Danilo knew that he had no other choice but to proceed with the lucrative yet illegal and dangerous operation. It was in 2002 and he was struggling to make ends meet with his two children and wife. His family lived in the slums of Manila, and he was hoping to purchase their own house. Danilo was approached by an agent who connects the likes of him to potential organ buyers. In his case, he had his kidney removed and transplanted to a Canadian citizen. Both of them do not know each other. In the end, he only received P85,000 after enduring the six-hour organ extraction surgery. The cost was a far cry from the agent’s original offer worth P115,0001.

Danilo’s case is neither new nor unique. In the Global South, underground organ trading is a multimillion peso illegal enterprise where questions of ethics, morality, and legality often find themselves conflicting with each other. The situation is often archetypal: A financially disadvantaged person is matched with a well-off person in need of an organ transplant. These transactions are primarily motivated by the financial gain that the donor stands to receive and the health benefits the receiver would get2.

Physicians, ethicists, and legal experts have long debated various issues surrounding the sale of body parts. In the Philippines, organ donation may only be done between family members or between people who have an established emotional bond, like long-term partners, friends or colleagues. Illegal organ donation is criminalized by the Anti-Trafficking in Persons Act of 2003, where violators could face up to 20 years in jail and a fine between P1-2 million. Physicists are bound to follow the law, or risk facing similarly stiff punishment. Some ethicists, meanwhile, have considered organ donation as an exercise of bodily autonomy.

In his 2003 paper, Australian-Romanian philosopher and bioethicist Julian Savulescu argued for the correctness of the sale of body parts3. Specifically, Savulescu wrote that people “should have a right to make a decision to sell a body part … To ban a market in organs is, paradoxically, to constrain what people can do with their own lives.” Savulescu provides two basic arguments. Firstly, the labor market allows people to sell their strength or labor for money, so it might be fine for people to sell the means for that labor, too. Secondly, some people willingly destroy their bodies by engaging in vices or other risky behavior, and so it might be better if body parts could be sold instead, rather than get destroyed. In that way, the donor “(realizes) other goods in life.”

Savulescu’s arguments appear to advocate for the right of a person to self-determination and bodily autonomy. It is important to note that he does not explicitly argue on the correctness of organ donation. What he simply advocates is that a person should at least be given the right to decide whether to enter an organ market, free from impositions like the possibility of punishment (as in criminalization) or being coerced to donate a body part due to financial hardships (akin to the underground organ trading in the country). The right to sell a body part, it appears, is part of a string of individual freedoms, such as the right to self-autonomy, freedom of thought, and even economic freedom.

Equally interesting in Savulescu’s argument, too, is his focus on the effect of poverty in the person’s determination whether to sell a body organ. In fact, it is one of his two caveats in arguing in favor of an organ market. A prerequisite in organ-selling for him is the person’s ability to freely decide whether to sell or not. However, a person cannot fully divorce themselves in the conditions that push them to sell an organ–especially economic conditions. Precisely in the case of Danilo, while he exercised his personal agency in choosing to donate a kidney, it was his poverty and his love for his family that became the primary moving factor for him to make such a decision. He was free to decide otherwise, but he has not chosen so because of the underpinning economic situation that he found himself and his family in4.

Organ markets or commercial organ donations cannot coexist under the existing framework of the country’s organ donation laws and policies5. Here, the ethical dilemma becomes the crux of our present case: Under a commercialized and liberalized organ donation framework, we are risking the exploitation of financially disadvantaged individuals. But at the same time, we are also offering terminally ill individuals a second chance at life. I argue that there is a greater necessity in liberalizing our organ donation policy. In 2016, only 480 kidney transplant operations were recorded6. This number pales in comparison with the 58,815 dialysis patients during the same period. With such a number of underserved patients, the current donation policy is bringing more harm than good. The prohibition of commercial donation only brings more harm than good to the general population.

In terms of operability, exploitation in the organ market may be minimized by letting a singular buyer of all body parts. Under these premises, a heavily regulated market may be implemented to allow critically ill patients to undergo transplant at a quicker pace, while avoiding the less fortunate but willing donors from being exploited due to financial reasons7. Because of the restrictive market, a decision to donate based on poverty alone may not be used by the donor. Organ donation cannot be used as a way out of poverty.

The moral question of the organ market is far from the Trolley Problem. I have argued for the course of action that minimizes risk yet maximizes benefit for the most. Moving the lever of our train tracks here will not kill anyone. The donor may have given up a body part, undeniably decreasing their quality of life, but they have nonetheless gained financially. To some extent, we can argue that there is no net change vis-a-vis harm and gain for the donor.

This short note was submitted in partial fulfillment of the requirements in Philo 1.

  1. Pichayada Promchertchoo. “Kidney for Sale: Inside Philippines’ Illegal Organ Trade.” CNA. October 19, 2019. https://www.channelnewsasia.com/asia/kidney-for-sale-philippines-illegal-organ-trade-857551. ↩

  2. Republic Act 9208. An act to institute policies to eliminate trafficking in persons especially women and children, establishing the necessary institutional mechanisms for the protection and support of trafficked persons, providing penalties for its violations, and for other purposes. ↩

  3. Savulescu, Julian. “Is the Sale of Body Parts Wrong?” Journal of Medical Ethics 29, no. 3 (2003): 138–39. https://doi.org/10.1136/jme.29.3.138. ↩

  4. Supra note 1. Savulescu tried to counter this point by conjuring a concept called acceptable poverty. This may not be precisely acceptable in the Philippines, especially that third-world countries are the global hotspots of illegal organ trading due to the rampant poverty incidence. ↩

  5. Revised national policy on living non related organ donation and transplantation and its implementing structures. Department of Health Administrative Order No. 2008-0004. ↩

  6. Department of Health. “Philippine Renal Disease Registry 2017 Annual Report Version 1.” ↩

  7. Richards, J. Radcliffe. “Commentary. An ethical market in human organs.” Journal of Medical Ethics 29, no. 3 (2003): 139–40. https://doi.org/10.1136/jme.29.3.139. ↩

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