The Underground Organ Trade: Utilitarianism Gone Rogue 

In America, another person is added to the nation’s organ transplant waiting list every ten minutes. The country loses almost one person each hour because organs are not donated in time, yet only 54 per cent of the population are registered organ donors. These statistics, alone, offer a window into the wider picture of severe organ shortages.

The Happiness-Harm Ratio

There are a number of factors contributing to the lack of organ donors. Some of these include organ donation being incompatible with spiritual and cultural traditions, issues surrounding the deceased person’s autonomy and a general lack of awareness regarding the importance of organ donation. The issues of organ donation and harvesting are intimately linked with the principle of utilitarianism. 

It will be helpful to understand the basics of classic utilitarianism. This is a philosophical model that emerged in the 18th Century from philosophers such as John Stuart Mill and Jeremy Benthem. One of its founding principles says that actions which have good outcomes are those which bring about ‘the greatest good for the greatest number’ whilst ‘hurtful’ actions are, in and of themselves not bad unless they cause ‘harm’. Of note is the idea that utilitarianism determines the moral worth of an action according to its happiness- or pleasure-giving potential for the greatest number of people. In other words, numbers count.

Harvesting for the ‘Greatest Good’

We find utilitarianism applied unethically in the illegal practice of non-voluntary organ harvesting of convicts. In China, only 0.6 people out of every million citizens donate organs. Despite this, the waiting time for a transplant in China takes mere weeks rather than months or even years when compared to Western countries. In 2014, China promised to terminate the practice of harvesting prisoners’ organs. Today the Chinese government is suspected of continuing to carry out large-scale organ harvesting of death row prisoners and prisoners of conscience. In fact, the WHO have since published reports which suggest the illegal transaction of organs occurs on an hourly basis. Hamid Sabi (a lawyer for the China Tribunal) presented evidence from the tribunal’s final report which found that: ‘a very substantial number’ of prisoners were ‘killed to order’ by the Chinese government.

Some invoke utilitarianism to justify the harvesting of organs from death row prisoners. These arguments normally centre around the idea that harvesting organs from those who committed heinous crimes benefits society. More precisely, the practice serves the utilitarian ideal of doing the greatest good for the greatest number of people. Of course, this way of thinking is problematic. Each time, a call is made to determine which life is more or less valuable.

Despite utilitarianism’s well-meaning beginnings, authoritarian governments have found a way to abuse the philosophy. Under the banner of achieving the most ‘good’ for loyal citizens, persecution of so-called ‘dangerous’ groups is justified.

Desperate Voluntary Sales

A shortage of human organs and extreme poverty pushes some to sell their organs for money. The illegal trade of organs has been fuelled by unscrupulous doctors and dealers who capitalize on desperate recipients and destitute sellers.

At face value, the voluntary sale of organs seems to simultaneously resolve two problems: the need for organs and the need for money in the poorest parts of the world. Sadly, the organ trade is quite a lucrative business. Selling a kidney, for instance, can get you as much as £7,000. In Iran, 26 million people live in absolute poverty. Consequently, the buying and selling of organs for transplant is legal. In an interview with the BBC, Ms Hussein explains her motivations for selling her kidney: ‘I am tired and we cannot make any money to pay for the rent, medicine, children’s needs and food,’ she says.

Superficially, voluntary organ sales appear to provide the best outcome for all parties. On closer inspection, the practice reveals a gruesome reality. In the most troubling cases, vulnerable people may be trafficked and exploited by gangs who force individuals to undergo dangerous procedures in unsanitary conditions whilst they keep most of the profits. Examining the demographic of organ donors reveals more problems. Most organ donors work in low-paid jobs and are often illiterate. The main reason for donation is often a desperate need for money rather than altruism. In some cases, organ sale perpetuates the cycle of poverty when unsafe procedures lead to health problems that limit a person’s capacity to work. Most disturbingly, children and young adults are pressured into selling their healthy organs without proper consideration of their own welfare. Being young, most are unaware of the implications of having a transplant and what that involves. 

Is an ‘Ethical Market’ Possible?

Some have suggested that in order to reduce illegal organ trafficking an ‘ethical market’ is needed. This would involve a reliable purchaser, such as the NHS, taking responsibility for buying and screening organs. However, even under such a system, the abuses and exploitation of the most vulnerable in society would likely continue.

The UK’s opt-out system, where individuals are automatically enlisted for organ donation after death, seems to be the safest bet. This system maximises the number of organs available for transplant whilst disincentivizing organ traffickers who seek a monetary gain from illegal sales. Crucially, it takes into account an individual’s right to autonomy over their body.

However, the system alone is not enough to ensure supply meets demand. It is, like most systems, an imperfect one. But however serious the issue of organ shortages may be, the manipulation and suffering of the most vulnerable in society cannot be used to achieve that moral ideal of ‘the greatest good for the greatest number.’