Features (1) and (2) combined are supposed to rule out exploitativeorgan trafficking from poorer countries, while the ban on direct salesand allocation by a central agency ensure that the organs go not tothose most able to pay, but to those in most need. In common withmany other defenders of organ sale, Erin and Harris also proposebuilding in practical protections for donors and recipients (e.g.,adequate medical care and thorough health checkups before donationtakes place).
Mrs. KVP is a 40-year-old woman in excellent health who developed hepatitis C from a blood transfusion following surgery. Her family doctor sent her to a liver expert who told her that she was seriously ill and must be treated immediately with interferon and ribaviron. KVP had no complaints and had heard that the standard treatment often made people much sicker than doing nothing.
KVP presented to my office, and her blood tests were all normal, except her ALT liver enzyme was elevated at about 300 mg/dL. This indicated that there was viral activity and inflammation in her liver. KVP's original laboratory tests and her progress after being treated with my triple antioxidant therapy over three years are demonstrated in figures (41KB .pdf)
After three years, she once again visited her hepatologist who told her that actually that she was getting sicker because her viral load had increased dramatically (Figure 12 in above .pdf). Again, he said that she should be put on interferon and ribaviron and be evaluated for a liver transplant. Incidentally, she had great health insurance.
Mrs. KVP is a health professional and questioned her hepatologist. She asked him if the original viral load was acceptable. He said, yes, however, it had increased from 600,000 to 6,000,000 units, and that showed progression of her disease. She asked him if he knew that the first viral load tests were done by the Chiron method and the second tests were done by the Quantasure method. He did not know that. Then, she told him that viral load is an artificial exaggeration (amplification) of the amount of viruses by millions, and the Quantasure method appears to amplify the amount of viruses by ten times more than the Chiron method. After hearing this reasonable explanation, he answered that viral load was not a very important test anyway.
The three people described in this study continued to stay on the triple antioxidant therapy, and I still see two of them as patients today (Fall 2007). The two continue to improve. In addition to ALA, I added silymarin and selenium to my triple antioxidant therapy, because these agents also protect the liver from free radical damage, regenerate the other fundamental antioxidants, and interfere with viral replication. Although my first acute hepatic necrosis patients were treated with ALA alone and did exceedingly well, all the patients presented in this paper followed the triple antioxidant program and recovered quickly from their illness.
The standard-of-care treatments for severe liver damage, especially liver transplant surgery, can be painful, disabling, and extremely costly. From my experience in my practice, interferon and antivirals have less than a 30% improvement rate, and this response is usually not permanent. Liver transplant surgery in a few cases can be lifesaving and necessary, but is uncertain and tentative, partly due to the residual viremia that ultimately infects the newly transplanted liver. I have found that the highest viral loads are seen following liver transplant surgery, since the residual viruses in the bloodstream and tissues have a new healthy liver on which to feed.
The triple antioxidant therapy offers a more conservative approach to the treatment of hepatitis C that is much less expensive. One year of antioxidant therapies described in this paper costs only a few thousand dollars, whereas liver transplant surgery costs more than $400,000 a year, and in five years, the person will probably require a new transplant. And, in addition, the transplant patient will require anti-rejection drugs and many doctor and hospital visits. It appears reasonable to me that prior to transplant evaluation or during the transplant evaluation process, this conservative triple antioxidant treatment program should be considered. If there is a significant improvement in the patient's condition, liver transplant surgery may be avoided.
Not too long ago, I was invited by the Internal Medicine Society of Saxony to present my triple antioxidant protocol to the group in Dresden, Germany. I was asked why viral loads did not always fall to very low levels with my treatment program. I answered that from a microbiologist's point of view that I did not believe that one could ever completely eradicate a viral disease without killing the patient. I added that we could only hope to support and "teach" the immune system how to recognize and control a virus. Normally, viruses remain part of our biology for the rest of our lives. And this does not necessarily make a person sick. We are all filled with billions of dormant viruses. As long as we have a healthy lifestyle and avoid unnecessary emotional and physical stress, the viruses should remain dormant. I believe that one can live to 100 years old with hepatitis C and still be a healthy person.
Given this, how exactly will allowing organ sale lead to there beingless altruism in the world? The main answer given is that it wouldundermine the practice of free donation. Abouna (1991, 167), forexample, claims that there is:
… living organ donation is now so safe that many surgeonsactively recommend it, and they would hardly do that if they expecteda string of dead or damaged donors. They expect that virtually alldonors will make a full recovery to normal health. But the onlyobvious difference between paid and unpaid donation is that the vendorreceives something in return which is, to all appearances, a positiveadvantage. (Radcliffe Richards 2012, 55).
This may be one area then where the differences between differentpossible organ sale systems are relevant. For it is not wildlyimplausible to posit the existence of a duty to donate one'sorgans for posthumous transplantation. Indeed, this view is notconfined to utilitarian bioethicists, with even the Church of Englandstating in 2007 that (posthumous) organ donation is a Christianduty (BBC News Online 2007). Thus there may well be a validaltruism argument against a system in which people sell rights to theirbody after death: the argument being that they should donate themanyway without expecting payment. This style of argument looksless promising, though, when looking at non-directed living kidneydonation (to strangers). Here, I suspect most of us want to saythat becoming such a donor is heroic and supererogatory, not a moralobligation, and so the altruism argument does not engage. Anotherinteresting example is blood (from living donors). In manycountries, there is a widespread view that people ought to do thisfreely and (if this view is correct) this could underpin an altruismargument against paying for blood: the claim being that people oughtnot to be paid for that which they have an obligation freely togive.
The shortage of transplant organs is a major worldwide public healthproblem. According to the US Department of Health and Human ServicesOrgan Procurement and Transplantation Network, there are approximately123,000 patients on transplant waiting lists in the US and around300,000 patients waiting for an organ transplant in China (TheEconomist 2014). In the US in 2014, the overall median waiting timefor a kidney transplant was over three and a half years (NationalKidney Foundation 2014). The situation is similar in the UK(Department of Health 2014). Furthermore, waiting list sizes do noteven fully reflect the actual level of need because doctors aresometimes reluctant even to list patients who they feel do not stand arealistic chance of getting an organ intime. (see below).
When ethically evaluating organ sale therefore it is best to focusnot on the worst aspects of today's organ trafficking practices(since that is not what any serious ethicist is defending or proposing)but rather on what a reasonably well-regulated system of organ sale,controlled by some combination of the medical profession and stateregulators, would look like. More specifically, it should beassumed (as it is in what follows) that the doctors, nurses, andtransplant coordinators implementing an organ sale system should atleast adhere to the standards around consent and clinical careadvocated by The Transplantation Society and the World HealthOrganisation (leaving aside of course those bodies' opposition toorgan sale itself) (see below).
The expression ‘organ sale’ covers a wide range ofdifferent practices. People most readily associate it with the casein which one individual (who needs or wants money) sells his or herkidney to another (who needs a kidney). But there are otherpossibilities too. One (in countries where the prior consent of thedeceased is required for cadaveric organ donation) is to pay peopleliving now for rights over their body after death. Another (incountries where the consent of relatives is required for cadavericorgan donation) is to pay relatives for transplant rights over theirrecently deceased loved ones' bodies.
Opposition to the Saving of Lives Argument takes one of twoforms. It may be objected to empirically, with the critic arguingeither that permitting organ sale would be ineffective or that analternative system would work better: for example, the ways in which weapproach bereaved relatives could be improved, as could the ways inwhich the possibility of (unpaid) living donation is publicized, orthere could be a move to a Mandated Choice or Presumed Consentsystem (Hinkley 2005). Alternatively, one might concedethe empirical point that allowing organ sale would be an effectiveoption, but nonetheless argue that there are sufficiently strongcountervailing (moral or practical) reasons to justify leaving theprohibition on sale in place. These reasons are the subject ofsome later sections.
Organ sale—for example, allowing or encouraging consentingadults to become living kidney donors in return for money—hasbeen proposed as a possible solution to the seemingly chronic shortageof organs for transplantation. Many people however regard this ideaas abhorrent and argue both that the practice would be unethical andthat it should be banned. This entry outlines some of the differentpossible kinds of organ sale, briefly states the case in favour, andthen examines the main arguments against.
One initial response to the ‘coercion by poverty’ refersus back to the fact that almost all defenders of organ sale are arguingnot for unfettered international trafficking in transplant organs butrather for a regulated system of compensation. Within the contextof a regulated system (particularly that advocated by Erin and Harris,which would be limited to one economic area) there is no reason tobelieve that most organ sellers would be desperately poor. Organsale may admittedly be more attractive to those with the least money(for why would someone rich need or want to sell an organ?) but thenmuch the same can be said of some of the least sought-after and worstpaid agricultural and cleaning jobs, and we do not generally say thatpeople cannot consent to do these or that these types of employmentshould be banned.