Sociology 130 Makeup Writing Assignment: Kidneys for Alonzo
Upated August 16, 2009

Write a three page paper in which you take a definite pro or con position on the following question: When basketball star Alonzo Mourning needed a kidney transplant, should he have purchased a kidney on the black market if one did not become available through the normal, American gift-based system?

Recently pro basketball star Alonzo Mourning required a kidney transplant. He was fortunate in having many people offer to donate to him and ultimately received a kidney from his cousin. But if Mourning had not received donation offers he would have had to be placed on a waiting list like a normal citizen and if he did not receive a kidney within a month he would have had to go on kidney dialysis, a painful and debilitating process. Following the Finkel ("Complications" from the NY Times Magazine) article, extremely wealthy people like Mourning have the option of illegally purchasing an organ, probably having the surgery overseas. However, in the Pence article we learn about reasons our organ donation system is based on the idea of a "medical commons". Were he in this position of needing a kidney, should Mourning have purchased the organ?


 

Alonzo Mourning's situation was highly publicized but never was there any suggestion in the press that he was considering purchase of an organ. However, the Finkel article raises the question of what someone with great personal wealth would do if they were faced with not being able to secure an organ transplant through the system run through and supported by American hospitals. There is a great shortage of organs for transplantation and more than half of those in need cannot get them. We are uncomfortable with the thought that famous people will be placed in line ahead of other citizens with similar medical need (and hopefully this does not, in fact, happen). On the other hand if we have substantial wealth and we are confronted with death we might well think that any step that would protect our lives would make sense to pursue. Traveling overseas to have a purchased organ implanted is such a plausible option. Alonzo Mourning certainly had the resources to take this step had he wished to do so.

Your task is to think what you would do if you were in his situation. On the "yes" side, one aspect of the discussion involves the medical aspects of this approach to transplantation. There are reasons to think that a purchased organ (or one donated from a healthy person) would give you a better outcome than an organ from a cadaver. At the same time, in Finkel's article you would have to travel to a less developed country than the United States to have the surgery done. You may have doubts about the quality of the surgeon, the quality of the hospital and its aftercare, and the healthiness of the donor. Who would give an organ for $10,000? Presumably someone who is quite poor and who has lived a stressful live. Is that a true statement? Would there be any reduction in the quality of the organ given by such a person?

The overall goal of this assignment is for you to identify and think about arguments that we should not follow this straightforward, self-serving course. We see one case in Finkel where there was a bad outcome and no accountability. If you received a transplanted kidney and things went wrong you might be in a desperate medical situation and unable to gain adequate care. Finkel's overall case suggests this is not a problem but it ought to figure into your thinking as one of the risk factors.

One of the subtle aspects of this point has to do with where trustworthiness comes from in the medical system. Government regulation for medical procedures is weak unless procedures are funded by the government in the form of research or medical insurance benefits (Medicaid or Medicare). Medicine is accountable and responsible because it is organized as a system where certain norms are followed and certain collective governance agreements are accepted. This is the kind of system that governs the American system of organ transplantation. It is a system that seems to have broken down where other procedures are concerned. Surrogate parenthood is an example because a strong business presence has emerged. This is fueled in significant part by the willingness of wealthy potential parents to pay any amount of money and engage in any sort of dishonesty to get a baby. This same ethical orientation would likely prevail in the sale of organs. Again, you need to balance the value to you of taking whatever steps you need to in order to remain alive against the risks that go along with moving into a different kind of health care supply system.

One of the things you want to know about in answering this question is how the American system of organ transplantation works. Although some organs, like kidneys and livers, can be donated by living people (like Alonzo Mourning's cousin), most organ transplantation comes from cadavers. Donations are only possible from people who are brain dead—people who have suffered massive and irreversible damage to their brains while the rest of their bodies remain intact and healthy. These are people who have head injuries in accidents, strokes, and certain kinds of drug reactions. Families must agree to the transplantation and it must be possible to medically stabilize the donor in the hospital. These conditions reduce the percentage of all people who die eligible as candidates for donations to a small fraction of the total. Only a fraction of those who need transplants can receive them.

Our system also is one that is based on a gift relationship (see the reading by Titmuss on Blackboard) between donor and recipient. Donors' families do not pay for medical costs but they also receive no payments for the gift. There is a medical registry in which those who need transplants within a restricted geographical area (close enough to travel for the procedure before the donor's body declines to a point where the gift will not work). When a donor becomes available, a transplant coordinator goes into the registry to develop a list of potential recipients and there is an attempt to match the donor and the potential recipient in terms of their immune systems, body size, and other factors. Once a match has been achieved, the recipient's surgeons travel to the donor's hospital, remove the organs, and transplant them home for implantation. Medical insurance often pays for transplants since in the case of a process like kidney transplantation the costs are actually less than would be the costs for long-term dialysis.

One thing to consider is how our system would change if patients were allowed to purchase organs and receive transplantation in the U.S. Titmuss would argue that this would destroy the gift system. Would that be a bad thing? Questions are whether a system of purchasing organs would result in more donations. One of the problems inherent in our current system is that since there are not enough organs to go around we must have some system perceived as fair so that losers are not too angry. If rich people could buy organs we might end up with sharp class conflicts unless the increase in supply meant that there no longer were a shortage. That does not seem very likely.

The other thing to consider is how we feel about the socioeconomic inequality inherent in a purchasing system. We are uncomfortable about a surrogate parenting system where low income mothers are essentially paid to rent out their bodies for nine months so that rich people can get babies. Do we worry about the health consequences for those low income mothers, about the emotional consequences for them of giving up the baby, or about some inherent debasement involved in having people and their bodies exploited in this way?

If we worry about this with low income American women where surrogacy is concerned, is there a reason not to be even more concerned with organ donors who come from low income societies overseas? Do we feel comfortable about rich people from western industrial societies exploiting the bodies of people from poor countries when we may feel uncomfortable about the way we exploit other natural resources in their countries? How do we think about medical risks these people assume? What guarantees do we have that they will receive adequate follow up medical care so that they can return to full health? Do we worry about the emotional consequences of giving up an organ to a stranger for money (notice that in Iraq great care was given to minimize this psychological discomfort)? There is an impassioned statement in Finkel about the impropriety of westerners exploiting the poverty of people in other parts of the world to secure organs for transplantation.

There is a moral juxtaposition in this question. On one hand, we are asked to take the position of someone who confronts likely death and who has endless resources to resolve the medical problem. On the other hand, we are asked to consider what amounts to a moral responsibility in accepting a system that is based on a concern for justice and economic fairness. We might be able to finesse the question part way by saying the purchase of an organ is not safe but certainly with enough resources and if the recipient were sufficiently concerned on humanitarian grounds these problems could be resolved. So how do you choose?