Instigator / Pro
christianm's avatar
8
christianm
1527
rating
14
debates
39.29%
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Topic
#3631

That adults should be allowed to sell their kidneys

Status
Finished

The debate is finished. The distribution of the voting points and the winner are presented below.

Winner & statistics
Better arguments
0
6
Better sources
4
4
Better legibility
2
2
Better conduct
2
2

After 2 votes and with 6 points ahead, the winner is...

whiteflame
Tags
Politics
Parameters
Publication date
Last updated date
Type
Standard
Number of rounds
4
Time for argument
Two days
Max argument characters
10,000
Voting period
Two months
Point system
Multiple criterions
Voting system
Open
Contender / Con
whiteflame's avatar
14
whiteflame
1724
rating
27
debates
88.89%
won
Description

The subject of this debate is whether individuals should be allowed to sell kidneys to each other. The government could observe the transaction if necessary to make sure all parties are in agreement. This debate doesn't negate the possibility that the government could buy organs independently and give them to the poor.

The government could also intervene to ensure the procedure is conducted properly.

This debate simply asks whether someone should be allowed to sell one of their kidneys. Maybe they should be allowed to sell both, but it's not the subject of this debate. I simply argue that adults should be allowed to sell kidneys to each other. By default, this would be on the free market through whatever means they choose, but I don't mind government intervention so long as it doesn't prevent people from selling kidneys to each other. Consider the proposition "People should be allowed to sell cars" and apply the obvious caveats. This is talking about general cases (I think this is usually implied when a general statement is given, but maybe not). If someone would be allowed to donate their kidney under the current system, they would be allowed to sell it under my system, generally speaking.

Round 1
christianm's avatar
christianm
Pro
#1
Thanks to my opponent for agreeing to participate in this debate. My opening will be nearly identical to the one I used in a past debate on this subject.

The current kidney shortage

According to the National Kidney Foundation, 13 people die every day waiting for a kidney transplant [1]. In the United States, it's illegal to sell human organs [2]. Price ceilings tend to result in shortages [3]. Since people are only allowed to donate organs, a price ceiling of $0, the quantity of organs demanded exceeds the quantity supplied. In Iran, the government compensates organ donors, and as such, there is no shortage of kidneys [4] (not that Iran is a perfect country, of course—take the good and leave the bad). Implementing a system like this in the United States and other countries could effectively eliminate the kidney shortage and save thousands of people every year.

Killing vs. Saving

In a free-market economy, individuals are free to buy and sell at will. If the government allows people to buy and sell food, they can hardly be credited with saving people. Instead, if the government restricted buying and selling of food, causing a famine, they would be killing people. In this case, the government is killing thousands of people a year by refusing to let them buy and sell kidneys even without government intervention. While the government buying kidneys and giving them to those that need them would be the best system, restricting anyone from selling kidneys at all, even independently, is morally indefensible. Therefore, any objections to my proposed system must justify killing thousands of people every year.

Is allowing organ trades immoral?

One common objection to this system is that allowing people to sell organs is wrong because the poor would be incentivized to do so. But to justify killing thousands of people a year, my opponent must establish why this is wrong. Firefighters are blue-collar workers who are paid to risk their lives (and kidneys) to save others. But hiring the poor to be firefighters is allowed because people would die without them. In the past, fire departments were private [5]. While a public fire department is the best system, banning private fire departments and refusing to establish public fire departments would be extremely immoral. The government would be responsible for thousands of deaths.

Who should pay?

Personally, I think that the government should compensate kidney donors. One study estimates that such a system in the United States would save thousands of lives—and even save taxpayers $12 billion a year [6].

I look forward to my opponent's response.
whiteflame's avatar
whiteflame
Con
#2
Thank you to christianm. Like him, I’ll recycle a previous opening round, though it has been trimmed and includes some rebuttal.

Framework

Distributive justice is the principle that resources should be allocated justly, with the rewards and costs equitably distributed across all groups within a given population. If utility comes at substantial cost to any given subset of society, then the bias of those effects must be addressed, as they create, exacerbate, and entrench inequities.

What separates this market from others is the hawking irreplaceable pieces of the sellers. This loss stands as a permanent symbol of their status that no other gains can erase, justified by a monetary windfall and by someone else’s utility.


Onto my sole contention.

I) Informed Consent

I will frame this using four questions:

A) What risk is there in organ sales?

An organ seller must submit to surgery to remove an organ and live without it. Kidney donors are prone to reduced kidney function and elevated protein levels in urine, a concern that may exacerbate symptoms in patients predisposed to proteinuria and result in kidney failure. Depression and anxiety are particularly prevalent among those also under greater financial burdens. This presupposes the existence of a strong medical system, which many countries do not have.

B) Who is most likely to be selling organs?

In the case of donations, these risks are balanced by a desire to save another life, rendering it independent of societal status. For sellers, the balance is accomplished by financial gain, which has a differential effect: someone who is financially well off and appreciates the risks would be far less likely to sell their organs. Those without sufficient education to understand these risks and those in unstable financial circumstances are far more likely to be induced by financial gain, the former because that may reduce their comprehension of those harms, and the latter because the benefit of the windfall could be perceived as outweighing the perceived harms.

C) Can those people provide informed consent?

1) "Informed"

“[K]nowledge of facts and appreciation of those facts are different aspects of understanding, both of which are important to informed consent.” Whether we are talking about clinical trials, where patients also choose to subject themselves to substantial health risks, or organ sales, comprehension of the information provided will vary person-to-person, even in developed countries. That comprehension is often lacking in organ donation.


2) Undue inducements

Economic duress can also undermine consent. This is a market, regardless of who is buying. Countries will compete over pricing. If one country is buying at a higher price, donors will travel to that country to get the higher price, so market forces will drive prices up. In a clinical trial, such an inducement is deemed undue “if it is so ‘attractive that [it can] blind prospective subjects to potential risks or impair their ability to exercise proper judgment.” Particularly if the payment is high enough to lead some to participate who “would otherwise have a profound reluctance, the offer demonstrates disrespect for their deep reservations or preferences.” Those same inducements may also lead “subjects to lie or conceal information that if known would disqualify them from enrolling or continuing as participants”, risking the safety of both donors and recipients. Screening processes may be insufficient to prevent these organs from being transplanted, putting patients at greater risk.

3) Coercion

Individuals are often influenced by family members. Potential donors may be subject to explicit or implicit threats that are inherently coercive, but organ markets generate a substantial new incentive for coercion to explode among potential sellers. Coercion is particularly problematic among younger sellers: in countries like Canada where the age of consent to donate is 16, those donors are still dependents and thus may be subject to intense financial and psychological pressures.

4) Effects on the black market

And this is the best-case scenario. Non-UHC countries may be induced by this system to enter the market, resulting in far less regulated markets opening worldwide and offering legal guises for organ trafficking and transplant tourism. There are already numerous examples of these offered by enterprises in China, and regular commerce in kidneys that goes unaddressed in India, the Philippines and Eastern European countries. This won’t change so long as transplantation can be done elsewhere cheaper and more quickly, which is why the insurance industry and doctors (in the US and Israel, respectively) have also been pushing transplant tourism. Boosts to national organ supplies will invariably boost the international organ trade, which is fraught with abuse, fraud and coercion, leading to the deaths of donors and recipients alike.

D) What do we risk by legalizing kidney sales without tackling these issues?

Ignoring the effects of remuneration on informed consent blights the medical field. Informed consent plays an essential role in safeguarding trust in medical practice. That trust is necessary to promote health, compliance with treatment, and participation in research. “Justice in healthcare cannot be significantly advanced in reality without a robust culture of patient–physician trust.”
 
It also causes irreversible harm to patient autonomy. There is no dialysis machine to feed them back their lost autonomy. A failure to obtain informed consent before proceeding does more harm than refusing to comply with their wishes because it is combined with the permanent loss of an organ, thus violating not only autonomy, but personal integrity and self-ownership.


I also present a counterplan that addresses supply issues and does not violate distributive justice.

CP) Reimbursement

I support a universal system that compensates donors for any related costs, including “indirect incentives… such as health insurance, life insurance, disability coverage, or social benefits”. These would cover surgical costs, incidences of side effects, psychiatric care in cases of depression, and lost wages. In UHC countries where some of these costs are already covered, this will address any shortfalls. This removes impediments to donation, but does not provide financial incentives, thus increasing the number of donations without creating a market. This can also extend to dead persons, including offering “money for funeral expenses to families who agree to organ donations, enabling families to honor their deceased relative.”


Rebuttals

1) Solvency

Pro never validates his solvency. The closest he gets is citing Iran as an example (it’s not a great one, since we know that Iran still has a waiting list for kidneys, and that even that list is an underestimate of actual need because access to those kidneys is price-limiting), and an NCBI article that largely assumes solvency (they cite a paper by Becker and Elias that estimates the cost of donation, triple it, and assert that that incentive is sufficient). They also do not account for any potential concomitant declines in donation; there is likely to be a lot of overlap between populations that would donate and those that would sell.

2) Loss of life

Pro’s metric for “killing” would apply to him as well, since he isn’t creating a completely free market for kidney sales (his description says otherwise, but his fourth contention suggests a price ceiling, single-payer system, restricts sales by number and age – he can’t have it both ways), even though doing so would, by his logic, result in more available kidneys and save more lives. And all this assumes that governments won’t bias availability as Iran has, restricting access to those organs for certain subsets of the population. Pro tries to cover for this by including the “possibility that the government could buy organs independently and give them to the poor,” but the opportunity is not part of his fiat, so at best, some countries may do this to address disparities, and doing so would also restrict the total number of kidneys available on the market, simply shifting the restriction to other parts of the population. If it is truly “morally indefensible” to restrict the sale of kidneys such that access to kidneys is not complete, then Pro is guilty as well.

We accept that policies will cause harm, some of which includes actual deaths. Pro clearly doesn’t believe that we should take every measure possible to solve this problem, so he accepts that some restrictions are justified at the cost of lives, presumably because of the harms that a completely free market would cause. I’m simply arguing that any market, free or regulated, causes enough harm to warrant similar caution.

3) Risky business

Everyone accepts a certain degree of risk regardless of the job we choose, and some jobs compensate their workers in part by recognizing the physical risks they take. That is very distinct from someone giving up a permanent, limiting part of themselves for the purpose of a one-time cash payout. Even if we do recognize compensation for exceedingly dangerous labor as a perverse incentive, Pro’s false dilemma between having these jobs and banning them entirely is absurd. Changing the way we compensate workers who do dangerous jobs like firefighting is far more realistic.


Back to you, Pro.
Round 2
christianm's avatar
christianm
Pro
#3
Framework

I agree with some of my opponent's framework, but it completely negates liberty and free choice. According to this framework, someone who worked hard and earned millions of dollars should have almost all of this money taken from them and redistributed. Perhaps my opponent would consider this unjust or at a substantial cost to that person, but the framework relies entirely on the subjective definitions of "just" and "significant."

I would counter that the government should only pass laws with an adequate justification. The burden, generally speaking, is on the government to explain why someone shouldn't be allowed to do something. In effect, infringing on the free market for kidneys is redistributing organs from those who would buy them, and redistributing money from the poor who would profit from selling their kidneys. Both of these clearly violate the framework that my opponent has established.

Risk in organ sales

By the free market system, kidneys will be transferred to those who need them, and only from those willing to sell them. The risk of organ failure would slightly increase for the seller, but the buyer's life would likely be saved. Furthermore, the seller now lives in a society where it's much easier to get a kidney transplant should they need one. Under the current system, donors already have increased priority when in need of a transplant [1]. Without a shortage, they would fare even better.

Informed Consent

Con states that many people would not choose to donate again because they were not well informed. I'll compare this to soldiers and firefighters later on, but for now, notice that this applies to donors as well as sellers. If kidney donors are well enough informed to consent to this decision, why wouldn't sellers be? We can make a strong effort to inform both sellers and donors about the effect of their decision, but banning either would cause much worse outcomes. We shouldn't ban sales, just as we shouldn't ban donations. We should instead prevent doctors from lying to patients. Note that Con's source also states that "potentialdonors don’t understand the ramifications of kidney donation, and are toldby transplant physicians and staff that they are at very low risk for complicationssince they could survive perfectly well with one kidney" [2]. My description states that "The government could observe the transaction if necessary to make sure all parties are in agreement." Therefore, the government should make sure that all parties clearly understand the consequences of such a procedure.

Undue inducements

Adults buy and sell things all the time. Con states that "economic duress can also undermine consent," but the only alternative to paying people to do things is slavery. If someone's economic situation is so bad that they're desperate to sell a kidney, then selling one is probably the best decision, unless they have incomplete information (addressed above). In this debate, I only argue that adults should be allowed to sell their kidneys. Forms of outright or implicit coercion could occur for donations as well, or even sex. But we don't ban kidney donations or sex for consenting adults even though coercion is possible.

Economic coercion

My opponent has argued that economic incentives can impede people's judgment. Using firefighters and the military as examples, I will demonstrate that whatever these effects may be, they are not sufficient to restrict transactions between consenting adults. Con states "Everyone accepts a certain degree of risk regardless of the job we choose," but then argues "That is very distinct from someone giving up a permanent, limiting part of themselves for the purpose of a one-time cash payout." But it's not very different at all. Firefighters and soldiers are expected to risk their lives. If they die, this is a permanent effect. Why should consenting adults be prevented from selling their kidneys, when soldiers are paid to risk their very lives in defensive wars? Con then argues that "Changing the way we compensate workers who do dangerous jobs like firefighting is far more realistic." But how would they be compensated? Con's argument holds that any form of compensation could impede someone's judgment, and would hold that soldiers risking their lives in battle can't really consent to be there in the first place. If fire departments and the military are justified, my proposal for allowing kidney sales is only reasonable.

Effects on the black market

Non-UHC countries may be induced by this system to enter the market, resulting in far less regulated markets opening worldwide and offering legal guises for organ trafficking and transplant tourism.
Right now, this is speculation. As it happens, black markets exist because of the organ shortage. If anyone could get a kidney legally and morally, paying for one in a back alley becomes much less appealing. We should promote legal kidney sales, which can be observed by the government and regulated properly. The incentive for non-UHC countries to enter the market is already there; we should show them that a regulated, ethical system is the best one.

Reimbursement

We agree that this is a good idea, I just don't think it goes far enough. But not many complaints here.

Solvency

Pro never validates his solvency.
I did show a study supporting my proposed system [3] and gave Iran as an example. Pro's source argues against the majority view, stating that Iran does have a waiting list for donors [4]; but even this source believes that the waiting list is very small. If this view is accurate, it's likely that very few of these people die waiting for a kidney. But where is the solvency in America's current system, in which thousands of people die every year waiting for kidneys?

and an NCBI article that largely assumes solvency
The study I used aggregated from a large amount of literature for its estimates and erred on the side of conservatism (evidence against their proposed system). $45,000 is likely an overestimate (almost ten times the amount paid in Iran). They also state "This conservative $45 000 estimate also covers the small possibility that—after the government starts compensating kidney donors—all kidneys might come from living donors and none from deceased donors." Based on existing systems, $45,000 is meant to be ridiculously higher than the price actually required; it's there to demonstrate that even if a new system were somehow much different, the benefits would still be worth the cost.

The study also states, "Note also that it is conservatively assumed that all donors will be paid $45 000 per kidney, including those who previously were willing to donate their kidneys for free. If some of the latter are still willing to donate for free, that will just reduce the costs and increase the net benefits from compensating kidney donors. But if some now decline to donate at all, the cost of replacing their donations with kidneys from compensated donors is already included in the above calculation." The study does rely on estimates, but intentionally picks estimates that should make the system look worse than it actually is.

Loss of life

Pro’s metric for “killing” would apply to him as well, since he isn’t creating a completely free market for kidney sales
I don't argue that people shouldn't be allowed to sell organs independently—perhaps I should have made it more clear. I just think that a government system should exist as well. This saves lives, so it wouldn't be killing anyone—for it to be killing, someone would have to die. I think we should use Iran's system but also allow independent sales without restrictions on who the buyer and seller are.

Pro clearly doesn’t believe that we should take every measure possible to solve this problem, so he accepts that some restrictions are justified at the cost of lives, presumably because of the harms that a completely free market would cause.
I only advocate for restrictions ensuring that transactions are consensual and that everyone is properly informed. If an adult is informed of the risks and decides to sell their kidney, I would not advocate for restricting this. Perhaps some extreme cases should be restricted, but it's not the subject of this debate. Even then, the firefighter and war analogies justify the vast majority of kidney sales. If we let people become firefighters, generally speaking, we should let them sell kidneys, generally speaking.

Risky business

See Economic coersion above.

whiteflame's avatar
whiteflame
Con
#4
I) Overview

This debate does not solely regard a single country or even a subset of countries. This market for organ sales would be worldwide. Governments in many nations are corrupt; they will seek to profit from this newly legalized market – Pro showed how the US would profit, and that’s assuming they enforce restrictions and regulations that many countries may not employ.

Transplant tourism represented just 5% of all recipients as of 2005, but Pro is actively incentivizing this practice, creating a market that will drive up the price of organ, creating legal opportunities for the rich to easily cut to the front of the line. This will come at the cost of local populations in developing countries, who will suffer consequences including common post-transplant infections, persistent pain, and yes, death. Even the financial impact for donors is often negative, since family incomes often decline and more people end up living below the poverty line.


II) Framework

My argument is that, when it comes to adding an influx of resources to a given system (someone owned it before and is now putting it on the market), that influx should be distributed equitably, i.e. everyone should have an equal opportunity to pay for them without pricing schemes that bias their availability for the rich. This isn’t a give-away, and it isn’t redistribution.

Pro’s counter framework is poorly explained and only begs the question: what makes an “adequate justification”? I have provided a more than adequate set of justifications, though refusing to establish a market is not “redistributing” anything, no matter how Pro wants to frame it.


III) Informed consent

A) Risk in organ sales?

See my overview. There are many countries where these surgeries and their aftermath commonly result in worse outcomes.

B) Who will sell?

Pro concedes that the poor and uneducated will be far and away the most common sellers.

C) Can they consent?

1) “Informed”

Pro concedes two points:

1) That many individuals, particularly in developing countries, are ill informed about the consequences of kidney donation.
2) That, if given the choice after learning those consequences, those people would not have donated.

Pro must explain how he would ensure that sellers both know the facts and understand them, not just say that assert solvency. Similarly, doctors currently lie to their patients. How does Pro solve for that? He doesn’t say, and that will get worse in a world where people are considering selling their kidneys because doctors have an incentive to acquire kidneys for other patients. Pro does argue that government observation will solve the transaction, but it just begs the question of how. What will the government do to prevent these transgressions? No specifics, no solvency.

2) Undue inducements

Pro doesn’t address the comparison to clinical trials. Not only are they more akin to organ sales than Pro’s examples (clear cases of informed consent for medical purposes), but it also clarifies the problem: payments can become undue inducements if they are excessive. Pro himself argues that that $45,000 inducement is “ridiculously higher than the price actually required” (though I’ll note that he never justifies that statement), creating a unique and massive inducement. Rather than engage with the definition I presented, Pro pushes another false dichotomy that the choice is between paying someone anything or not paying them at all. I’m not arguing that compensation is inherently problematic, but that compensating excessively to “impair [a persons’] ability to exercise proper judgment” is.

3) Coercion

Pro’s response to my point about a permanent loss doesn’t track. He’s arguing that death is a permanent effect, but neither firefighters nor soldiers are expected to die. It does happen, but it is not inherent to the job. You accept a degree of risk when you take these jobs. By contrast, there is no degree when it comes to losing an organ in donation. Your risk is 100%.

It has never been my point that “any form of compensation could impede someone’s judgement” and that is patently absurd. We can simultaneously recognize that payment for labor is both good and necessary, but that paying in excess to draw in poor workers is coercive.

4) The black market

This argument is not speculative. There is evidence of black markets expanding in nations that have legal organ sales, even in Iran. Pro will have to explain how that’s possible if they have truly eliminated their organ shortage. Pro also ignores the nature of those black markets; transplant tourism happens because rich people know they can skip the wait for a kidney in another country. The international organ trade exploits discrepancies between countries (incapacities, different regulations and implementation), and expanding that market by legalizing the practice deepens and entrenches existing inequities.

D) Impacts of legalizing anyway?

Pro drops physician-patient trust. If he can’t solve for understanding and physician misinformation, this still happens, potentially affecting countless lives. Pro also drops the irreversible harms to patient autonomy, personal integrity and self-ownership.


CP) Reimbursement

Opinion polls taken of the public and medical community favor these or direct-payment organ donation. These “models potentially are scalable in developing countries,” providing a means for implementation that does not feed into black markets. In Sweden, where this is ongoing, “donors do not regret their donation and report a good quality of life post-donation”; they also don’t suffer health or financial distresses that are common among those who sell their organs. Pro also hasn’t established a necessary amount of compensation to eliminate waiting lists. My CP removes two major impediments to donation:

1) It provides the means to perform a live donation at no cost to them.
2) It provides the means to buy family members at no cost to them.

In both cases, the poor are the ones who benefit most. As the largest population in the world who often lack the means to do either of these, the removal of these disincentives to donation and the enabling of families to honor deceased relatives are both substantially positive impacts that Pro dismisses as not going “far enough” without explanation. I would contend that this CP will also solve for the kidney shortfall without offering undue inducements.


IV) Pro’s case

1) Solvency

Pro argues that $45,000 is not an undue inducement… and that it will bring in droves of people to sell their kidneys. It’s not coercive… it just induces behavioral changes in a lot of poor people who would not donate their organs otherwise. I can’t reconcile these statements. Either Pro’s case offers a “ridiculously higher price than the price actually required” to assert full solvency and bite coercion, or his solvency is suspect because no one is coerced.

So, let's talk about his solvency.

It’s unclear how much Iran’s waiting list has declined over the years. However, Pro’s focus on the waiting list is misplaced, as “we do not know the total numbers who are in need but unable to afford a kidney”, “many dialysis patients are still not scheduled for renal transplantation and continue chronic hemodialysis”, “women, in particular the unemployed, are less likely to be listed”, “many patients who are from villages and small towns and do not receive a diagnosis are not referred for dialysis”. In other words, the numbers are skewed, resulting in artificial reductions in the number of patients on the waiting list. Other countries like Pakistan with paid donation still fall well short of their needs.

Pro’s second source, they arrived at $45,000 by taking the cost of donation and multiplying by 3. The authors don’t provide any evaluation of the effectiveness of this price point in yielding sufficient kidneys. They assume that conclusion. Pro argues that it is much higher than Iran’s, but this assumes that a) Iran’s price point has been effective, and b) Americans don’t need the price hike to sell their kidneys since Pro asserts that to this market the same way that Iranians have, which makes the “ridiculously higher” price offered by Pro an undue and entirely unnecessary inducement.

Moreover, Pro is supporting major inflation in the price of a kidney, which will start a bidding war that will drive the price of kidneys up. Grant Pro his argument that this is very profitable for the US at this price point because that gives a lot of room for the US to keep raising the price while staying profitable. Other countries could as well, particularly those that don’t add to the cost with red tape. At some point, that price will induce a lot of sales. That point, however, will undoubtedly be intensely coercive.

2) Loss of life

Pro and I would both place restrictions on the circumstances that allow an individual to give/sell their organs to another person. Pro agrees that the government system should exist with regulations that would both slow the rate at which organs are acquired and reduce their number. Those independent sales that he’s talking about are still regulated, not just on the basis of consent, but also to prevent instances of coercion, prevent black markets from forming, restrict the number of kidneys an individual can sell, determine the age of consent (Pro says “adults”) and monitor the sale to approve it. These aren’t minor restrictions, as many of these could delay sales by months or years in order to ensure that every box is checked. Much as Pro accuses me of “killing” individuals by prohibiting this market, Pro is also engaging in a certain amount of the same “killing” by tying the market up in red tape. If Pro wants to stand on this principle that the government should never kill individuals by restricting the free market, then his case conflicts with this framework. He's also creating an international market that, in many countries, will prioritize profits over people and result in more deaths. If that's not killing, I don't know what is.

Round 3
christianm's avatar
christianm
Pro
#5
Overview

Pro showed how the US would profit, and that’s assuming they enforce restrictions and regulations that many countries may not employ.
The countries I'm criticizing restrict organ sales altogether. I simply argue that this is immoral when they could place lesser restrictions that would prevent organs from being stolen or patients from being lied to.

legal opportunities for the rich to easily cut to the front of the line
The rich can cut to the front of the line for food, shelter, etc. Should we ban people from selling those? Communism has been shown to be remarkably inefficient.

My opponent argues that kidney sellers are often worse off than before, and their source [1] states "Middlemen in particular are criticized as misleading potential donors about what a nephrectomy involves and keeping a large share of the payment." I suggest that the government take steps to prevent this, which I will address later in my argument.

Framework

everyone should have an equal opportunity to pay for them without pricing schemes that bias their availability for the rich
Being rich means having more money and more availability to pay for everything. As I said before, short of communism, nothing will prevent this. I also argued that the government should pay for kidneys for those who can't afford them.

Pro’s counter framework is poorly explained and only begs the question: what makes an “adequate justification”?
What makes something "just" or a "substantial cost"? Con's framework is just as vague. My framework is similarly open-ended, as whether there is an adequate justification to restrict an organ market is the subject of this debate.

refusing to establish a market is not “redistributing” anything
The government is not only refusing to establish a market, it is refusing to allow a market for kidneys between consenting adults. A government that restricted food from being bought and sold could rightly be accused of killing people in the event of a famine.

Consent

Informed

Pro must explain how he would ensure that sellers both know the facts and understand them, not just say that assert solvency.
The system I suggest is the same one used to ensure kidney donors are properly informed [2]. The seller must meet with members of a living donor evaluation team who will discuss all risks associated with the procedure. Due to corruption in certain countries, I will add that the team must be recorded explaining each of the risks and that the seller must sign a form of understanding. If Con believes that doing this is unrealistic, does he oppose kidney donations as well? Con's issue is with kidney sellers being uninformed, but there's no reason that donors would be any more informed than sellers. If a kidney seller won't benefit economically and still agrees after being informed of this, it would be silly to conclude that they must be intentionally working against their own interests. People can also be motivated by altruism, as proven by the significant (yet insufficient) number of donations every year.

Undue Inducements

comparison to clinical trials.
Con only argues that people might think irrationally when agreeing to clinical research; but does he think that paying clinical research subjects should be illegal? People need kidneys in the same way clinics need research subjects. Like with firefighting and the military, I think Con would argue for greater transparency, but not for banning these transactions altogether.

I’m not arguing that compensation is inherently problematic...compensating excessively to “impair [a persons’] ability to exercise proper judgment” is.
It seems that where we disagree is how much a kidney donor or seller should be paid. Should they be given only enough to cover expenses or given an even greater amount to act as an incentive? In clinical trials, the military, and firefighting academies, it's generally agreed that whatever price the market will bear is sufficient. Very rarely do we worry that firefighters or soldiers may be paid too much and that this will impede their judgment. Often the military will pay for someone's entire college expenses [3]. This deal is very attractive to many people. Also, a deal being "very attractive" is relative. Does Con suggest that we pay poor firefighters or clinical research subjects even less to avoid making the deal too attractive?

Coercion

neither firefighters nor soldiers are expected to die
During a time of intense war, soldiers can have a large chance of dying (55% during WW2 [4]). Construction workers have a very significant chance of death (over 9.6% [5]). Is losing a kidney really worse than a 55% chance of dying? In one case, the permanent effect isn't definite or even always likely, but it's much worse. Regardless, Con's argument is that large payments can make people unable to consent. Would he really be happy with hundreds of thousands of construction workers risking their lives without agreeing to take that risk? Or soldiers fighting a proxy war? (These analogies clearly deal with autonomy, personal integrity and self-ownership.)

Con has dropped arguments about coercion by family or of minors.

The black market

Con's sources don't show that Iran's policy has worsened the black market, only that one still exits [6]  [7]. L.A. Times states, "Rezaei considered signing up to sell his kidney through government channels, but his brother-in-law needed the money back immediately." If government channels didn't exist at all, we'd likely see more people using black markets.

Reimbursement

positive impacts that Pro dismisses as not going “far enough” without explanation
I'd rather have reimbursement than the current system. But if Iran must offer more than the cost of the procedure to bring in more kidneys, it's silly to suggest that such a system would alleviate the shortage entirely in other countries.

Solvency

Iran

 It’s not coercive… it just induces behavioral changes in a lot of poor people who would not donate their organs otherwise.
Incentives are not coercion. Force and threats aren't being used here. There's a difference between making someone a really good deal and a "deal they can't refuse".

Con's source states that overall, "The waiting list for kidney transplantation in Iran has improved more than in any other country in the world." [8]. While Iran might have independent problems that impede healthcare, its system has greatly improved since the introduction of incentives for kidney donors.

The source states, "A major cause of this is the many patients who are from villages and small towns and do not receive a diagnosis and are not referred for dialysis." This is not a problem caused by kidney sales, it's a logistical issue that would exist with or without them. But the system has helped many other patients.

Cost-Benefit Analysis

The authors don’t provide any evaluation of the effectiveness of this price point
This is almost ten times the amount offered in Iran. A system like this doesn't exist in the United States, so the best way to determine whether it would is to account for an extremely wide range of possibilities. The authors assume a worst-case scenario (choosing a number much, much bigger than the amount required in an existing example). Based on the system shown in Iran, it's probable likely that the price required will be much less than $45,000 per kidney. This inflated number accounts for variability.

Pro argues that it is much higher than Iran’s, but this assumes that a) Iran’s price point has been effective, and b) Americans don’t need the price hike to sell their kidneys since Pro asserts that to this market the same way that Iranians have, which makes the “ridiculously higher” price offered by Pro an undue and entirely unnecessary inducement.
a) Iran's system has reduced at least most of the shortage (admitted by Con's source) caused by a lack of donors. Iran has an excess of people willing to sell their kidneys (ads appear almost daily [9]); the issue is simply Iran's other problems (women not being treated, people not being diagnosed.)

b) Americans may need some increase in price offered, but likely not 10x. The point is that whatever the price required, it's probably low enough that the government will save money in a government incentive system.

This price point...gives a lot of room for the US to keep raising the price while staying profitable.
I'd support lowering the price if it turns out that $45,000 is more than required (allowing private transactions should take care of this initially). But Con doesn't seem to contest that the government will save money under this system. His contention is with coercion. (I addressed this in the earlier section on the subject.)

Loss of life

From a utilitarian perspective, allowing the sale of kidneys gets them to those that need them most. The regulations I propose wouldn't prevent kidney sales between consenting adults (murder). They would prevent non-consensual transactions. Non-consensual transactions, such as those achieved through lying or buying a kidney from a five-year-old are unjust; preventing them is not murder. But if a transaction between two consenting adults is just, as I have argued, then preventing such a transaction is unjust and will likely cause someone to die (murder).

Pro is also engaging in a certain amount of the same “killing” by tying the market up in red tape.
The red tape prevents unjust transactions, not consensual ones. Per my earlier analogy, the government can ensure child laborers don't produce food and prevent food from being stolen. But disallowing the sale of food would cause starvation and is unjustified.

An international market...will prioritize profits over people and result in more deaths.
No one is being forced to buy or sell anything; they are allowed to make their own decisions. I'm deciding not to directly kill a large number of people to save a smaller number.
whiteflame's avatar
whiteflame
Con
#6
I) Overview

A reminder: this is a worldwide market for organ sales. Countries, particularly corrupt ones, can and will take advantage of opportunities to profit off the organ trade when you open that can of worms. Pro’s “lesser restrictions” won’t solve for that. Pro concedes every consequence I’ve listed for local populations in many nations, including infections, pain, financial hardships and death.

Pro’s arguments throughout much of this round break down to whataboutism and straw-manning so I’m just going to cover that here.

Whataboutism: Food distribution and the availability of shelter are important issues that have nothing to do with this debate. How much people get paid to work dangerous jobs matters, but it has nothing to do with this debate. We are talking about the opportunity to get access to life-saving organ and how that access varies based on wealth. It is better to have a donor-only market for organs because that prevents much of the issues with biased access to said organs. If Pro wants to explain how increasing that bias is beneficial, he’s welcome to do so.

Straw-manning: Preserving more equal opportunity to buy medically necessary organs is not  communism. Objecting to for-sale organs because the rich could take greater advantage of that system is also not communism. Rejecting sales of organs is not a veiled rejection of all sales of goods.


II) Framework

Pro doesn’t justify why the rich should have greater access to life-saving organs. He concedes that his case will afford them greater access, so he concedes the harms of expanded transplant tourism and the harms of defaulting to utility over distributive justice: creating, exacerbating and entrenching inequities on a permanent basis.

I did explain what is “just” – equal opportunity to pay for life-saving necessities like organs – and what suffices as “substantial cost” – the entirety of my harms scenario. Pro is welcome to argue against either of these directly, but just dismisses them as vague. By contrast, Pro doesn’t tell you what suffices as an “adequate justification” under his framework.

III) Informed consent

I’ll come back to A, B and D where pertinent, but Pro conceded all of them.

C) Can they consent?

1) “Informed”

Pro appeals to the existing system as a means of informing kidney sellers... the same system that results in misinformation and misunderstandings in the status quo. So, he relies on what is an already a broken and ineffectual response to address what he believes will be a massive seller market, so he is ballooning the problem.

Regarding corrupt countries, there is no international agency that exists to regulate them as Pro suggests. Pro relies on the establishment of a brand-new agency that will monitor hundreds of thousands of recordings in every language. They’ll also have to be given authority by every nation to block sales and hold those who violate its standards accountable, even when these countries profit from a lack of regulation. Unrealistic? More like impossible. No international agency has that kind of legitimacy or manpower. If we’re suddenly in the wishing business, sure, it would be great if I could just fiat that all kidney donations were well regulated worldwide. Pro is the one creating a massive new market, so the consequences of failure for him are catastrophic.

2) Undue inducements

Not all payment is undue inducement, but excessive payment is. Excessive payments exert pressure that is exceptionally powerful on those in greatest financial need. Transparency doesn’t solve this, so that is a non-sequitur.

A lot of Pro’s responses to this problem are whataboutism (see: I). We are not talking about established markets (labor or clinical trials included), for which the price is usually stable. We’re talking about establishing a brand-new market on an international scale. There is no established cost of a kidney in most countries, no way to determine whether the price “is sufficient” or excessive, and no way to control for fluctuations in that price resulting from inter-country competition.

3) Coercion

Since the loss of a kidney always results from its sale, the harms are pervasive. Everyone who sells incurs a permanent loss. Pro may not see that loss as substantial, but every case inflicts permanent harm to autonomy, personal integrity and self-ownership. Pro compares this loss with death tolls from jobs (soldiers were drafted in WW2 so they were literally coerced), though their relative weight to those losses is irrelevant to my point. They are not killed 100% of the time. Construction workers are paid fair wages. Soldiers are paid fair wages. Those wages reflect the danger they incur in those positions. They can and do still consent to do them.

And hey, thanks for the reminder, Pro. I did forget to mention that you dropped this point from my R1, so I’ll just re-post it here:

Individuals are often influenced by family members. Potential donors may be subject to explicit or implicit threats that are inherently coercive, but organ markets generate a substantial new incentive for coercion to explode among potential sellers. Coercion is particularly problematic among younger sellers: in countries like Canada where the age of consent to donate is 16, those donors are still dependents and thus may be subject to intense financial and psychological pressures.

The above harms exist regardless of Pro’s regulations. He can only assess whether sellers knowingly agree to sell based on those recordings, not what led them to do so.

4) The black market

Pro claims the lack of a legal market results in a larger black market, though he provides no warrant or evidence to support that. My sources tell a different story: “[r]egulation in Iran has not ended the black market, it has simply made it an official policy”. In other words, the black market and Iran’s legal market are inextricable. If you buy that Iran’s organ market has expanded, then you buy that their black market has as well.
 

CP) Reimbursement

Pro drops every response on this point. Instead, Pro treats Iran as the bar for determining the necessary cost to bring in more kidneys. Pro in no way justifies this, he just assumes that Iran has it right. Even if he is correct that Iran has solvency, that does not mean that their price is the lowest possible price to achieve it.

As for the CP’s solvency, I’ve already demonstrated this. It is more popular than a direct-payment system (which suggests more people would buy into this system and donate), scalable across all countries (there won’t be inter-country competition that deprives many countries of access to organs by driving sellers elsewhere in search of better prices), lead to fewer regrets, post-donation harms, health and financial distresses (all of which might discourage future sales in Pro’s world, harming his long-term solvency). It also uniquely incentivizes the poor (removing financial burdens for health of live donors and providing free honorable burials for the dead) without being coercive.


IV) Pro’s case

1) Solvency

On Iran’s solvency, Pro drops that there are many people who need kidneys that are not on the waiting list. That makes it difficult, if not impossible, to evaluate whether their organ market is reducing the total number of people who need a kidney. Having a lot of advertisements for selling kidneys doesn’t demonstrate this, either, since it only shows that there is still demand. Pro also ignores the Pakistan example, where donors are paid and yet supply remains low. This suggests that any positive effect in Iran is specific to Iran.

Pro’s case relies on inducement – his solvency wouldn’t work if he didn’t – so the only question that remains is if that influence is undue. An undue inducement is “when an incentive is so attractive that it causes people to ignore their personal values or preferences in order to participate” in the kidney market. Despite acknowledging that his $45,000 total is “ridiculously higher than the price actually required”, despite conceding that it is the poor and uneducated who will comprise the vast majority of sellers and therefore be uniquely vulnerable to this form of inducement, he somehow doesn’t view it as undue. Pro says that he’d support lowering the price if his price ends up being too much. That’s irrelevant. Pro is already suggesting inflating the price, and that price will continue to rise with or without the US, sparking a bidding war as countries endeavor to corner this new organ market, which will drive up the price well past that amount. Any countries that lower their prices, or those that can’t match them, will suffer from prolonged shortages of kidneys that will worsen the absence of kidney donors that now have incentive to sell to the highest bidders.

2) Loss of life

I’ll note that Pro’s new “utilitarian perspective” would also support getting those organs regardless of consent. If getting these kidneys to those who need them most is the priority, then consent shouldn’t be a consideration. He’d get more kidneys faster that way. I’ll also note that his utilitarian perspective conveniently sidelines any harm that an international market will do to the people who are coerced (yes, with force and threats) into selling their organs. Pro can claim that they aren’t going to be coerced, but his system of prevention is too ill-defined to address what he claims will be a massive new international market.

Pro keeps changing his mind on what regulations he would put into place since not all of the ones he has suggested up to now regard consent. He also seeks to place regulations that will prevent black markets from forming, restrict the number of kidneys a person can sell, and restrict the age at which one can consent to selling an organ (a 17-year-old could not consent under Pro’s restrictions). All these efforts would slow kidney acquisition, and all of them thus would engage in the same “killing” (now he’s calling it murder) that Pro accuses me of facilitating.


Back over to Pro.
Round 4
christianm's avatar
christianm
Pro
#7
Overview

Countries, particularly corrupt ones...will take advantage of opportunities to profit off the organ trade
The can of worms is open already. It's much easier to take advantage of an unregulated black market where many people need kidneys than regulated markets in other countries.

Pro’s “lesser restrictions” won’t solve for that.
If we don't trust these countries to enforce "lesser restrictions," why would we trust them to ban all organ sales?

Whataboutism
Analogies are not whataboutism. If selling food is morally permissible, then rich people having more money doesn't mean we should ban selling things. My opponent says "a donor-only market for organs...prevents much of the issues with biased access to said organs." but we know that having a donor-only system for food is ridiculous, despite the worldwide market for food that exists today.

Straw-manning
I said that negating the effect of the rich being able to afford more of everything requires communism. If Con wants to be consistent, why not ban the sale of everything so the rich don't get most of it? So I guess the other alternative would be allowing people to donate things only. Whether we do that or communism, free trade is getting banned. My opponent clearly supports free trade in plenty of cases, so they don't think that the rich being able to afford more than the poor is a good enough reason to ban it.

Framework

Pro doesn’t justify why the rich should have greater access to life-saving organs.
If the rich are willing to buy them and someone is willing to sell them, why should the government prevent this exchange, effectively killing the rich person who needs an organ? We allow people to buy and sell food (clearly not immoral) even though this gives an advantage to rich people.

I did explain what is “just” – equal opportunity to pay for life-saving necessities
Food is a necessity, but we let free trade do most of the work and give food stamps to the poor. My proposed system for kidneys mirrors this.

Pro doesn’t tell you what suffices as an “adequate justification”
Adequate justification = A good reason to ban something. Con has been listing potential justifications in each of his arguments, and I have been countering them. Do we disagree on what an adequate justification is? Yes. But we also disagree on justice and substantial costs.

Informed Consent

I’ll come back to A, B and D where pertinent, but Pro conceded all of them.
I argued that (A) would be addressed by properly informing sellers. I argued that (B) is irrelevant. I gave a clear solution for D (informing sellers) that Con addresses later.

Informed

Pro appeals to the existing system as a means of informing kidney sellers
Con argues that kidney donors should be reimbursed. I argue that we should use the same methods of informing people used for donors in the USA. If Con thinks they are insufficient, why does he support people being allowed to donate kidneys at all, if they aren't informed enough to make that decision?

 there is no international agency that exists to regulate them as Pro suggests
Each nation should create its own agency. I'm sure Con would say we can't trust them to do that, but then why would we trust them to ban kidney sales?

Undue Inducements

Not all payment is undue inducement, but excessive payment is.
I gave an example of huge payments offered to soldiers. We don't consider that to be immoral, so how can Con suddenly argue that it would be immoral to do the same for kidneys?

We are not talking about established markets, for which the price is usually stable
Stable can still be excessive. As I said before, a "reasonable" price for a wealthier person might be "excessive" for a poor person. And this isn't whataboutism, I'm saying that we should be morally consistent here. If it's fine to offer large payments to soldiers or firefighters, why not to kidney sellers?

Coersion

Con's argument for coercion is based on excessive payments. The only difference here would be that I support coercing someone to give up their kidney, but he supports coercing someone to risk a significant chance of death.

soldiers were drafted in WW2 so they were literally coerced
I'm sure Con doesn't support drafts in all cases, and I tried to address this. Suppose there's some proxy war that doesn't require a draft. If soldiers were paid huge amounts of money to fight as they are today, would Con consider this coercion? I don't think so.

their relative weight to those losses is irrelevant to my point. They are not killed 100% of the time.
But why does that make paying them any better? Con argues that paying someone to give up a kidney is bad, but paying them to risk a 50% chance of death is fine. They're clearly giving up more in the second scenario, so where's the logic?

Individuals are often influenced by family members...organ markets generate a substantial new incentive for coercion to explode among potential sellers.
There's already an incentive to coerce people to become donors. Under my system, the shortage is alleviated, so there's less of an incentive to do so. So why does Con support allowing donors, when there's even more of an incentive to coerce them? I don't advocate for allowing 16-year-olds to sell (Adults is in the title of the debate) because they can't consent.

Pro claims the lack of a legal market results in a larger black market
Con brought up the issue of black markets. I said that as long as we're speculating, they'd be more likely in the event of a shortage. An "official policy" is the opposite of a black market—the incentive for illegal kidney sales has decreased. The article compares this to a black market by arguing that it exploits the poor. (I have already addressed this.) It argues that some illegal sales are being made, but there would be more motivation to offer illegal incentives in a donor system where a huge shortage exists. There's no evidence that this system has increased the number of illegal transactions.

Reimbursement

Pro treats Iran as the bar for determining the necessary cost to bring in more kidneys.
Clearly, reimbursement doesn't work everywhere, so my system will be required in at least some countries. And if reimbursement does alleviate the shortage entirely, then why ban adults from selling kidneys? (There'd be no one to sell them to, anyway.) In places like America, the costs associated with donating a kidney are even lower compared to average income, but we don't see the shortage anywhere close to being alleviated. Rich people aren't showing up in droves to donate kidneys out of the goodness of their hearts even though they could afford the expenses; the problem isn't that expenses are holding people back, it's the lack of an incentive.

Even if...Iran has solvency, that does not mean that their price is the lowest possible
Iran's government has a strong incentive to lower their price to save money; it's illogical to suggest they would inflate their price if they didn't think they had to.

As for the CP’s solvency, I’ve already demonstrated this.
Except for alleviating the shortage, which my system has been shown to be extremely effective at.

Solvency

There are many people who need kidneys that are not on the waiting list.
The system helps people on the waiting list but doesn't make it any harder to get on the waiting list. Is Con suggesting that, now that anyone on the waiting list can get a kidney, people are avoiding it more than before? The obvious conclusion is that the total number of people that need kidneys has been greatly reduced and that there are enough kidneys to go around; logistical issues are the problem.

I'll address this now since Con still has another round to counter me. The article states that "In Pakistan the bill for cadaveric organ donation has sat in the Senate awaiting approval for the last nine years because of the apathy of the legislature." and "For a population of 140 million there are 150 dialysis centers, mostly in the private sector where dialysis costs US$ 25/session." Instead of arguing that kidney sales haven't improved the shortage, the article argues that other factors have made the problem worse. Furthermore, banning kidney sales altogether would harm many people without solving the aforementioned problems. (The article states that almost 50% of Pakistan's donations are paid.) That allowing kidney sales has alleviated the shortage a significant amount is not the subject of much contention.

bidding war
There's many more kidneys to go around than people who need them. The price will level off at some point, we just don't know exactly where. I addressed Con's argument against "excessively high" incentives earlier.

Any countries that lower their prices, or...can’t match them, will suffer from prolonged shortages of kidneys
This is speculation. The system in Iran indicates that there's enough kidneys to meet the demand. Overall, the total number of people dying of kidney failure will decrease; who cares how rich they are? The government shouldn't prevent people from selling necessary items (kidneys, food, baby formula) across borders. Free trade tends to alleviate shortages, not worsen them.

Loss of life

Con's argument that resources should be distributed equally is utilitarianism. If we follow the maxim "to each according to his needs," then a free market is the best way to get kidneys to those who need them. I'm not utilitarian, but Con keeps arguing about the net effect of this system which is why I'm bringing this up. If people have a right to voluntary exchange, then many of these effects are irrelevant.

All these efforts...would engage in the same “killing”
I've been fairly consistent that only consenting adults should be allowed to sell kidneys since the description. If selling a kidney is not coercive and both parties can consent (as I have argued) then unjustly preventing this is murder. This is especially relevant if the ends don't justify the means, which Con agrees with.
whiteflame's avatar
whiteflame
Con
#8
A couple of important considerations before I start breaking down the debate.


First, Pro has compared the kidney market to food and labor markets. He calls them analogies, but this is whataboutism, i.e. if you’re willing to do this here, what about elsewhere? My arguments are specific to the kidney market. Harms that apply to this market are unique because: there is 100% incidence of harm to patient autonomy, it’s a brand-new market with no existing rules or pricing standards, and trade between nations is unregulated. None of these apply to his examples. Pro cherry-picks minor points of comparison that do not relate to this market.


Second, Pro’s offense and his entire case, absent a few poorly defined and continuously shifting planks, is confined to his first round. He spent the vast majority of this debate playing defense, and it shows in the lack of comparative analysis.


Onto my crystallization.


1. What solvency do each of us achieve and for whom?

I’ll simplify things up front:

This means that I grant Pro some access to his one and only impact of consequence - that he prevents the deaths of patients in some countries who otherwise would not have access to these kidneys. He provides other arguments, though none of them generate distinct impacts aside from a small amount of savings for taxpayers in the US that Pro cannot guarantee for any other country, and saving money is a pretty weak impact.

A couple of caveats.

Pro’s solvency is restricted. Wealthy countries (i.e. the ones that can afford to pay top dollar for them) will have access to a plethora of kidneys if they pay top dollar. Access for the poor in any country to these organs is likely to be limited, given that the rich will offer higher prices to both individuals and governments to obtain them. That is his best cast scenario. Poor countries, which make up the vast majority of the world, will lose access to the few donors they have now since any potential donors would have a huge incentive to sell their kidney in a rich country (this is why having a reimbursement system alongside a sales system doesn’t work - sales parasitize donations). As such, the wealthiest countries and people are winners under Pro’s plan. Everyone else loses. That is both the limit of Pro’s solvency and its key flaw: any gains and losses are heavily biased. Pro’s claims about pricing coming down rely on ready, equitable access to kidneys across social classes and countries. He doesn’t and cannot achieve that, so prices will stay high even as the market saturates in some nations. Corrupt countries might thrive in this market as well by ignoring costly regulations and coercing their citizens to sell.

Compare this to my case. Pro’s only response to my CP is that it doesn’t solve, but his argument relies on the existence of some undefined floor price that must be met. Neither Pro’s study nor his Iran example demonstrate that there is a minimum price to achieve this result. If anything, the discord between Iran’s and Pakistan’s results suggests that sales price alone is an insufficient metric for assessing solvency. As such, it remains unclear what threshold is required to achieve the solvency on a similar scale to Pro’s. His only basis for claiming that my solvency is lesser is that he attributes the current lack of donations to a “lack of an incentive”, ignoring the fact that even in Canada, a country with universal health care, the costs of donation to the patients can range from $1000 to $10,000. Removing that barrier makes donation accessible to the largest population in the world: the poor. Offering to remove barriers to bury loved ones would similarly increase accessibility to both honorable burials and donations. Maybe Pro achieves his solvency faster, he may even achieve an excess of kidneys within rich countries, but he hasn’t provided any reasoning for why my CP does not achieve base solvency.

Meanwhile, I’ve provided several reasons why it both achieves solvency and is preferable to Pro’s case. Pro drops the popularity of reimbursement among the public and medical community, so there is mass buy-in for donors and providers. It is “scalable in developing countries,” providing a means for implementation that does not feed into black markets, incentivize coercion, and cannot engender undue inducements. The CP also solves for regrets, quality of life issues, and does not add to financial distresses. 


2. Does Pro rely on undue inducements and how harmful are they?

Pro’s case exacerbates issues with informed consent that currently exist. Pro concedes that informed consent is a problem now. There are a set of risks that are both inherent to kidney donation that scale with poverty and corruption. The population that is most likely to sell is mainly composed of poor and uneducated people. Pro concedes that the promise of funds will increase this disparity, particularly in the former population as they suffer from economic duress that they experience more deeply and continuously. This establishes that the population is uniquely vulnerable to inducements, also lowering the bar for what makes such inducements undue.

Both knowing and appreciating the facts are essential to consent. Comprehension of the risks of donation already varies widely in and across countries and many who have donated end up regretting their choice afterward due to that lack of understanding. Yet, Pro relies on existing measures that fail to ensure consent while he massively expands the pool of people who must consent.

There is a difference between excessive and large inducements, with only the former consistently constituting undue inducements. Pro tells you why $45,000 is not just large, but excessive: setting a price for kidneys that massively exceeds Iran’s at “almost ten times the amount”, and he even says that it is “ridiculously higher than the price actually required”. But you don’t have to bank on his numbers as it will soar far higher as countries scramble to corner the market. Countries that try to keep the price stable will lose access to their sellers as other countries that can afford to pay more lure them away. Pro claims that the price will “level off at some point,” another assertion without warrants or evidence that simultaneously concedes tremendous short-to-medium term inflation. Those rising prices will be undue inducements for those already under economic duress. Coercion adds to this, and considering the disparities between countries and the resulting donor drain I mentioned, those shortages will worsen in poor countries. This will also increase incentives for family members to threaten their loved ones for a bigger payday. Moreover, if every nation is now creating its own agency as Pro suggests (new to this round), then they all have a perverse incentive to increase the number of sales through that agency. Some might even define an “adult” differently, as many already do for other purposes, so Pro just gave them the means to include 16-year-olds.

And that coercion only gets worse with a black market. Pro claims that a legal market solves, though his sole example is Iran, which has entrenched and expanded their black market:
Legal markets for organs do not erase black markets - they just incorporate and exploit them.

Pro’s case devastates informed consent via undue inducements that will get more undue as competition rages, transforming existing black markets by legitimizing and expanding them, with similarly ballooning effects on coercion.


3. What’s the harm?

Pro concedes that my CP causes no harms and avoids many of the harms his case causes.

Pro’s harms are numerous.

Pro keeps trying to redefine my framework, calling it redistribution, communism, and now, utilitarianism. None of these are accurate. It’s distributive justice, and it regards two things about organ markets: recognizing that sellers should not be parasitized for the desires of others, and there must be equal opportunity for buyers to access the supply. Pro was hung up on terminology and presented a vague opposing framework, but my framing is straightforward, my definitions for “just” and “significant” are clearly articulated, and there are clear impacts: the creation, exacerbation, and entrenchment of inequities.

These inequities destroy patient-physician trust and cause irreversible harm to patient autonomy, personal integrity and self-ownership. That trust is integral to health, compliance with treatment and participation in research. Pro is causing irreparable damage to the healthcare system, damage that gets worse in countries where more sales occur (i.e. where he is more successful). Pro dismissed the risks of kidney sales, but he relies on people getting follow-up care after the kidney is removed. That care won’t happen due to the dissolution of this trust, which will exacerbate all the health risks that I’ve laid out worldwide.

Add onto the this the harms of undue inducements, as patients will “lie or conceal information that if known would disqualify them from enrolling or continuing as participants”, risking the safety of both donors and recipients, incentivizing perpetuating country- and family-level coercion, and the expansion, legitimizing and perpetuation of black markets. This perverts much of Pro’s solvency, turning his case from a simple “more kidneys = more transplants” into a tangle of new and enhanced problems. These are all uniquely worse in Pro’s world.

Voters, if you buy any of these, then you buy that any impacts Pro achieves are tainted by deep and pervading harms. Even if you don’t buy that the CP will solve for the entire market, Pro grants it some solvency. That solvency is absent these glaring costs, and includes making strides against existing harms.

Vote Con.