Last week BioEdge reported that a 46-year old businessman from Piraeus, Greece, said that the only way he saw fit to rescue his family from the financial crises was to sell one of his kidneys.

He received €100,000 for it (a person can live on a single kidney). This raises two issues – the first is whether the sale of organs can be legal (we recently had something similar occurring in Malta), and the second is whether bioethics can do something about it.

What price should one put on a kidney? Of course, for a gentleman to be given 100,000 euros, there has to be a market price in existence; unless he bargained for it. He could have asked for one million euros. Why he did not or why he did not get them implies that there is an underground market value which, as markets usually go, is ‘reasonable’ to both parties. People will not sell for very little; but asking for a high price may not bring you a buyer.

The issue of whether I should have rights over my body parts has been debated long enough. Morally, one might not see any reason why not to; but when one looks at the consequences of allowing such sales, one will see that it is the most vulnerable who are put into a position of having to sell an organ – as is happening here. If the selling of organs were allowed, there would come a time when people will be pressured into selling an organ for their relatives’ health care or even to pay for a better education for their children. The question will then be, ‘do we want to live in such a society?’ Is this the same as selling your personal belongings?

The fact that this trade in organs has hit Europe is allegedly due to the financial crises. Experts say that the black market is moving from the ‘traditional’ countries such as India, China and Brazil, to ‘crisis-hit’ EU countries like Italy, Spain and Greece; and naturally to the poorer Balkan states. The internet helps people sell their organs.

Of course, this is the realm of organised criminal groups who prey on the vulnerable situations of both patients and sellers. Around 20,000 organs are sold around the world each year; about 10% for kidney transplants – and the buyers invariably come from the West, ‘US, Britain, France, Israel, Italy and Germany’. However, where they come from and where they go is irrelevant. The point is that such organs go from vulnerable countries to the more privileged. And when vulnerability hits home, then its effect ranges from a mere raising of eyebrows to moral panic. But we should have been concerned all along.

So what can bioethics do about this? In reality very little since, as the name implies, bioethics deals with ethics and morality and not with crime. It can discuss whether something is a crime or not but when it is and things are entrenched in laws, then there is little scope other than to discuss laws. But should it be so? In a recent text on the Anthropology of Patients’ Rights, published by Cambridge university press, the blame for organ trafficking is also put at the feet of bioethicists, who are quoted as not doing enough. Whilst bioethics is not meant to be a pressure-group, it has, on the other hand, acted as such to influence or change laws. What can it do in the face of crime?

We know that the selling of organs is wrong and the fact that it occurs is not because it is being debated but because people on both sides are so vulnerable that in order to save their lives or that of their families respectively, they resort to illegal trade which is facilitated by third parties. Short of prosecuting both those who receive an illegal organ and those who are known to have sold an organ, one can do very little but to monitor and try to catch the people who perpetrate this sort of trade. Certainly, being illegal, it remains within a bracket. Should it increase, then the authorities have more probability of success. But the law should also be a deterrent; people in a vulnerable state have to see that what they are doing is illegal and that there are consequences, even though we may sympathize with them. Any form of stealing is given the same sentence and one does not take into consideration the vulnerability of someone who stole – even if they wanted to feed their family. Courts may be lenient, but there should be penalties. Moreover, a law is not enough; you need to have the resources to implement that law and take action.

Let’s not confuse buying and selling with giving a fair compensation for trouble and loss of work. We are speaking big money here. Whether the intention of both sides of the vulnerable spectrum is good, the fact remains that in the long run it is a bad thing, as it says something negative about society if vulnerable people have to resort to these things. If there were a way that the sale of organs would not affect only those who are poor, then perhaps one can debate rights vs. altruism. But even this will mean that once there is the possibility of money, not-for-profit donations may be affected negatively as well.

Pierre Mallia is Associate Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta; he is also Ethics Advisor to the Medical Council of Malta. He is also former president of the Malta College of

Family Doctors