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. Last Updated: 07/27/2016

ESSAY: Should Human Organs Be Bought and Sold?




Remember that scene in Fellini's "Satyricon," where the guy gets his hand chopped off? I heard that it was real: The man was some poor Italian farmer, or baker, who really needed the money. Fellini gave him maybe $1,000. Good deal for both of them.


Apocryphal stories like this one, which circulated on my college campus after the movie was released in 1969, abound in American popular culture. Rod Serling worked a similar theme in his pilot for "Night Gallery" in the same year: Joan Crawford played a rich, blind art collector who saves a gambler's life by paying off his debts to the mob, in return for his agreeing to submit to a radical operation that would give her his eyes.


We find these stories disturbing because there is a deep, if somewhat vague, presumption in our culture that the body and its parts are special or sacred and shouldn't be subject to the standard economic laws of supply and demand. We donate rather than sell our blood, bone marrow and kidneys because we believe it's wrong to engage in cold-blooded commerce in corporeal components.


Yet the buying, selling and even renting of body parts does happen outside the bounds of television and the movies. Many people routinely sell their plasma to companies that extract from the straw-colored fluid therapeutic proteins worth far more than their weight in gold. Young women can, and increasingly do, sell clutches of their ripened eggs for $5,000 or more. And in many U.S. states, women rent their wombs for nine months at a time, charging whatever fee the market will bear.


In fact, the more you look into the issue of what is allowed and not allowed in the trafficking of body parts and bodily fluids in the U.S., the more inconsistencies you find. Buying and selling organs such as kidneys and livers is illegal under the National Organ Transplant Act of 1984. But sperm can be sold (though on a per capita basis, they have a tiny fraction of the value of human eggs). And you can sell your hair to the neighborhood wig maker. It's illegal, however, to sell a lobe of your liver to someone in liver failure, even though your body would regenerate the missing lobe at least as quickly as your hair would grow back. Moreover, restrictions on the sale of body parts, where they exist, generally don't apply to third-party profiteers.


Because we're so confused and conflicted about the market valuation of our bodies and their parts, and in particular our reproductive tissues, wouldn't it make sense to come up with a consistent approach to regulating commerce in body parts? Especially given that today, as never before, the body is valued not simply as the vessel within which we each enjoy the brief privilege of personal existence but also as a biological resource that can be transformed into value-added commodities.


Consider the rules for participating in medical research. The government allows healthy people to participate in risky medical research - and be financially compensated - even when the research has no promise of benefiting them personally, as long as they have consented. Those rules could apply to giving up a kidney - or the hand in Fellini's movie. Just five months ago, surgeons in Kentucky did this country's first hand transplant. Other transplants are planned. Donors will be needed!


A few brave souls have seriously suggested that market forces should reign in the arena of organ transplants. An article in the Fall 1997 Cato Journal, known for its free-market orientation, argued that the U.S. ban on buying and selling organs is causing today's massive shortages, which leave thousands waiting for a transplant.


The need for organs grows, but donation rates have long remained almost flat. Let's face it, the Cato authors say, lots of people are not crazy about giving up their organs, even after they die. A little cash incentive may well grease the gears.


And, at the risk of sounding old-fashioned, there is still the argument that our bodies and their components are not simply economic units of trade: That even though they are worth more, monetarily, than ever before, they also have special personal and cultural meaning, and by putting too much emphasis on the money we actually cheapen ourselves.


Surely there is room for a Third Way of dealing with this. To find such a way would require some legal and ethical trailblazing. Pennsylvania is about to try one novel approach: an experimental program that will allow payments of $300 to aid families of deceased organ donors. The money would be available not as a direct payment for the organs, but to offset funeral expenses.


Another plan, floated by Cato authors Charles Carlstrom and Christy Rollow, would create, in effect, a barter system for patients who are in need of a kidney but whose willing relatives turn out to be a bad match for transplantation. A relative could donate a kidney to someone who is a good match, in return for someone else donating a kidney to their family member.


Neither of these approaches deals directly, however, with the fastest-growing class of trade in body parts - the burgeoning quasi-marketplace in genes, cells, tissues and, yes, embryos and fetuses. Here, more than with organs for transplantation, some legal heavy lifting is going to be needed.


Specific models are still wanting, but experts believe that it's time to consider allowing for some modest, non-coercive and properly regulated payments for people who give up their personal cache of biological resources to for-profit entities. A properly drawn system would protect people in the same way labor agreements protect people from slavery.


Alternatively, says E. Richard Gold, a professor of law at the University of Western Ontario and author of "Body Parts" (Georgetown University Press), perhaps companies should have access to volunteers' tissues for free but should be granted only limited patent rights over products they make from those materials. The remaining rights could be passed to a nonprofit foundation whose mandate would be to ensure that any medical benefits derived from those human tissues are made available to everyone equally.


No doubt there are other ways to compensate people willing to share their biological resources. But we'll have to be sure the pendulum does not swing too far. There's always the risk that in the effort to protect ourselves from plundering biotech buccaneers, we will grow greedy ourselves and forget that, in the long run, even we don't necessarily own our own biological wealth.


Rod Serling, for one, recognized the universe's perverse propensity to punish those who forget such humility. The blind dowager in his story, desperate for even a fleeting tryst with vision, saves the gambler's life and arranges for the surgery, knowing that she'll get just a few hours of sight before the transplanted eyes will fail.


The episode ends with the removal of her bandages one night - just as New York City experiences the great blackout of 1965.


Rick Weiss is a writer for The Washington Post.