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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.

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 ...
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 ...
 
 
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HUFFPOST SUPER USER
baseballmom
My microbio: as empty as Michelle Bachman's noggin
07:56 AM on 03/19/2009
Appel says that fetal organs develop rapidly if transplanted to adults, but does not indicate the point at which the fetus has developed enough for this to happen. Does anyone know at what point fetal organs are developed enough for this to occur?
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HUFFPOST PUNDIT
jsgaetano
Legum servi sumus ut liberi esse possimus
10:37 AM on 03/18/2009
Conservatives need to ask themselves- WWARD?

When you simply ask what would Ayn Rand do, the answers become perfectly obvious- greed is good, and we can't let anything stand in our way.

That's how Real Conservatives run a business. So these whiny ethics-mongers need to just step off.
12:01 PM on 03/18/2009
The ethics question is not about money but about how to help living people. There is nothing alive about a lump of cells in a trash can.
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HUFFPOST PUNDIT
jsgaetano
Legum servi sumus ut liberi esse possimus
02:24 PM on 03/18/2009
It can be both.

Conservatives shovel aside any ethics question when it comes to finance, the economy, the environment, international relations, war profiteering, etc. It's definitely not asking too much for them to shovel aside their ethics questions on this issue either.

Heck, St. Reagan's family supports stem cell research... so why are they listening to GWB rather than St. Ronnie? Blasphemy!
07:23 AM on 03/18/2009
I think this could only work if there was a strict window of time during which a fetus could be legally harvested, e.g. between the 14th and 19th weeks. While this would limit the number of sufficiently developed organs potentially available, you'd still get a lot, and this way you'd prevent abuses that could damage the mother's health (3rd-trimester abortions are not "extremely safe procedures") and avoid the ethical dilemmas poised by the brain activity that starts taking place around week 20. In fact, this might be a good way to solve the whole moral issue surrounding abortion once and for all. Since organs can be legally harvested at the moment of "brain death", we can use the same standard at the beginning of life, and declare that up through the 19th week a fetus is simply a mass of tissue before the brain becomes "alive." (I am well aware that, at both ends of the life span, these designations are really just convenient fictions.) It's a moral trade-off: if you get an abortion during the first half of the gestation period (which is when the vast majority of abortions take place anyway), not only is all stigma removed, but you're actually doing something beneficial to society; but if you get an abortion after week 20 it's murder. Everyone's happy, right?
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HUFFPOST SUPER USER
FogBelter
Illegitimis non carborundum
02:30 AM on 03/18/2009
Would a market for fetal organs be any worse than the current market for poached human organs that is taking place in developing countries? We live in interesting times.
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HUFFPOST COMMUNITY MODERATOR
mexamerican
professor
11:58 PM on 03/17/2009
no way. it'll never happen in this country. nor should it.
HUFFPOST COMMUNITY MODERATOR
ReasonIsMyReligion
Don't know much micro-bio-logy
04:51 PM on 03/17/2009
Where's a bioethicist when ya need one.
07:57 PM on 03/17/2009
Jacob M. Appel, J.D., is an Adjunct Assistant Professor of Community Health at Brown University, where he teaches courses in bioethics.
HUFFPOST COMMUNITY MODERATOR
ReasonIsMyReligion
Don't know much micro-bio-logy
10:22 PM on 03/17/2009
I meant in the field at large.
I can and do read bios, ya know.
04:22 PM on 03/17/2009
1) Aborted tissues shouldn't be sold at a profit by the carrier of the fetus. This could lead to women risking their lives being constantly pregnant and getting abortions. While abortions are low-risk themselves, multiple ones had consecutively can scar the uterus which can lead to other issues.

2) There is also the possibility of turning OB/GYNs into for profit businesses that are one ethically bankrupt doctor away from creating a systemic crisis. When businesses compete unregulated, the one with the worst ethics usually wins. Then their competitors sink to that level to stay in the game. That can't be allowed to happen in a medical setting.

3) If sex slavery is a big issue now, this would make it seem tame by comparison. Imagine one enterprising sociopath, kidnapping women and turning them into breeding machines much like animal-fighters do with dogs and roosters now.
08:14 PM on 03/17/2009
Since Henrietta Lacks and her runaway cervical cancer over 50 years ago, it's established that doctors own any tissue they remove. Even today, tissue from neonatal circumcisions is often procured from doctors and reprocessed for use in biomedical research and skin grafts.
HUFFPOST SUPER USER
dctackett
06:14 PM on 03/18/2009
good point, I had heard of this and other related legal cases and had forgotten...

I remember one about a man who sued his doctor because he found out his doctor was making millions off of this guy's tissues... that's why the doctor paid for his flight and room, and encouraged multiple trips...
HUFFPOST SUPER USER
Bethab
09:06 AM on 03/18/2009
"This could lead to women risking their lives being constantly pregnant and getting abortions"

Thank goodness someone like you is available to "save" women from the folly of their decisions!
HUFFPOST SUPER USER
dctackett
06:12 PM on 03/18/2009
apparently you must live in a world were everyone is intelligent, knowledgable and uses their ability to reason...

are you here to visit or are you staying?
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HUFFPOST SUPER USER
jagoneely
04:05 PM on 03/17/2009
I just know that some people equate stem cell research with what this article is about. But it is not the same thing. I will never support mining organs from aborted fetuses. Stem cells are different. Very few stem cell research advocates (if any) would support mining fetal organs. It's gross.
04:00 PM on 03/17/2009
stem cells- great, potential medical "miracles" from a cluster of cells. But growing fetuses for their organs? If it has grown into a fetus and has organs, like a brain, harvesting these organs sounds ghoulish to me. By the end of the article I had to wonder if this was an anti-choice article written tongue-in-cheek.
07:58 PM on 03/17/2009
We "harvest" complete animals for nothing but the burgers that cause heart disease to begin with. Every time we eat meat we have killed. That it's not our own species does not make a difference to the animal. The day before it was alive and probably even well (although that's already unlikely), now it's gone. And the death, in some cases, wasn't exactly humane.

In contrast a fetus feels nothing. It does not even have to have a developed central nervous system in order to remove the organs. It certainly has nothing resembling even a cow brain. So that's "ghoulish"? Why?
11:43 PM on 03/17/2009
Clearly you do not know very much about fetal development...by week five the fetus has a beating heart. By week 16 facial expressions are able to be seen. Many studies have shown that the fetus has a complete enough nervous system to feel pain at week 20. So in fact, the fetus does feel pain when it is aborted beyond that point in time (when most of the "valuable organs" that our author claims to want to harvest in "unlimited" amounts are developed).

Those are facts. In my humble opinion (and that is just what it is) animals are not the same as humans. While we should take care of them they are on the lower run of the evolutionary ladder and thus we have perfectly good reason to "harvest" them. Sorry, just simple natural selection.
HUFFPOST SUPER USER
dctackett
06:17 PM on 03/18/2009
I'm a vegetarian and I think killing cows and harvesting fetuses are both a bad idea.
03:51 PM on 03/17/2009
That is the road we are on. As we further and further devalue human life, nothing shocks me anymore.
04:09 PM on 03/17/2009
We devalue human life? How so? Because we spend half a million dollars or more on a middle aged man who needs a heat transplant? Or because we train teams of surgeons for a decade to be able to operate for ten hours straight on a person who would be dead within hours if they didn't get half their abdomen removed and replaced with the innards of a, sadly, deceased other person?

That's not how you devalue life. That's how you express your willingness to save one of yours at any cost.

The only devaluation that results from this is that for the average cost of one of our people a dozen, if not a hundred could be save in Africa and other parts of the world.
10:25 PM on 03/18/2009
I'm a kidney transplant recipient from a dead donor who was generous enough to sign his or her donor card. The money spent on my transplant saved the U.S. taxpayers thousands and thousands of dollars per year because of the difference in cost between dialysis and a transplant surgery.. I would prefer a comparison to the cost of paying for bonuses to rich people out of taxpayer money or waging a war than to whether I should have gotten a transplant.

I am appalled at the idea of fetal farming, it will exploit women--I don't see calls for anything that would exploit men here--and it is simply wrong. I would rather die than except such an organ. And it is a stupid idea since we are already on the road to developing organs out of people's own cells--a bladder was grown in 9 months for a 17 year old girl, mice skin cells have been used to grown mice organs now, why even suggest such a Brave New World idea at this point in medical progress?

Where will it stop? Is the next article going to be harvesting organs from living people with cognitive disabilities? How about old people? How about unwanted live babies?
Utilitarian ethics leads us to these horrible places whether on on the right or on the left. Do you think conservatives don't use utilitarian ethics too? This is NOT about reproductive choice.
07:12 PM on 03/17/2009
Life is nothing but ethical roads to travel. And our society has figured out time and again where we need to stop and say, "okay this isn't ethical."

We have made these kinds of calls many times before, from abolishing slavery to agreeing that teachers can't spank their students. We will handle this one too.

My personal stand is that research and medical treatments using stem cells are on balance a benefit to human life, but harvesting organs from fetuses is not.
07:54 PM on 03/17/2009
So letting a person who has a family and friends die that one could save with a scrap from the other doctor's garbage bin is "the ethical road"?

I would like to see the logic behind that. And then, please, please, tell us how we explain that logic to the family at the dying man's bed.
03:38 PM on 03/17/2009
I fully support embryonic stem cell research, but this idea just gives me the living heebee jeebees
04:12 PM on 03/17/2009
Put yourself in the shoes of the loved ones of someone who has months or weeks to live without a new liver, kidney or heart. Suddenly the possibility that a little bit of tissue that would otherwise end up in the dumpster (literally) makes all the difference in the world.
08:30 PM on 03/17/2009
Hey, I said it gives me the heebee geebees, I didn't say there wasn't a lot of logic behind it that should be discussed, because there definitely is.
10:35 PM on 03/18/2009
True in the case of livers and hearts, not accurate in the case of kidneys. People with kidney failure can survive on dialysis for many years. What we really need to be talking about is optimal dialysis which is not generally available in the U.S. as it is in other countries, thus our embarrassingly higher mortality rate on dialysis, not due to the kidney failure but due to the archaic and dangerous 3 times a week in and out clinic dialysis schedule. More people die after their 2 days off than any other day. Of heart failure or attacks. Because of the way we stick to a profitable for dialysis companies but dangerous for patients schedule and method of delivering dialysis in this country. Daily home hemo, nocturnal long hemo, all of these lead to much better outcomes and longevity. People have lived for 35+ years on dialysis, not so with heart failure. Please keep your facts straight.