The recent case of a woman seeking a kidney for the father of her child in return for €5,000 has raised concerns on sale of organs.

There is no doubt in my mind that the intentions of this lady are noble and good and neither is there any doubt in my mind that the money offered, while certainly what one would assume to be a very large amount in these days – hardly two months’ salary, where beyond the scope of covering costs for the donor.

The question however arose on whether this constitutes sale of organs and it seems that at least one of the respondents was interested solely in the money. It was nice on the other hand to see so many altruistic responses on the web pages.

Under current Maltese legislation there is no framework for organ donation. It is to be expected that the selling of organs would follow EU and international policy of not being allowed. We desperately need legislation to guide people in this regard. Certainly this case raises the query that it is not in fact a sale but a donation for costs incurred, which, under normal protocols would be allowed. It is however the ethics committees concerned which would have to decide what constitutes a just amount.

Donating to people you know however does carry risks and both parties will need to be counselled. Certainly the recipient will not have to feel obliged in any way and the donor has to understand the changes donating a kidney would bring about in life. Naturally they would have to be screened medically and perhaps there character and life-style taken into consideration. But other than that, under restricted circumstances, donating to a specific person falls within an altruistic and permissible thing to do.

But the question being raised is that if I own my body, what keep me from selling my organs? Why cannot I, for example, say that when I die I wish not to donate my organs but to sell them to the highest bidder so as to leave my children some money. Now altruism and our-body-is-not ours arguments apart, this seems quite an innocent thing. Is it in fact a wolf in sheep’s clothing? If not for the individual concerned, it does open a Pandora’s Box which will turn out to be exactly this wolf we are avoiding. This is the perfect example where even though the moral act in and of itself may not sound harmful, the consequences, and especially the long term ones are so great that countries have gone back to not allowing the sale of organs at all.

It is more than likely that only people in need will sell organs and this would bring about a vulnerability of the rich world cannibalizing the poor. Just like euthanasia, once it becomes habit, people may start feeling pressured to lose a kidney if they owe money or if they cannot afford school fees.

In the USA a suggestion on an ethics journal was once made that they can have a central institution that buys organs and then distributes them free according to need as is done today. Again however this still leaves the fact that those who sell organs will be those in more need. What is a just price, then, for an organ? Too little and the person may regret it; too much and you fall into a market force which will make you even turn to poorer area or poorer countries to obtain you organs. We are back to the vulnerability situation.

There are many other considerations. Can I choose the person I wish to donate my kidney to? Or should I simply be content to donate my kidney and allow an ethics committee to decide who is in greater need. Certainly it is acceptable for members of family to donate to each other. Donating to friends may also be considered under the right circumstances and with proper counselling and ethics filters. Donating to others, especially where a conflict of interest can arise is trickier: e.g. donating an organ to your boss. Moreover any donation has to respect other laws: laws against discrimination, for example – a reason why a Buddhist monk was not allowed recently to donate his organs to a person who would fulfil certain criteria, namely, that the person has never killed any animal in his life, including insects, and has a total respect for nature as in Buddhism. This amounted to religious discrimination which was not deemed acceptable. I leave to the reader to make his or her own judgment whether this was just.