3 December 2018

A ban on paying organ donors puts squeamishness ahead of what works


Sir James Munby, the former head of the family courts, has suggested that surrogate mothers should perhaps be paid. Or, to be more accurate, paid directly for bearing a child, instead of the lightly and roughly disguised system of “expenses” in operation now.

This is bound to cause a furore, not least because we have a blanket ban on such methods of actually solving problems in this country. It is, largely, illegal to bring filthy lucre into such problems as body parts and, particularly, personal services. Paying sperm donors is not allowed, so we import from countries such as Denmark instead. Egg donors cannot be paid either, so we have a desperate shortage of them. Surrogacy, too, cannot be paid for directly, which is why we hear tales of people flying off to India and the like.

The point is most starkly illustrated by organ transplants. No payment, no inducement, may be made. The result of this interdiction is that people die on dialysis while waiting for a kidney – just to give one example.

We also know how to solve this. The one country that has cash inducements to donate is Iran. Granted it is government-controlled, with the state running the market. There’s also just the one country in the world that doesn’t have people slowly being poisoned by their own bodies as dialysis becomes less and less effective — Iran.

Whatever else we might say about a paid market in kidneys for transplant, it does work. Those who bemoan the lack of money for the NHS should also note that it’s cheaper to do a transplant than to have someone on years of dialysis. Despite these compelling facts, a kind of moral squeamishness prevents us from putting in place sensible policies.

The problem with this approach is that nothing else does work. The opt-out system for organ donations – effectively the nationalisation of your corpse – has not changed transplant rates in Wales. It’s not going to in England either.

What are we even to make of the apparently moral case for not allowing payments? We can indeed argue that such wondrous gifts as our internal organs should not be polluted by money-grubbing. The problem is that people who may not even ascribe to that view are dying from the law being informed by this supposed morality.

It also seems rather outdated. After all, we no longer insist that our sex lives, family life, gender identification or, to be honest, near all things, accord with any imposed moral code. As long as our actions don’t harm any third party it’s as it should be, chacun a son gout. This is just and righteous.

It is about time that Britain became a properly liberal country concerning organ transplants and gamete services. Morality may be important, but it also differs for each one of us. Instead of having such decisions imposed upon us – you may not do that because I think it immoral – we should make it a personal decision. You have every right to die by your moral code, to not accept a kidney from a paid donor, but for you to impose your code upon me is a form of authoritarianism.

Let us, out here, make the decisions according to our views on such matters. We even have the evidence that this actually solves the problems faced by those stuck waiting for transplants. As I’ve argued before, there are some problems that are so important we must use markets to solve them.

Tim Worstall works for the Continental Telegraph and the Adam Smith Institute