Should there be a market in human organs?

It’s easy to make organ markets look nasty. The prospect of the poor literally selling their bodies to the rich makes us recoil in disgust. But while the act of donating an organ is accepted as good, it is not without ethical questions. We may wish for a bright line between selfless gifts and selfish markets, but we constantly cross it in both directions.

For example, gifts can mask self-interest. They are an effective way to put people in your debt. A request from a friend is hard to refuse. We calculate very precisely the “right” amount to spend on a present when birthdays or holidays come around. Meanwhile, market exchanges are routinely moralized. There are good and bad ways to spend. We are careful to pay people depending on their status and our ties to them. Some we pay in public, others in private. Some we pay in cash by the hour, others we discreetly reimburse later.

We also mix these forms, as with gifts of money. A lawful market for organs would probably be considered more legitimate with gift-like aspects. We see this in the case of human eggs, where the language and form of donation predominate, even as the goods are bought and sold. The underlying balance of power in these exchanges matters as much as their outward form, with the form often expressing and reinforcing that balance. So in one possible world, we exchange organs for money in gift-like ways, through reimbursements and with social benefits—such as health services—that help make the sacrifice plausibly fair.

In a different world, we insist people have a moral obligation to donate, for the common good. But everyone except the donor profits from the gift, and the common good is just a rhetorical device, not an institutional reality. Take your pick.

—Kieran Healy

Healy is an associate professor in sociology and the Kenan Institute for Ethics.