Practical Philosophy Seminar: Aksel Sterri, "Reward kidney donors"
The current system for procuring kidneys from living donors is badly flawed. The problem is that we to a large degree treat living kidney donations as a dyadic relationship between the donor and the recipient. Besides failing to provide kidneys to those who need it, we fail to live up to widely shared ideals of fairness and equality. In this paper, I will argue that kidney transplants are better understood as a triadic relationship, where the state plays a crucial mediating role between donors and recipients. In fact, it is the collective, not the individual, that are responsible for providing a new kidney to those that need it. If we adopt this view, we can move beyond the market-gift-dichotomy that often permeates the debate over organ transplants. I will argue that we should generously reward people that volunteer to donate kidneys as this is a fairer way of distributing the burdens involved in providing people in need with a kidney and will express the collective’s gratitude to the donor. A sufficiently generous reward framed in a moral language of duties and rights, will also be more likely to meet the demand for kidneys. It will thus enable the collective to fulfill its responsibilities, while protecting the status of both donors and recipients. Drawing on recent work in economics and sociology, I will argue that rather than crowding out altruistically motivated donors, it could crowd in altruistically motivated kidney vendors and have positive expressivist effects. The reward model can also deal with claims that paying people to give up kidneys wrongly commodifies kidneys and that it comes with a disadvantage to the poor.