RMPS DissertationWhat is the most morally justifiable method of procuring organs? Buying and Selling of Organs.The buying and selling of organs is already happening around the world, both legally and illegally. Around 10,000 black market operations involving purchased human kidneys take place every year. However Iran is the first and only country in the world to legalise the selling of kidneys and have done this since 1997. This is a controversial issue and has spurred many different views. Many people believe that legalising the buying and selling of organs is a positive move particularly as in the world there is estimated to be around 700,000 patients on dialysis (Harris, 2003) and, therefore, being able to buy and sell organs would reduce this number dramatically as people would have a bigger incentive to donate their organs. There is proof of this in Iran as their waiting list has reduced to almost nothing (Muzi, 2015). However, the most common objection to the buying and selling of organs is that it exploits the poor. The World Health Organisation support this view, saying: “Transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should be prohibited.” This was proven in a 2002 study when 350 Indians who had sold their organs were asked why they did it. The majority of the answers were that they had sold their kidney to pay off a debt, but six years later, many of them were still in debt and 75% regretted selling their kidney (SInger, 2009). This demonstrates the exploitative nature organ commercialism has. However, a counter argument to this is that the selling of organs is a way for those in poverty to make money and if this source of income was taken away they would not be given any money in return therefore exploiting them even further. Although people may regret their choices of selling their kidneys they aren’t as impoverished as they were before they sold their kidney. Nancy Scheper-Hughes the founder of Organ Watch, a documentary on the illegal trafficking of organs said to those who believed that the selling of organs was a way of helping the poor “Perhaps we should look for better ways of helping the destitute than dismantling them,” (Cherry, 2015) suggesting that maybe we should find other ways to help those in poverty so that they do not find themselves in the position of having to sell their organs in order to survive.Pope Benedict XVI expressed his objections towards the buying and selling of organs when he said that the body can never be considered a mere object so the logic of the market cannot be applied to organ donation (Zenit, 2008). The eighteenth century, German philosopher Immanuel Kant also expressed similar views when he said we have a worth “beyond all price” (Jenkins, 2003)However some would argue that the selling of organs is right as everyone else involved in the transplant gets paid. The healthcare professionals get paid, the transplant team get paid, even the recipient gets paid in the form of an organ, however, the donor does not get paid. Some say that this will threaten the quality of organ supplies if the donor gets paid and it will make it a less altruistic act. However, we don’t regard medicine as a less caring profession because nurses and doctors get paid.Presumed Consent (The Opt Out System)Presumed consent (more commonly known as the opt out system) is being used widely across the world in countries such as Austria, Wales, Belgium, Finland, Sweden and Norway. There are two types of presumed consent: the soft system and the hard system. The soft system is where individuals who do not want to donate have a mechanism of registering their objection and after their death, even if they have not ‘opted out’ families are still consulted to identify any unregistered objection. The hard, or strong, system is where the relatives are not consulted after death and if the patient has not opted out then their organs are automatically harvested and used for transplant. There is a lot of support for presumed consent as it had proved successful in increasing the amount of donors in the country. In countries that have presumed consent their organ donation rates are 25 to 30% higher than those of countries who require consent (WHO, 2014). A study was done in two hospitals in Belgium. One, Leuven, switched to presumed consent and its donation rate increased from 15 donors per million to 40 donors per million whilst the other hospital, Antwerp, did not change its policy and only maintained previous levels. These two pieces of evidence show that the opt out system does help increase the number of organs available from deceased donors.However some would argue that presumed consent is wrong as it ignores one of the main principles of medical ethics, respect for patient autonomy, as the patient is not actively giving their consent and therefore not giving any consent at all. There is also the difficulty of not knowing whether the patient was fully informed or not. This is an important factor as consent hinges on being informed and without knowledge of the procedure, we do not know if this is really what the patient wants. However if there is an ‘opt in’ system then the patient has to read about and understand what will happen before they give their consent, making it easier to identify that organ donation is what the patient wanted. Another argument that would be given to support the opt out system is the fact that there are many unnecessary deaths happening because of people waiting for an organ donation whilst viable body parts are being buried or cremated. If there was an opt out system then the number of viable body parts being wasted would be reduced and there would be a great decrease in the number of people dying whilst waiting for and organ. In the UK, 96% of people support organ donation however only 30% of people have signed up as donors (ITV, 2013), so the opt out system is seen as a good way to increase the number of donors as the lack of donors could just be out of the inconvenience of registering.Anencephalic Babies as DonorsThe term anencephaly comes greek origin and means literally, ‘no brain.’ Anencephaly is a disorder that comes in two forms. Either, the top of the skull is missing and the head finishes at the eyebrows, or, the skull is malformed and filled with fluid. Anencephaly affects one in two thousand foetuses and although many women choose to have an abortion on finding out their child has anencephaly, there are still 300 babies born with anencephaly every year in the United States. A child born with anencephaly is missing its higher brain. This part of the brain controls consciousness, hearing, sight, pain and pleasure. However the baby still has its lower brain which consists of the brain stem. This controls breathing, heart rate and reflexes. A person in this condition would be described as being in an irreversible coma or a vegetative state, they will never become conscious.Across the globe there is a high rate of infant mortality due to organ defects in young babies. However there is a shortage in organs that are small enough to be transplanted into these babies bodies. There has been situations in the past where there has been both a baby dying as one of their organs are failing and an anencephalic baby in the same hospital. In this dilemma there are two babies that will die within a few days or even a few hours. one, has a fully working brain, is conscious, has the ability to feel pain and pleasure but has a failing heart. The other baby, has all its organs in tact apart from its brain of which the upper part is missing, it will never be conscious, will never feel pleasure or pain and is described as being under a general anesthetic forever. In this situation harvesting the heart from the anencephalic baby and donating it to the other baby would be the ideal situation, however the anencephalic baby is not seen as medically dead. Some would argue that taking the anencephalic babies organs would be morally permissible, however others would say that to do this would be incredibly wrong. Those who believe that it is not morally permissible to harvest an anencephalic baby’s organs whilst it is still ‘alive’ argue that although the baby may not be conscious its family are and harvesting its organs whilst it is still alive would have a detrimental effect on those around it, including not just the family but also the doctors and nurses who have been caring for it, as they do not see it as a dead individual, they see it as an alive and breathing baby. Another point to the argument is that we wouldn’t choose to bury a spontaneously breathing, persistent vegetative child, how is this any different from treating it as though it is dead by harvesting its organs.However, Peter Singer argues that anencephalic babies are not persons by his definition. Peter singer believes that a person is a being who has a capacity for enjoyable experiences, for interacting with others and for having preferences about continued life and an anencephalic baby does not fit this definition. Peter singer argues that as anencephalic babies are not ‘persons’ they should not be given the same moral standing as one. If both babies are left, both of them will die. If the transplant takes place one will continue to survive.