the organ, therefore, serves to save lives. A well-regulated kidney market presents a chance to save a life. The necessity for an organ and its demands are illustrated in The Need Is Real: Data graph. (Adapted from U.S. Government Information on Organ and Tissue Donation and Transplantation, http://www.organdonor.gov/about/data.html) Considerations in favor of permitting market exchange The market sm hould have key features of a perfect market. First, all parties demand to have full information. Second, they should be perfectly rational. Third, there should be no ‘transaction costs’. Third, all rights should be observed for goods and services traded. Fourth, the market should be subject to perfect competition in which none of the entities has market power. The fifth factor is that there should be no ‘external effects’. Sixth, the preferences of parties should be complete. Furthermore, the preferences should be determined prior to the operation of any market. In fact, they should not be subject to and not influenced by the operation of any such market. The sixth, the nature of the goods and services in question is determined prior to the operation of any market, and is not be influenced the operations of any market. Under the circumstances outlined in the market, approval of a legal market for kidneys is justified because of the following advantages. The market has pareto-optimality or efficiency that permits transaction and allows both parties to achieve satisfaction of their preferences. The market promotes freedom that permits market transactions and expands opportunities for all parties. In the market setting, all parties have an option that was not available to them before undergoing loss of opportunities they had, previously. The market allows parties to have their rights fulfilled by granting them the freedom to transact at will. That promotes compatibility with full rights of ownership and control over everything that every party owns. Failure to grant freedom to transact to parties would limit or violate the rights that parties have in the market. The market also promotes neutrality through free operation of the market by allowing people to value various goods and services as per their will and preferences. It, therefore, is compatible with liberal neutrality that promotes the view that the state, by any applicable standards, should restrain from endorsing any particular idea(s) of the good life, or about value, as the right view(s) of the good or the valuable. Although there are justified reasons to favour market-alienability, there should be strategies to address market failures. That prompts pro tanto regulations in the market. The market may be overweighed by failures in regulation. Because not all parties will tend to adhere to restrictions set in the market and not all will be rational, regulations are important. Regulations should apply to blood donors and recipients. Blood sellers should also be subject to such regulations because they might be motivated to make profits over other vital considerations. Regulations should include considerations of substantial costs of operations and mechanisms of operations. A well-regulated legal market There are proposal by advocates of a legal market that proper regulations can be effective in addressing the current shortage of organs for transplant. A well-regulated market, as advocates argue, would be effective to promote fair compensation for donors of organs. Besides encouraging fair compensation, regulations would ensure protection of donors of an organ. Instead of giving money, donors of kidneys can get other incentives in return. The may have health or life insurance as an exchange for their kidneys. Under a well-regulated market, professionals would chose donors who may have least complications from the kidney transplant process. Choice of healthy people to donate kidneys promotes safety, as opposed to the apparent situation in which compensation for a transplant is banned. Further, the market definitions meet the social norms of a proper functioning liberal institution as emphasized by Bowles (2011). A legal market is justified based on the success of other nearly similar arrangements such as in the case of paid plasma donations in the U.S. Since 2008, there has been an increase in plasma pharmaceuticals in the U.S. Paid plasma donations in the U.S. is a success and has helped patients in America and other regions including Canada. Under the solely voluntary model, no country can meet its demand for plasma as noted by the Canadian Plasma Resources (2014). A non-remunerated model that is based on volunteers’ donations cannot satisfy the demand for plasma. That is similar to the case of kidneys. Just like paid kidney donations, paid plasma donations help save lives. Furthermore, instituting a compensated model for kidney transplant would not weaken the voluntary donors system. Instead, it would serve to complement the model by enhancing the supply of kidneys that remains a grave challenge, today. Another key factor to consider is proper assessment of voluntary consent submitted by willing donors in the market. In addition, there should exist a robust program of public education on the consequences of kidney donation, especially its negative health implications. Such programs will ensure informed decisions made by willing donors of the organ. Applicable Regulations In a well-regulated market for organs, only government entities and non-profit agencies should be certified to acquire organs. Such regulations would promote fair compensation, avoid overexploitation, and enhance protection of donors. The market should not be profit-oriented. Money raised from sales of kidneys can be valuable in supporting government initiatives to improve health such as through research. The process should provide full information to all the parties involved in the process. In fact, it is imperative that the government or non-profit making organizations have the ultimate mandate of providing the information. In a case when private entities of profit-making organizations are mandated to give information, they would fulfill their interests. Under the assistance of a panel of professionals and qualified members, the process should involve only rational parties. There should be no transaction costs, and if any exists, it should be subject to regulations or subsidies. There should be full ownership of the kidney donated based on set regulations. The market should not be subject to forces of monopoly. Instead, it should be based on perfect competition. It should have no external effects. Any external effect considered in the market should be those that have positive effects. The nature of goods should be predetermined and based on set market regulations. The case of Iran In 1988, the Iranian government adopted a model of compensated and regulated program that was aimed at benefiting donors of renal transplants. There was an increase in the number of renal transplant centers in Iran. The program saw successful elimination of the long list of renal transplants in the country. Iran’s paid kidney donation model was successful and by 1999, nearly 19, 609 transplants were instituted in Iran. By 2006, there was no list of patients awaiting kidney transplant in Iran. The Iranian model promotes transplant from living-related donor. Under the model, there is a comprehensive system of donor and patient evaluation. There is a comprehensive session of selection and evaluation of potential donors. Qualified and accredited professionals in renal transplantation undertake the process of assessing potential donors. A donor selection panel is mandated to assess the voluntary consent of living kidney donors. The system has been as success in reducing the -renal transplant list in Iran. Transplant patients who have low-income may pay for the services on monthly basis. Similarly, charitable organizations in Iran also help pay for kidney transplant costs for the poor. Without considering social status, rich or poor, all ESRD patients on the renal list in Iran are entitled to the transplant. To ensure success of the model, the Iranian government, in coordination with the country’s health sector, upholds diverse ethical principles and issues. First, there are no brokers or agencies involved in the process of organ transplant in Iran. The program, instead, is run by a charitable organization. Charity favors the poor and, therefore, improves access for members of all social classes. The model is efficient to avoid organ trafficking that is evident according to a study by Budiani-Saberi and Delmonico (2008). The organization receives no incentives from donors. Hospital expenses for renal transplants are upon the government. There are low medical and surgical fees during renal transplant under the Iranian model. According to accounts by Ghods and Savaj (2006), the Iranian model was successful in eliminating the illegal renal transplants in the country. Iranian kidney donors also receive health insurance as social benefit. Critics’ Viewpoint Although advocates of a legal market for kidney argue for its institutionalization, critics oppose the idea based on diverse justifications. Instead of the paid kidney model, critics advocate the presumed consent model (Denneman & Mol, 2012). Critics of a legal market for kidney argue that it has ethical limitations as illustrated by Anderson (1990). Critics argue that humans have immeasurable worth and, organs cannot be tagged on a price scale or valued (Gray, 2015). Such goods have market limits as explained by Satz (2010). A legal market model would promote transplant tourism, which is unethical as emphasized by Evans (2008). There are emerging concerns and questions that donors might attempt to sell low quality kidney in exchange of benefits such as money and other packages. That would promote exploitation. Exploitation is denounced by organizations such as WHO as an unethical act (Chin & Campbell, 2012). There are further concerns that the poor might be compelled to donate the organs because of their financial vulnerability and expectations of high benefits (Canca, 2012). In the case of India, doctors displayed corruption and attempted to remove organs without the donors’ knowledge. Radin (1987) refers to goods and services that can only be transferred freely and not through any other means as market-inalienable. Based on Radin’s concept of market-inalienables, critics of a legal kidney market highlight violation of the principles and factors that promote its basis. They highlight possible market failures as a reason not to institutionalize a legal market. First, the market may be short of failure to provide full information to all parties. Second, the model may fail when not all parties are rational. Substantial transaction costs may also hamper success of the model. Possible exclusion of others from the benefits is another reason for critics’ disapproval of a legal market for kidneys. Conclusion Despite concerns raised by critics over the ethical nature of a legal market for live kidney donors, the challenge of expanding gap in demand and supply necessitates the model. Proponents of the debate have justified arguments to promote their viewpoint as a remedy and an initiative to save lives. The case of Iran is a success story that proves the model can be implemented based on moral principles. Furthermore, a well-regulated market would address current concerns of an expanding black market for the organ, promote donor protection, and ensure fair compensation. Bibliography Anderson, E 1990, The ethical limitations of the market, Economics and Philosophy, 6, 2, 179-205. Bakdash, T., & Scheper-Hughes, N 2006, Is it ethical for patients with renal disease to purchase kidneys from the worlds poor?. PLoS medicine, 3, 10, pp.e349. http://dx.plos.org/10.1371/journal.pmed.0030349 Becker, G & Elias, J 2014, Jan.18, Cash for Kidneys: The Case for a Market for Organs, The Wall Street Journal, Retrieved April 11, 2015 from http://www.wsj.com/articles/SB10001424052702304149404579322560004817176 Becker, G. S & Elias, J. J 2007, Introducing incentives in the market for live and cadaveric organ donations, The Journal of Economic Perspectives, pp. 3-24. http://people.virginia.edu/~slf9s/teaching/econ452/readings/Becker%20and%20Elias%202007.pdf Berger. 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T 2007, Financial incentives for organ donation: An investigation of the ethical issues, The Hague: Center for Ethics and Health. http://hottproject.com/userfiles/Publicaties/FinancialIncentivesVanDijkHilhorst.pdf Read More