– FAUSTO GOMEZ OP
One person may be a cadaver donor or a living donor of a bodily organ, of a kidney. One person can be a vendor of his organs, too. There is an international trade of organ trafficking and sale. There is, moreover, a growing kind of medical tourism, which is transplant tourism that may also involve at times organ sale from the poor and vulnerable to rich transplant tourists.
The basic ethical question: May a person be a vendor of an organ, a kidney? An unavoidable question today: Should the recipient pay to the known donor? Kidney for a fee or for free?
The kidney donor offers his/her kidney as a donation – a gift. He or she, however, ought not to be financially burdened by his generous deed. The South East Asian Center for Bioethics (SEACB) asserts: “The intention of a living non-related donor (LNRD) must be to help a sick person and offer the gift of a chance to extend life. It is understood that the donor will not pay his medical and surgical expenses and will be reimbursed for income lost during procedure.”
We are firmly against organ sale. Still we have to ask: Is any educational or financial help to the donor (particularly the poor donor) absolutely unethical? An enlightening classical text of Pope Pius XII (May 14, 1956): Is it necessary, as often happens, to refuse any compensation as a matter of principle? The question has arisen. Without doubt there can be grave abuses if recompense is demanded; but it would be an exaggeration to say that any acceptance or requirement of recompense is immoral. The case is analogous to blood transfusion; it is to the donor’s credit if he refuses recompense, but it is not necessarily a fault to accept it.”
The question persists: How to remedy, the acute shortage of organs for transplants? By selling human organs? Unfortunately, organ sale is a reality in our world. The poor, refugees, prisoners, slum dwellers and other marginalized groups are the ones selling their organs. Bioethicist Alastair Campbell comments: “The sellers are always going to be the desperate poor; to trade the human body as some sort of material possession like a car or house is crossing an unacceptable line.”
Although there are voices advocating legalized and regulated organ sale as a solution to organ shortage, practically all countries of the world condemn organ sale, including the European Council and the World Health Organization. The practice of organ sale is condemned because organ sale is objectively unethical: contrary to the dignity, the proper autonomy and the equality of persons. The main argument given by libertarians in defending organ sale is based on the principle of autonomy: the body is mine, its body organs are mine, and therefore, I may dispose of them freely. May we ask: How free are the poor when they sell one of their kidneys? The poor consent, of course, but their giving of “informed” (?) consent is highly conditioned by their situation and economic need. A young donor who sold one of his kidneys commented – after he spent the money he received from a rich recipient -, that there was no improvement in his life. He added: “I was left with a weakened body and a long scar.”
Certainly, we are autonomous human beings: our autonomy is part of our human nature and an expression of our freedom. However, we are also heteronomous or relational beings, that is, we are related to other human beings. Autonomy is not an absoluter but limited autonomy. It is limited by the principle of communion and solidarity (the ethical principle to defend organ donation), and, for believers, by the principle of stewardship (as a steward of my body and its parts or organs, I respect the sovereignty of God, my creator and savior, the Lord of life and death).
Our body, composed of many organs, is not a commodity or an object I may dispose of at will, but a personal body, which is a constitutive part of our individual identity: each one of us is body-soul, spirit incarnate, embodied person. Organ sale is generally against basic religious and cultural values, and against a culture of life and solidarity. Mayor religions are generally in favor of organ donation and against organ sale, including in particular Judaism, Christianity, Islam, Buddhism and Hinduism. From a humanist and Christian perspective we affirm: no to the sale and commercialization of human organs, which is a form of human trafficking.
We are told by some of the authors who favor kidney sale by the poor: there are many things wrong in our world, and somehow society allows them, such as slavery, prostitution, child labor, offensive war, etc. Why not allow organ sale? Obviously, ethically speaking one evil cannot be a reason for another evil: evil has to be fought or at most in some extreme cases tolerated as a “lesser evil” (when one may has to choose – exceptionally – between two evils).
May organ sale be, circumstantially, a “lesser evil”? May the poor not sell one kidney if they have to choose between two kidneys and survival, or between two kidneys and educational help for their children? Certainly, there are other ways to solve the problem of poverty! Nevertheless, we do not blame the poor (“a victim or a trafficked person”), nor do we justify the sale of organs by them. We strongly accuse those who take advantage of their economic vulnerability and their forced poverty.
Some ethicists even argue that precisely because there is “a black market” in human organs, let us legalize sales and let the government control and regulate the compensation of living – and deceased – donors.
For many of us who consider organ sale unethical, this is the argument of the veil of compassion, of false compassion – also used to wrongly allow abortion and euthanasia in “extreme” cases! Is not the sale of organs, organ trafficking, on the same path of coercion and exploitation with trafficking of persons, or sex trafficking? As the French bishops said, the terrible market in organs implies “an exploitation of others’ poverty and a denial of their dignity.” Pope Francis cries out: “Organ trafficking and human trafficking for the purpose of organ removal are true crimes against humanity, and need to be recognized as such by all religious, political and social leaders, and by national and international legislation.”
CONCLUSION
Like other governments, the Macau government highly recommends organ donation: “Organ donation is an indicator of the harmony and progress of civil society” (Secretary Alex Tam Chon Weng). The Church recommends to all the donation of organs as an expression of human and Christian solidarity. Church and State firmly oppose organ sale.
As human beings, we are in favor of organ transplants and donations. In human perspective, we ground our affirmative stand on the dignity of the human person: every human person is a man or a woman for others; we belong to the human family and as such ought to be just to all persons and in solidarity with all. We strongly oppose, however, sale of organs, which is against human dignity and solidarity, and against distributive justice. Therefore, “abuses in transplantation and organ trafficking … are to be decisively condemned as abominable” (Benedict XVI).
As followers of Christ, in particular, we are stewards of our life and health. Donating an organ may be an act of charity as love of neighbor, for love means to serve others, to give ourselves to others, to share with them what we have. Jesus advises us: “The gift you have received, give as a gift” (Mt 10:8). Organ donation is, indeed, an offering to Christ, who suffered and died for us – and continues suffering today in the sick and wounded of humanity (cf. Jn 15:13).
Let me close with the story of an organ donor. Liz Courain was a Christian volunteer in a hospital in the United States. She worked with a co-volunteer who at one point urgently needed a kidney to survive. After reflecting deeply and prayerfully with her husband, Courain decided to give her one. The transplant was successful for both donor and recipient. She was happy she donated a kidney as an act of charity. Narrating her experience, she concludes: “Christians should be taught that by becoming organ and tissue donors, whether in life or at death, they are performing an act of charity and self-giving love, responding to Jesus’ new commandment, to ‘love one another as I have loved you” (Jn 13:34).
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