Selling the ‘Gift of Life’: The Ethics of Paid Living Kidney Donation

Kidney transplantation is the treatment of choice for end-stage renal disease. Unfortunately, in most countries the number of patients that could benefit from a transplant significantly exceeds the number of kidneys available from deceased and living organ donors. This thesis considers the ethics of one potential strategy for overcoming the kidney shortage: a system of regulated payments for living kidney donation.
   
   Live donor kidney markets are most commonly defended on utilitarian grounds. Proponents argue that renal failure patients and impoverished kidney sellers alike could benefit from a legal trade in organs. Most also claim that allowing the sale of kidneys would not have any significant negative effects. This thesis critically assesses, and ultimately rejects, utilitarian arguments for paid living kidney donation. I discuss four under-recognised ways that organ markets might produce harmful outcomes. First, I argue that kidney sellers are likely to experience significant physical, psychological, social and financial harms that more than offset the short-term benefits of the transaction. Second, I argue that a legal trade in organs would likely give rise to harmful social and legal pressures to sell one’s kidney. Third, I argue that a legal trade in organs would exploit the poor in ways that reinforce structural injustices. Fourth, I argue that a legal trade in organs is likely to undermine social solidarity. I conclude that there is good reason to doubt that the consequences of establishing a live donor kidney market would be positive on balance, and suggest that there are likely to be better ways of alleviating the current shortage of transplantable kidneys.