We should consider allowing the sale of blood and body parts

'A kidney specialist in New York said spring was his favourite season because fit young men started to go out on their motorbikes again.'
TODAY, there are expanding possibilities for the use of human body parts and human bodily material. We are all familiar with blood donations and kidney transplants. We may also recollect old stories about grave-robbing, or of the more recent ghastly occurrence where some of the bones of the distinguished radio commentator Alistair Cooke were stolen by a dishonest funeral director to be used in the manufacture of human-bone-based medical devices.

The mention of blood donations may well conjure up associations with blood-donor recruitment drives, the gift of blood, and gratefulness to blood donors. It may also have reminded some of Richard Titmuss' The Gift Relationship (1970). This pathbreaking work combined an innovative comparative study of blood provision focused on the US and UK with an extended argument for the moral and practical benefits of a donor-based as opposed to a market-based system for soliciting blood donations. Titmuss argued the donor-based system of blood supply offered a model case against the extension of markets into the provision of social and medical services.

Titmuss' argument was a powerful factor in moves that led to the elimination of commercial provision of blood in the US in the 1970s, where it had previously played a limited but significant role in the health system. It has inspired continuing discussion among philosophers and by writers more generally concerned with problems of commodification. In addition, it has reinforced the ethos of using volunteer donors rather than paid ones not only for blood and blood products but for organs, human tissue, and human milk.

These issues are sensitive but it seems to me there is a case for re-examining our dependence on donor provision and looking again at whether there is a place, here, for commerce for the Real Body Shop.

Clearly, no one can have anything but admiration for those who give blood. But admiration for donors does not equate to its being good public policy to rely on volunteers for donations. While reliance on volunteer donors is fine in some circumstances, in others it has led to shortages whether of blood products — where even recently in Australia, some of those who require blood-derived products are not being prescribed the desirable amounts due to endemic shortages — or of whole blood as has been the case in some US cities. In the US, some hospitals, when it was legal for them to do so, moved from relying on volunteers to creating paid panels of people drawn from their volunteer group, on the grounds that it was cheaper to do so and that paid donors were more reliable.

When a shift from paid to volunteer donors was being discussed in the US, it became clear there would be problems obtaining sufficient supplies of blood plasma just from donors. Even in the early 1970s, it was commented that it seemed strange to ask people to give blood and blood products to for-profit pharmaceutical companies rather than to sell it to them. The problem of supply is also relevant when it comes to human organs.

Advances in our understanding of the human immune system have led to a situation where it is not necessary that, say, kidneys be obtained from close relatives. But the supply of them is limited. Currently, kidneys — like other organs — are largely obtained from corpses. But nowhere near enough are available to be able meet the demand for them. A kidney specialist in upstate New York brought this fact home to me through a chance remark that spring was his favourite season because fit young men started to go out on their motorbikes again.

Currently, different countries operate different systems into which people either have to opt in or opt out. In opt-in systems, organs are available from corpses only if the deceased has indicated positively that they are willing for this to take place. In opt-out systems, they are available unless the deceased has explicitly indicated that they are not willing for this to occur. There are, however, currently some legal complications to these systems.

The disposal of people's bodies is not a straightforward matter of divining what the deceased wished but is rather a matter for the deceased's family to decide. In addition, there are different regimes for the harvesting and effective utilisation of organs. Spain has a reputation for being particularly effective but it is not clear that adopting current best practice would solve the supply problem.

While I am, on balance, inclined towards commodifying bodies and body parts, I do not think this is an area where there are easy answers to questions. However, I suggest we need to look again at our relatively dogmatic but at the same time uncritical preference for the use of volunteer donors. Donation is fine when it works. Arguments in favour of volunteer donation are really not as good as is often supposed.

If our reactions to body-commodification are due to our revulsion at the intrusion of commerce into such an area, it is worth bearing in mind that the cost of our sensitivity could be borne by those who suffer and die because they cannot get access to organs and other human-derived materials.

* This is an edited extract from an article in The Centre for Independent Studies' Policy magazine.