Bioethics Issue

n engl j med 353;14 www.nejm.org october 6, 2005

The new england journal of medicine

1533

book reviews

kidney for sale by owner: human

organs, transplantation,

and the market

By Mark J. Cherry. 258 pp. Washington, D.C., Georgetown University Press, 2005. $26.95. ISBN 1-58901-040-X.

hen i first became aware of com-

mercialism as a possibility in organ trans- plantation, I, like most everybody here . . . was very opposed to it and thought it a terrible thing. More recently, I am not so sure. I think the issue is much more complex than it appears to be at first. . . . I wonder who decided that it was morally wrong. . . . Who is it that sits on these boards and makes these decisions?”

This quotation from Kidney for Sale by Owner, re- flecting a nephrologist’s comments at a conference, perhaps summarizes the thoughts of a growing seg- ment of the general public, as well as some medical professionals. Whereas federal law and societal standards prohibit individual adults from buying and selling solid organs for transplantation, our current ethical views on the commercialism of or- gan donation have recently been challenged, in part, by several living-donor transplantations in which donor–recipient pairs were linked through for- profit Internet sites. The sudden application of free- market economics to organ donation has forced physicians, patients, ethicists, and regulatory bodies to reconsider this complex issue.

Kidney for Sale by Owner, written by Mark J. Cherry, a philosopher with expertise in bioethics, is a time- ly and important contribution to the current dis- course. The book seems to have two goals: to re- view the ethical basis for the current proscription on organ sales, and to provide a philosophical and societal framework by which organ sales could be considered morally acceptable.

The author first takes us through the fundamen- tal arguments for the prohibition of organ sales, which are largely centered on exploitation and vio- lation of human dignity. He then explores the basic philosophical framework by which organ sales could be morally acceptable, drawing on relevant

threads from Immanuel Kant, John Rawls, and theological teaching. In this exposition, Cherry, who is an authority in the field of organ donation, reviews philosophical questions concerning per- sonal autonomy and the concept of self as they re- late to the sale of one’s organs. Although this book is clearly written, the general medical reader will probably find portions of this discussion, such as “The Body, Its Parts, and the Market: Revisionist Interpretations from the History of Philosophy,” to be arcane and somewhat difficult to read.

The remainder of the book presents a balanced view of the practical aspects of developing an organ market. Cherry describes the negative societal ef- fects of an organ market, including the potential reduction in charitable organ donation, harmful effects of exploitation of donors, and whether a for-profit organ market would erode medical and scientific standards in the field of transplantation. He then reviews the potential positive societal ef- fects: increased numbers of organs available for transplantation; increased expression of personal autonomy from organ donation; and achievement of societal goals through income generated from organ sales.

Cherry gives us a comprehensive, balanced re- view of the philosophical and practical aspects of adopting a market-driven system for organ sales. Transplantation professionals, bioethicists, and the public will find Kidney for Sale by Owner invaluable for framing discussions of this complicated topic. With thousands of patients dying each year while on the list for transplants, our society should ex- plore every reasonable means to increase the avail- ability of donor organs. This book challenges our current views on the commercialism of organ dona- tion and argues that from an ethical, medical, and societal viewpoint, the current prohibition of organ sales may cause more harm than good.

James F. Trotter, M.D.

University of Colorado Health Sciences Center Denver, CO 80262 [email protected]

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