On kidneys and prostitution

There's been a lot of talk about selling kidneys lately (see, e.g., here and here), partially because of Virginia Postrel's Atlantic article on the issue. I know the permissibility of organ-selling has also been a hot topic in the philosophical literature, but it's not my area and I'm not up on it -- I have seen a few conference presentations on it, though.

Currently, financially compensating a kidney donor is illegal in the U.S. People who need kidneys rely on deceased donors (of whom there are not nearly enough and have less-than-prime kidneys) and on altruistic donors (also of whom there are not enough).

The most typical arguments against permitting compensation of donors is either 1) it would "cheapen the gift" made by the altruistic donors, or 2) it would be exploitative of the poor, who would be more tempted to donate for financial gain. 1) just makes no sense to me at all. Saving a life is still a wonderful thing to do for someone, even though we pay people (doctors, nurses, EMS, etc) to do it. 2) makes a bit more sense, but it is not persuasive. It is possible that a situation that is consensual and mutually advantageous is still exploitative (see: Triangle Shirtwaist Factory). But without becoming completely redistributivist, we cannot prevent the fact that riskier and less pleasant enterprises will be more tempting to those who have no money. The poor do jobs that the rich do not want to do, jobs that are more dangerous (e.g., the military), more grueling (e.g., sanitation), etc. There seems something excessively paternalistic in telling a poor person who would be willing to trade a kidney for, say, $30,000, "We're not going to let you do this because you only think you have a choice in the matter -- but because of your poverty, you are not as free to choose to take on the risk. So we'll remove the choice entirely from your hands."

The most persuasive argument against selling kidneys is actually one that I think is also probably the best argument against prostitution. Prostitution is another case where consenting adults can negotiate a situation to their mutual benefit. Why shouldn't they? (Personally, I think a world where prostitution is legal would be a less pleasant place, but that doesn't mean it should be illegal). In both case, the commodification of human bodies in this most direct and intimate way (as opposed to hiring someone to, say, paint your house) increases our tendency to see other people as mere means, and not as ends in themselves. Even if in a single instance of prositution or kidney-selling, this was not the case, a culture's permitting it might encourage us to see people as stuff to be bought and sold.

I'm not sure that this is enough to make either one illegal. Especially in the kidney case, where the risk is so minimal and the benefits are so great. But it's the only argument against either one that I think has a real chance of getting off the ground.


  1. Does financially compensating donors for blood have any implications for kidney donations? Why is one illegal and the other not?

    On a bit of a tangent, do you think that treating people as group members, rather than individuals, also contributes to the tendency to see others as means and not ends in themselves? Like prostitution, in which the details of the transaction matter less than appearances, I suspect the use of group-identity judgements increase society's tendency to view humans as a commodity with a group lable rather than distinct, unique individuals (who by happenstance belong to certain groups).

  2. Gadfly, it is also legal to compensate people for egg and sperm donation, as well as temproary womb rental. I really don't understand why one is legal and the other not.

    And yes, I suspect group identity might contribute to more of a "mere means" problem.