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Jacob M. Appel

Jacob M. Appel

Posted March 17, 2009 | 03:15 PM (EST)

Are We Ready for a Market in Fetal Organs?

Professor Richard Gardner of Oxford University, a renowned expert on human reproduction and an advisor to Britain's Human Fertilization and Embryology Authority, recently raised the prospect of using organs from aborted fetuses for transplantation into adults. This possibility offers the potential to save or improve the lives of the hundreds of thousands of patients in desperate need of such organs throughout the world, especially the more than 70,000 in the United States waiting for kidneys. While such procedures have never been attempted in humans, research on mice has demonstrated that fetal kidneys develop quickly inside adult animals -- and according to Gardner, fetal-to-adult transplantation is "probably a more realistic technique in dealing with the shortage of kidney donors than others." If aborted fetuses do prove a useful source of organs for transplant, and there is hope to believe that they might, our society may soon have to grapple with the possibility of yet another controversial and startling -- yet potentially beneficial -- phenomenon: a legal market in fetal tissue and organs.

Ever since Dr. Peter Murray and his colleagues at Peter Bent Brigham Hospital in Boston performed the first successful living-donor kidney transplants in the 1950s, physicians and medical ethicists have debated -- often heatedly -- the merits of permitting the sale of organs. Supporters of such a market have argued that financial incentives will increase the supply of available organs and save human lives. For example, Iran has a well-regulated market in organs and no waiting list. Moreover, many supporters of organ sales believe that potential sellers have a fundamental right to choose how to use their own body parts. Opponents of organ sales fear that transforming transplantation into a financial transaction will lead to exploitation of the poor, particularly in developing nations, and will expose the world's least fortunate inhabitants to unnecessary medical risks and to exchanges in which they lack equal bargaining power. The striking benefit of a legal trade in fetal organs, unlike adult organs, is that it may provide all of the benefits that supporters desire without resulting in the exploitative harms that opponents fear. Such sales could prove the rare economic transaction in the medical field in which all participating parties can truly be said to benefit.

The first striking feature of fetal organs is that their supply, for all practical purposes, is unlimited. Unlike living kidney donors, who must then advance through life with only one functioning kidney, pregnant women who provide fetal kidneys could do so repeatedly without incurring the medical consequences of adult organ loss. When overseen by properly-trained physicians, abortion is an extremely safe procedure -- even safer than delivering an infant at term. Since far more women have legal abortions each year in the United States than would be required to clear organ wait-lists, if only a small percentage of those women could be persuaded to carry their fetuses to the necessary point of development for transplantation, society might realize significant public health benefits. The government could even step into the marketplace itself to purchase fetal organs for patients on Medicare and Medicaid, ensuring that low-income individuals had equal access to such organs while keeping the "asking price" elevated.

Opponents of reproductive choice will object to such a market on the grounds that it will increase the number of abortions -- which will indeed be the logical result. However, such a market might also bring solace to women who have already decided upon abortion, but desire that some additional social good come from the procedure. Like the families of accident victims who donate the organs of their loved ones, these women could well find their decisions fortified by the public benefit that they generate. An additional economic incentive would further assuage any doubts, and might even make the procedure more palatable to otherwise equivocal spouses or partners. Of course, those who believe that life begins at conception will never find such a market desirable. But for those of us, myself included, who sincerely believe that human life begins far later in the growth process, I believe that we have a moral duty to women to give due consideration to the legalization of such a fetal-organ trade. Society should not curtail a woman's economic liberty without a compelling reason any more than it should curtail her reproductive liberty.

Would such a marketplace lead to the exploitation of poor women? I imagine those scholars who oppose compensation for surrogate motherhood and oppose the sale of eggs for in-vitro fertilization will argue that a fetal-organ market presents yet another way in which women's wombs might be commandeered under duress for the benefit of a society dominated by men. I would prefer to believe that a market in fetal organs would empower women to use their reproductive capabilities to their own economic advantage. If a woman has the fundamental right to terminate a pregnancy, why not the right to use the products of that terminated pregnancy as she sees fit? Many women would likely use the proceeds of such sales to finance college educations or to help raise their children. While being pregnant and going to college, or being pregnant and looking after a family, is certainly a challenge, who is to say it is any less desirable than pursing these goals while working at Wal-Mart? Obviously, no woman should be compelled to sell fetal parts or tissue -- much as no living adult should be compelled to donate her own kidney or cornea. But "choice" need not end with the removal of the fetus.

Someday, if we are fortunate, scientific research may make possible farms of artificial "wombs" breeding fetuses for their organs -- or even the "miracle" of men raising fetuses in their abdomens. That day remains far off. However, the prospect of fetal-adult organ transplantation is a much more realistic near-term possibility. A market in such organs might benefit both society and the women who choose to take advantage of it.