For Preventing Shortages of Organs effectively and profitably without violating Humanity
By Dr. Ihrwir von Derdidas, August 2009
[1] It is an unquestioned advantage of modernity that science has found innumerable ways to greatly improve our quality of life, by increasing the average length of our existence ten, twenty, or even forty years, providing powerful means for fighting disease, allowing the production of food to exceed demand, and so on. Yet the young and fortunate can too easily forget that longevity comes accompanied by a high frequency of organ failure, and effectively treating conditions like diabetes and cancer requires biological materials of every conceivable kind. Victims of these afflictions need no reminder, though the reader might, that a daunting obstacle to the continued betterment of our lives is a massive global organ and tissue shortage.
[2] Indeed, the United States alone has nearly 100,000 candidates on its organ donor waiting list: 70,000 wanting kidneys, 18,000 livers, 2,000 pancreases, nearly 3,000 hearts, and thousands more who need multiple organs. China is reported to have over 2,000,000. As with any commodity where demand far exceeds supply, a black market exists for organs. The unique nature of the commodity, however, has given rise to particularly horrific practices and a tangle of ethical dilemmas. In China, for instance, the government has admitted to matching living death row prisoners with potential organ recipients, who pay around $66,000 for a kidney and up to $157,000 for a liver. And in India, debtors ignorant of possible health consequences are coerced into selling their kidneys for the going rate of $1,200, and subsequently suffer severe medical complications in addition to social stigmatization.
[3/4] Most every option for ameliorating these problems has been found wanting in some crucial respect. Creating and regulating a market for organs, encouraging people to become registered donors, using organs grown in animals (xenotransplantation) – all these alternatives prove to be impractical or, even worse, possibly unethical. It is precisely these two shortcomings I intend to avoid, having discovered a means to effectively satisfy the demand for organs that does not force us to sacrifice our moral integrity.
[5] There is another benefit in my plan, that it will sidestep those seemingly endless and intractable controversies about the proper definition of death, and the appropriate time to begin collecting material from a potential donor. These difficulties, while a fruitful catalyst for the discussion of important philosophical questions, must cause no end of frustration for those who still languish after organs, and are in no position to even effectively involve themselves in the debate.
[6] The number of sources that can conceivably provide harvestable organs is lamentably small. Swine are currently the popular candidates as a non-human source of organs, since primates are more difficult and costly to care for, and raise uncomfortable ethical questions. A British firm recently announced a cloned litter of genetically modified pigs, representing a milestone in xenotransplantation technology. Nevertheless, the still distant possibility already faces opposition. Transplantees might be subsequently vulnerable to retroviral infection, and some speculate this type of genetic meddling could lead to a devastating pandemic. There is also the ethical questionability of utilitarianism that values a human life over that of a pig. Using people, sadly, is no less problematic. With humans there can be little quality control; the supply from willing organ donors does not meet demand; and availability is completely unpredictable. Moreover, as we have already seen, the philosophical questions become insurmountably difficult: When is someone dead enough to harvest her organs? Should people be allowed to sell their organs? How should we regulate an organ market? And even allowing for the most relaxed ethical standards and a completely free market, Chance will continue to pile up the bodies of those hapless infants, children, and adults who die for want of a matching donor.
[7] The practical issues fail to admit of a ready solution, and I am persuaded that the ethical debate will never be resolved to the satisfaction of all parties. There are simply too many well-reasoned arguments for every position, and it may be beyond our intellectual capabilities to sort out the truth.
[8] I shall now therefore propose my own thoughts, which I hope will not be liable to any significant objection.
[9] I have been informed by an expert doctor that through a fortunate oversight of natural selection there exists a human genetic anomaly known as lissencephaly, which results in a creature that possesses virtually no morally relevant qualities, yet may be bred for the purpose of harvesting kidneys, livers, corneas or hearts; and it would equally serve for tissues and bloods.
[10] I do therefore propose to take these uniquely useful organisms, which occur at the tolerable rate of ten per one million births, and reserve them for breed; which is certainly a better fate than they would otherwise be entitled. Lissencephalitic “troglodytes” are often aborted, but I am sure many reasonable and well-meaning parents who cannot bear the prospective financial and psychological strain of raising a troglodyte would prefer helping a noble cause to having a wasteful abortion. Their donated specimens would become the property of public or private organizations (at the discretion of the law), where, for the sake of avoiding unnecessary cruelty and ensuring high product quality, they would be raised and bred according to rigorous standards, live in sanitized cages, and partake of a regimented diet. A troglodyte of any age will yield a bounty of organs and blood, in addition to providing ample attractive material for cosmetic surgery.
[11] According to widely recognized figures a human organ donor can save up to 7 lives, so we can speculate that a well organized breeding facility could save 9, 10, or even 11 lives with a single creature.
[12] I grant this plan might strike some overly sentimental people as distasteful, and therefore it will be the job of rational thinking to conquer unreasonable opinions with the truth.
[13] The providential condition that produces these strange organisms literally means ‘smooth brain,’ and physicians inform me that the consequent lack of crevices is often used to distinguish lower forms of life from humans. More significantly, it ensures troglodytes will never develop those capacities that make us and many animals bearers of significant moral worth; most have poor visual tracking, and only a few acquire the ability to sit up, much less feed at their mother’s breast or walk; of course they are completely incapable of reasoning and communicating; normal primates, pigs, cows, mice, and a variety of non-mammalian animals have far more developed brains and consequently deserve greater ethical concern. Therefore the actual distance between these creatures and ourselves is formidable. Any seeming evidence to the contrary, like the occasional attempts of would-be parents to raise these souvenirs of failed reproduction as though they were human, is simply an anthropomorphic illusion.
[14] My calculations indicate that the yearly expense of maintaining a troglodyte under the best conditions should be no more than $3,000, and much less than that for the first five years. Given current prices, we could permit the lucrative sale of three or four organs to the rich, and adopt policies where the remaining tissue and organs are distributed to those in greatest need, a status to be decided, as it should be, by the right reasoning of competent ethicists. A private biological research facility has confirmed my confidence in the economic and scientific feasibility of this project, and I imagine the prospect of combining profitability and social welfare cannot be found objectionable by any reasonable individual.
[15] Those pragmatic readers who are more concerned with profit (as anyone in our society must be) may entertain the additional possibility of selling troglodyte meat as a delicacy, especially flesh from younger ones whose organs have been used to save infants. This would be an exciting novelty for even the most jaded of gourmet palates.
[16] As for the concern that careful breeding may not avoid the occasional production of a human child, we can be thankful that the genetically recessive quality of lissencephaly makes this eventuality highly unlikely; and if 1 potentially human fetus per 1000 must be aborted for the sake of ethical consistency, I do not think it would be a great worry.
[17] A very creative thinker, a true lover of humanity, and whose reasoning I highly regard, was inspired to suggest a further use for these creatures. She observed that medical researchers, having of late become acutely aware of the ethical difficulties associated with experimenting on animals or with stem cells, might be better served by conducting experiments on troglodytes; in this manner we could cease experimenting on animals whose higher level cognitive function makes them candidates for the right to be free from such abuse, like birds, rodents, and primates; and furthermore would satisfy the objection that the distinct physiology of the animals experimented upon renders the relevance of results highly questionable. But despite the reasonable tone with which she enumerated these practical and ethical benefits, I found myself genuinely ill at ease; the image of experimenting upon creatures who bear such a strong physical resemblance to humans was too easily associated in my mind with images of Nazi experimentation on Jews to allow me any comfort. Disgust welled up at the very thought of condoning a practice which, while so metaphysically distinct, felt so viscerally similar to the wretched practices of the Nazi doctors. And though it is my avowed commitment to overturn wrong sentiment with right reason, I felt little desire or need to justify my reaction.
[18] But my friend reacted charitably to this unreasoned stance, and invited me to freely choose my opinion by thinking calmly and rationally about the facts. The strictest philosophical advocates of animal rights, she pointed out, only extend significant rights to mammals over the age of 1 year, but even the most accomplished troglodytes will never reach such a developmentally advanced level. And she cautioned me not to forget that irrational disgust with the notion of experimenting on cadavers greatly hindered the advancement of medical knowledge, and that my opinion was another instance of the same. Though I did begin to see the wisdom in her position, the danger of damaging organs, the potential for suffering, and my doubts about the utility of such experiments left me unconvinced.
[19] Some religious people who fail to recognize the proper limits of their faith are likely to offer objections whose premises are entirely inaccessible to public reason; we have all heard those stubborn arguments responsible for the historical misery of not a few people, attacking everything from homosexual rights to freedom of speech, menacing racial and sexual equality, restraining the advance of liberal democracy. Of course proper use of reason can authenticate the truth of a religious argument. Nevertheless, taking recourse to scripture, divine command theory, and the purported existence of souls, without offering corresponding arguments accessible to non-believers, is simply irresponsible ethics and betrays a lack of desire to engage in legitimate dialogue. Fortunately these irrational relics of an unillumined past have lost much of their currency, and thus should not be of great concern.
[20] I have digressed for too long, however, and therefore shall return to the practical and ethical strengths of this proposal, which I think are obvious and many, as well as of the highest importance.
[21] For first, as I have already observed, it will allow us to substitute something of irrelevant moral status for those poor sentient animals who are leading candidates for the practice of xenotransplantation; and this is no small improvement, as some eminent philosophers have made compelling arguments against the immoral utilitarian calculus of using a heart grown in a pig to save the life of a loved one.
[22] Secondly, this practice must meet with the approval of any good Kantian, as these creatures could scarcely be said to possess autonomy, and one must certainly be hard in his dealings with men to deny millions of children and adults life-saving medical benefits for their sake.
[23] Thirdly, legalized harvesting and distribution of troglodyte organs would stifle those black markets that serve to prolong the lives of the rich through the sickening victimization of the poor and uneducated.
[24] Fourthly, the undeniable success and appeal of this program may inspire otherwise modernized countries like Japan to move beyond antiquated conceptions of death and the human; though amusing in their oddity these beliefs are responsible for the needless suffering and deaths of thousands, and ought to be eliminated.
[25] Fifthly, there can be no questioning the utility of this plan; while many claim the benefits of stem-cell research and animal experimentation are highly exaggerated, and therefore do not justify the practices, the relationship of a troglodyte heart to a life saved is direct and incontrovertible.
[26] Sixthly, coming to recognize that the remarkably human-like troglodyte harbors no common potential for lived experience could be valuable in developing those virtues necessary for progress on the front of human rights. People often associate form with moral worth, and this irrational leap can be dangerous: skin color is used to show that a fellow human is inferior; male disgust with female biology becomes key for instantiating sexism; the characterization of Jews as animals allows them to be slaughtered wholesale.
[27] Many other advantages might be enumerated. For instance, a properly treated troglodyte carcass with the organs carefully removed could serve as an expensive sexual amusement; from the legions of internet sites that cater to interests ranging from bestiality to necrophilia there can be no doubt about a market, and it would be enough to justify this practice if one young girl or boy were to be spared abuse because a potential criminal used this innocent substitute to satisfy his perversion. But this and many others I omit, for the sake of brevity.
[28] There is one other small population whose quality of life may be increased, namely those couples who are currently raising troglodytes as their own offspring. The widespread practice of this sad charade is due in part to pseudo-psychologists who advocate such nonsense as placing these genetic eccentricities in classrooms with humans, and treating them as though they were real students, then justify this manipulation by pointing to marginal benefits in classroom interaction. Perhaps seeing the real good that can come of my proposal will inspire these delusional and suffering couples to liberate themselves and donate their enormous financial and psychological burdens to a better purpose.
[29] I can think of no one objection that will possibly be raised against this proposal, unless it is claimed that I do not properly take into account the importance of feelings that are entirely divorced from reason. This I admit, and indeed hold up as a virtue rather than a shortcoming. I should point out that my argument is tailored to human beings as they exist currently, that is, as rational beings with the desire to prosper and avoid suffering. Therefore do not talk to me of other approaches: Of devoting resources to eradicating the poverty that leads to many serious health conditions; of slowing down scientific progress to make time for ethical reflection; of revising our conception of the desirable life as one that is free from deformity and pain and as long as possible free from death; of understanding Daoist depictions of disease as philosophical facts, not rhetorical devices; of allowing ethical questions to be decided by people who are trained in wisdom, not ethics; or even of training people in wisdom at all, and thinking seriously about what that might entail.
[30] Therefore I repeat, do not talk to me of these and similar approaches unless you sincerely believe there is some hope they will be put into practice.
[31] But, as to myself, having been wearied out for many years with offering speculative, idle, visionary thoughts, and at length nearly giving up on the prospect of success, I managed to formulate this proposal, which is original and well-argued, practical, moral, completely feasible, and utterly uncontroversial. For no one can object to these ideas without contradicting herself, unless she is also opposed to stem-cell research, a strict vegetarian, and prepared to fight against abortion, although I know many who would gladly shirk the responsibility of avoiding self-contradiction.
[32] However, I am not so blindly devoted to my own ideas as to reject any other reasonable suggestion, which is equally ethical, economical, simple, and effectual. But before someone objects to my proposal and offers a better one in its stead, I ask her to consider two points. First, how she will find a practical solution possessed of widespread appeal, given the perpetual failure to generate compromise on these issues by people of undeniable diplomatic and intellectual abilities. And secondly, there being over 2 million people suffering for want of a transplant, whose prospects would be substantially improved if this wrangling ended or if a new solution amenable to all were adopted, whether it is not a better idea to gather these genetic aberrations and make something useful out of what is useless, than to continue deliberating and offering theories and counter-theories, forestalling practice in homage to theory.
[33] I maintain, as a testament to my objectivity, that I have not the least personal interest in putting this plan into practice, having no other motive than the public good, by increasing profit, helping the sick, and benefiting our ethical perspective. I am in good health and have no need of any organs, nor a troglodyte of which to rid myself.
