Neg Speeches

Offcase

1NC DA 1Global norms against sales solidifying from Declaration of Istanbul—but it’s reversible if the US legalizes salesCapron 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)

India was one of about fifty countries that undertook to reform their practices following the approval of WHO’s original Guiding Principles . These countries adopted laws in the early 1990s to institute the

anticommercial system recommended by WHO . Similarly, a number of countries—including several that were centers for organ sales, such as Pakistan and the Philippines, and other countries, such as Israel, that had sent large numbers

of “transplant tourists” abroad to receive vended kidneys40—have adopted laws and regulations in the past few years that aim to put the 2010 WHO Guiding Principles into effect.41 These changes have been strongly supported by other intergovernmental bodies such as the United Nations,42 the Council of Europe,43 and the UN Office on Drugs and Crime,44 all of which have addressed the phenomena of organ trafficking45 and of people being trafficked for the removal of the organs.46

Equally significant in driving ethical and legal reforms have been the advocacy efforts of leaders in transplantation medicine. For example, the Transplantation Society (TTS) and the International Society of Nephrology organized a global summit on organ trafficking and transplant tourism

in Istanbul in late April 2008, where a statement of professional opposition to organ markets, the Declaration of Istanbul, was adopted.47 The

Declaration of Istanbul has since been endorsed by more than 120 medical organizations and governmental agencies.48 Realizing that the declaration would not be selfimplementing, its creators formed the Declaration of Istanbul Custodian Group (DICG) in 2010 to encourage adherence to its principles and proposals.49 The DICG and TTS have produced some notable results by calling on government officials to adopt and enforce prohibitions, and by making clear to them the harm done to the standing of medical professionals who work in locales where organ sales are widespread.50 Furthermore, the DICG’s direct interventions to change professional practices have been even more successful.51 For instance, academic recognition has been withheld from physicians who have carried out transplants with organs from executed prisoners by barring the physicians’ abstracts from inclusion in international medical congresses.52 Many medical journals have announced that they expect adherence to the Declaration of Istanbul by their authors, just as they have long insisted that research conducted with human beings must adhere to the Declaration of Helsinki, first promulgated by the World Medical Association in 1964.53 In at least one instance, several articles were retracted from an academic journal when it was discovered that the work discussed involved living donors who had been paid to supply a kidney.54

C. Recent National Changes in Response to Global Norms

Bringing about thoroughgoing changes in transplant practices requires more than academic and professional sanctions; governments must also adopt and enforce bans on organ purchases and transplant tourism. The latter has proven particularly

difficult, not the least because of the built-in opposition of the people who have profited from catering to transplant tourists. Accordingly, the

hard-won gains in this regard that have been achieved in the past five years are all the more remarkable .

Some local proponents of organ-trade prohibitions have successfully used global standards in their transformative efforts. This is illustrated by the experiences of Pakistan where the Transplantation of Human Organs and Tissues Ordinance was adopted by presidential decree in 2007 before becoming a parliamentary act in 2010.55 Before the ordinance, an estimated 1500 patients from other countries—principally in the Middle East—as well as about 500 wealthy Pakistanis received vended kidneys each year, mainly in private hospitals and clinics in Lahore and other Punjab cities.56 The efforts to bring that practice to an end were lead by the professionals associated with the Sindh Institute of Urology and Transplantation (SIUT), a medical center in Karachi that provides donation-driven kidney dialysis and transplantation to all patients without charge. SIUT supplied the “moral entrepreneurs: groups and individuals in civil society who are committed to the elimination of trade they consider harmful and repugnant,”57 who mobilized public opposition to commercial organ donation. They urged the government to adopt the new law. Descriptions written by SIUT physicians of the socioeconomic

realities of the organ trade58 and of the resulting hazards to both donors and recipients59 led to critical reporting of the practice in newspapers and on television.60

The media coverage took specific aim at the role of the government, whose failed poverty-alleviation programs left individuals no choice but to sell their kidneys, and whose failure to enact a transplant law and later to enforce it allowed the organ trade to thrive. It was also noted that

reports of Pakistan’s “flourishing kidney market” had appeared in the international press, tarnishing the country’s reputation.61

The owners of the private hospitals who profited greatly from transplant commercialism and who had strong connections to high-level officials mounted fierce opposition to the transplant bill and sought to water down its prohibitions on unrelated living donation.62 On the other side, SIUT’s founder and director, Professor Adib Rizvi, used his strong connections with international medical groups, particularly his membership in

the DICG, to counteract these powerful opponents.63 Prominent transplant surgeons among the DICG leadership came to

Pakistan to convince government officials that organ sales were a matter of international concern and needed to be curbed to rehabilitate the reputation of Pakistani physicians.64 As Professor Asif Esrat

concludes, “For government officials, the desire to conform to widely held international norms and redeem the national reputation served as a motivation for action .”65 When the law was contested in a federal Shariat court as an interference with the Islamic duty to save life, the existence of the international standards, as embodied in the WHO Guiding Principles (which Pakistan had joined in endorsing at the World Health Assembly), weighed heavily enough that the court rejected the challenge.66 When several transplant programs continued to carry out commercial transplants, including on patients from abroad, Dr. Rizvi and his colleagues reported these violations to the authorities and prosecutions were brought against the surgeons and hospitals that had attempted to profit by breaking the law.67

The current situation in the Philippines resembles that in Pakistan in some ways but differs in significant respects. The country has been a well-known locale for organ purchases for the past several decades; indeed, it was one of the first places where the anthropologists of Organs Watch, an independent research and medical-human-rights project at the University of California, Berkeley, began their examination of the “new body trade” in which “the circulation of kidneys follows established routes of capital from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones, and from female to male or from poor, low status men to more affluent men.”68

Although Internet sites have made the Philippines another important locus for the global organ trade, the initial pattern of using vended kidneys there differed from what had occurred in Pakistan because the recipients were mainly wealthy Filipinos, not foreigners. 358 of the 468 kidney transplants recorded in 2003 by the Renal Disease Control Program of the Department of Health in the Philippines involved domestic patients (though the possibility of incomplete reporting by private hospitals cannot be totally discounted).69 It was thus not surprising that elite groups at that time supported a proposal under consideration by the government to institutionalize paid kidney donation as well as to formally accept transplantation for foreign patients.70 As appealing as this idea may have seemed to someone viewing it “from a private hospital room in Quezon City,” it was much less so for human-rights advocates trying to protect potential organ sellers in “a sewage-infested banguay (slum) in Manila.”71 These advocates used the attention that the World Health Organization was bringing to the issue at that time to halt the movement toward legalizing compensation.

Over the following five years, international pressure on the government intensified, not only from intergovernmental and medical bodies72 but from the Catholic hierarchy, particularly in light of press coverage about unscrupulous organ brokers trolling in the slums for donors to meet the ever-increasing demand for kidneys coming from Manila’s transplant tourists.73 On April 30, 2008, a ministerial directive barred foreign recipients from getting kidneys from Filipino living donors.74 The next year, the Inter-Agency Council Against Trafficking followed the international trend and used the organ trafficking provisions of the Philippines’ Anti-Human Trafficking Law as the basis for supplemental regulations outlawing all organ purchases, as well as other means of trafficking persons for organ removal, including the use of force, fraud, and taking advantage of vulnerability.75

The fragility of these legal changes in the face of the determined opposition is indicated by the next swing of the Filipino organ-policy pendulum. When Benigno Aquino III assumed office as President in June 2010, he nominated as secretary of health Dr. Enrique T. Ona, a transplant surgeon who had previously expressed his opposition to the ban on organ sales.76 The nomination was held up, however, when Ona announced his intention to allow organ donors to be compensated by a $3200 “gratuity package”77 and joined several American regulated-market advocates in sponsoring an international forum on “Incentives for Donation” in Manila that November.78 He was confirmed as health minister, however, after providing assurances that he would not institute financial “gratuities,” but he did sign the proposal for incentives that emerged from the international forum.79 In effect, the pendulum has swung back, as the number of foreign transplant recipients, which had risen to 531 by 2007 before the ban, fell to two by 2011, even as a threefold increase occurred in deceased-donor transplants for Filipinos.80 Movement in the opposite direction remains possible, however, as organ purchases by wealthy Filipinos have not completely disappeared, with brokers helping potential kidney recipients persuade review committees to allow as “emotionally related” donations what are in fact commercial transactions.81

Another variation on the theme of transplant tourism has taken place in Colombia, which “was a major provider of deceased-donor organs for wealthy foreigners” during the first decade of this century,82 mainly for liver transplantation.83 With strong international and regional backing, local medical leaders succeeded in redirecting organs to recipients from Colombia and neighboring countries. The annual rate of transplantation to foreigners, which stood at 200 in 2005 (16.5% of the national total), was reduced to 10 by 2011 (0.9% of the total, down from 1.45% the prior year).84

The situation in Colombia is indicative of the progress that has been made across Latin America with

the adoption by the Ibero-American Council of a set of principles and objectives in a regional parallel to the Declaration of Istanbul, the Document of Aguascalientes,85 which was encouraged through a strong alliance with the Spanish transplant program. The Document of Aguascalientes has provided legal and ethical as well as technical guidance for countries across that region as they have created or strengthened their own systems for organ donation, allocation, and transplantation that seek the support of the public and medical professionals and that aim to meet the transplant needs of the domestic population and achieve “self-sufficiency” nationally or through regional cooperation.86

Over the past five years, the most impressive examples of countries that have responded to stronger global norms regarding the opposite side of “self-sufficiency”— namely, not sending transplant tourists abroad as the means to meet domestic demand for organs— are in the Middle East . Israel’s enactment in 2008 of legislation halting insurance coverage for commercial transplants that violate local laws ended its reliance on Turkey, South Africa, China, and the Philippines, among other countries, as sites where Israeli patients could go to obtain vended kidneys.87 The law also stimulated the development of a robust system of deceased and living-related donation, which has been widely praised.88

A number of Arab countries have taken steps —thus far less sweeping in scope or impact than the Israeli program but still

effective—to treat patients at home rather than sending them abroad. The evolution of policy in Qatar provides a vivid example of the competing forces at work: expediency, selfinterest, generosity, and concern about adhering to international norms. The local provider of transplant services, the Hamad Medical Corporation (HMC), has concluded that it needs to go beyond the existing Qatari program for honoring donors if it is to achieve self-sufficiency in organ transplantation.89 Consequently, the HMC increased outreach within the expatriate community in Qatar (more than 85% of residents) to ensure that they too have access to transplantation services.90 Additionally, the HMC has substantially increased deceased donation by publicizing that “brain death” is acceptable under Islam91 and by having prominent persons, such as members of the royal family, not only recognize the generosity of living donors and the families of deceased donors but also enroll in the organ-donor registry.92

A central component of the new Qatari program is the Doha Donation Accord,93 which was formulated in November 2009 with assistance from the leaders of the DICG and the International Society for Organ Transplantation, and which came into effect in 2010 following approval by the country’s Supreme Council of Health. The accord aimed to combat organ commercialism, to create a deceased-donor program in which everyone—whether citizen or foreign worker—would participate as both a potential donor and potential recipient, and to provide a path to self-sufficiency in organ transplantation.94 The original accord departed from practices elsewhere in the region by not offering any financial payment to the families of donors,95 but several of its promises—in particular, that a their family member would be offered a free airplane ticket to accompany the deceased’s body from Qatar “at the time of donation”—do not align with Guiding Principle 5 of the WHO Guiding Principles, which states that “[c]ells, tissues and organs should only be donated freely, without any monetary payment or other reward of monetary value.”96 To the accord’s framers, it would have been inconsistent with cultural norms of reciprocal gift-giving not to provide something of value to those who agree to donate organs for transplantation. To outsiders, however, such a provision seemed to exploit the vulnerable situation of the families of Qatar’s manual laborers and domestic workers from India, Nepal, the Philippines, and other developing countries, who would otherwise find it difficult to repatriate their loved one’s remains.97

At a meeting in Doha in April 2013, held to mark the fifth anniversary of the Declaration of Istanbul, the leaders of the HMC transplant program acknowledged the remaining shortcomings in the Doha Donation Accord and pledged to make revisions satisfactory to the DICG.98 In particular, they pledged to ensure that any benefits provided to donors’ families would be offered to the families of all potential donors, irrespective of whether they agree to donate their deceased relative’s organs for transplantation; further,

[A] social welfare program at HMC, in association with Qatar charities, provides assistance where required to patients and their families. This assists in securing longterm medical care, supply of medications, and financial support during residency in Qatar and sometimes following the return home of expatriates. For example, following a formal socioeconomic evaluation, social services provide support to eligible families of all patients who die within HMC hospitals, including families resident abroad. [W]hile the team at the Organ Donation Centre may directly refer families of critically ill patients to welfare services for assistance as part of their routine care, such referrals and provision of welfare benefits are unrelated to donation decisions—a point that is made clear to families.99

The forces at play in the movement of Qatar toward a more self-sufficient program of organ transplantation are the same as those that have operated in the other countries described. In the countries that have provided transplants to large numbers of transplant tourists, the forces favoring payments to living donors have largely been controlled by those who directly profit from this business. But in Qatar, as in other countries that have sent most of their potential kidney and liver recipients abroad for transplantation, those who had supported transplant

tourism shifted toward favoring payments to donors in Qatar, because they do not believe a domestic transplant program can be built without such financial rewards.100 In a setting like Qatar where the population is sharply divided in both socioeconomic and ethnic terms, as well as by residents’ degree of integration in, and identification with, the country and its institutions, it is particularly easy to understand the view that those who are disadvantaged and disenfranchised will only respond to a request for assistance—in the form of a life-saving organ—when it is

accompanied by an offer to improve their condition materially. Nevertheless, the forces on the other side have been successful—as they have been in Pakistan and the Philippines—in finding ways of overcoming the barriers to voluntary donation that do not link benefits to an agreement to donate.101

In all these settings, the local medical and human rights advocates opposed to giving material rewards for organ donation have been inspired by professional and intergovernmental statements of principle and have derived strength from the medical leaders and WHO officials who have assisted them in persuading their governments to align national laws and practices with international norms.

IV BENEFITS, COSTS, AND INTERCONNECTIONS

National patterns of organ donation can be expected to be less diverse in the future, thanks to changes of the sort

detailed above, as countries move away from their former roles as buyers or sellers in what has been called “the global traffic in human organs.”102 But progress toward a world in which all countries where organ transplants are performed103

rely on deceased and living-related donors, rather than paying living donors and the families of cadaver donors, has been halting, and the

outcome is far from assured . To a large extent, the changes that have occurred have been heavily influenced by the WHO

Guiding Principles and the Declaration of Istanbul, which, in turn, rest on the consistent practice of noncommercial

organ donation in the U nited S tates , Canada, and Western Europe for more than four decades. The hands-on advocacy of

WHO and DICG leaders has conveyed this vision to the responsible authorities in countries that have previously relied on paid organ vendors, and it has reinforced the efforts of local medical leaders to reform national laws and practices.

But if systems that have so long embodied the ideal of voluntary, altruistic solidarity as their basis for organ

donation and that have thereby attained the highest rates of donation were to move to a “regulated market” with financial inducements for donation, the progress achieved in countries that have only recently come into line with, or that have been moving in the direction of, the WHO Guiding Principles and the Declaration of

Istanbul would reverse course in short order . The proponents of paying for organs in those countries —

whether they be surgeons and brokers who stand to profit from transplant tourists or those who believe it is necessary to offer material

expressions of gratitude in order to build a functioning organ-transplant system104—would seize upon the change of policy in the West and say, “Clearly, no principle is offended by the sale and purchase of organs, for these enlightened countries allow it; and if these countries, which are rich and medically well equipped, find payment necessary to generate an adequate supply of organs, how can we succeed in any way other than by following their example?”

Legal sales cause widespread suffering, economic ruin and structural violenceMoniruzzaman, 14 - Department of Anthropology and Center for Ethics and Humanities in Life Sciences, Michigan State University (Monir, “Regulated Organ Market: Reality Versus Rhetoric” October, Volume 14, Number 10, 2014)

To make matters worse, selling an organ does not alleviate the sellers’ poverty . In my study, 81% of organ sellers did not receive the payment they were promised . For example, Koliza, a liver seller, received 150,000 Taka

(US$1,875), only half the amount the broker had promised him. Proponents of the organ market therefore argue that a regulated system could offer full payment for the sellers (though the Iranian regulated market proves

otherwise ; Zargooshi 2001), yet these proponents fail to explain how the payment (if it is paid in full) ensures income-generating opportunities for impoverished populations . Here, Koplin aptly argues that an organ market could not compensate for the extensive harms and ensure long-term benefits for vendors’ overall well-being. My research cultivates Koplin’s claim by capturing that Bangladeshi sellers mostly used their money to pay off their microloans; buy material goods, such as a cell phone, a television, or gold jewelry; or arrange a dowry or medical treatment for their family.

Once the money had nearly run out, most sellers had already lost their jobs . Some managed to get new jobs, but their damaged bodies impeded their abilities to continue to do physically demanding jobs, such as rickshaw pulling, manual farm work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages not only himself, but also his family, noting that “three of my family members were depending on my income, and now I am done, and so are they.” As a

result, some sellers have turned to organ brokering; they prey on their families, neighbors, and villagers just to get by. My research also finds that many sellers entered the organ market to pay off their debts, but soon were back in debt (see Cohen 2003). For example, Koliza took out new microcredit loans to start a poultry farm a year after selling his liver lobe. With a chicken mortality rate as high as 50%, at the return of his microcredit debt Koliza remarked, “I no longer

have other parts to spare.” A regulated organ market could not ensure the long-term economic benefits of

organ sellers, but rather might corrupt the overall situation . My recent fieldwork reveals that moneylenders have pressured the poor to sell their spare organs to repay loans. Husbands have tricked or forced their wives to sell their organs for economic gain (in one case, a man married twice to profit from the sale of his wives’ kidneys, and in another case, a man sold his wife’s kidney after claiming to take her to the hospital for an appendectomy). A 6-year-old boy was murdered by an organ trafficking racket and his body tossed in a pond after both kidneys were removed (The Daily Star 2014). I also document that four members of one family (a father, two brothers, and a daughter-in-law) each sold a kidney. Buyers regularly publish organ classifieds in major

newspapers for soliciting organs, and brokers have expanded their networks from local to national to international levels. Such profound

violence, exploitation, and suffering would be rife in the regulated or rampant commerce of organs .

In sum, after selling their vital organs, the health of sellers is compromised, their economic situation has worsened, and their social status has declined (Moniruzzaman 2012). The outcomes of organ selling are invasive, harmful, and devastating. As seller Koliza said with regret, “I donated my liver lobe to: i) live better, ii) save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.”

It can therefore be argued that a regulated organ market is not the solution , but rather, the strict

criminalization of the organ trade is ethically and pragmatically essential . As Koplin notes, a regulated organ market would improve vendors’ well-being or minimize their harms lack evidential warrant. Such a system does not speak to the lives of the economic underclass, but rather seriously discriminates against them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and justice to organ sellers. We ought to oppose the organ market in order to curb this illicit practice.

The impact is widespread global exploitation and structural violenceMoniruzzaman, 12 - Department of Anthropology and Center for Ethics and Humanities in the Life Sciences Michigan State University (Monir, ““Living Cadavers” in Bangladesh: Bioviolence in the Human Organ Bazaar” MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 26, Issue 1, pp. 69–91, DOI: 10.1111/j.1548-1387.2011.01197.x)

The bioviolence , particularly for the extraction of organs , stems from the growth of the transplant industry and is closely linked to the suppression of the poor . It is not only widespread in the current practice of organ commodification but also in every aspect of transplant technology. I will argue that the bioviolence is

seriously exploitative and highly unethical ; however, it is deliberately concealed for personal gain s of

vested interest groups. So far I have documented how poor Bangladeshis are victims of bioviolence that turns

them into kidney sellers and causes extreme suffering . In the remainder of the article, I will discuss the varieties of

bioviolence, including physical, structural, and symbolic violence that dominate the lives of kidney sellers.

In Bangladesh, about 35 million of its inhabitants (nearly one-quarter of the population) face the violence of needless hunger—what Amartya Sen calls a humanmade disaster (Hartman and Boyce 1998; Sen 1982). Inevitably, 77 percent of poor Bangladeshis lack the minimal requirements for a healthy human existence; about 50 percent of women have anemia, and two million children are suffering from acute

malnutrition (United Nations 2009). To make matters worse, socioenvironmental factors, such as arsenic poisoning, air pollution, pesticide use, and smoking tobacco contribute to a high number of organ maladies.

Although the majority— the economic underclass—is at the greatest risk of organ failure because of high

exposure to these factors, they die prematurely without receiving a transplant , let alone dialysis.

Kidney transplant is one of the most expensive medical procedures, starting at about 225,000 Taka ($3,200) for the surgery and two weeks of postoperative care in a public hospital in Bangladesh. It is virtually impossible for most of the poor, as well as many middle-class Bangladeshis, to save this amount of money in their lifetime. Nevertheless, many of them strive for an organ transplant by literally begging for money in local newspapers, but in the end, they experience serious drawbacks.9 For example, a brother of a recipient who died from kidney rejection just one month after the transplantation told me, “All of our family members tried our best to save my brother’s life. We sold our land and jewelry, and borrowed money from the bank to arrange the transplant. But we could not save my brother and we are still paying off our debt.” Moreover, the health care for organs in Bangladesh is concentrated in two major cities; most poor people do not have access to organ care at all.

Evidently, transplantation does not proceed according to the principle of equity: The poor suffer from organ maladies, but the wealthy receive

care. The service of transplantation fulfills the needs of fewer than 1 percent of the population— the

wealthy minority, while the majority of Bangladeshis die in silence , knowing they could have saved their lives

through this modern technology. Consequently, the current practice of organ transplant constitutes a form of

“ structural violence ” against the poor (see the detailed discussion on “structural violence” in Galtung 1969; Farmer 2005),

which is palpable in every aspect of the transplant industry.

Not only are the poor deprived but also they are subject to physical violence as their vital organs are viciously removed from their living bodie s. As my ethnography explores, the wealthy buyers (both recipients and brokers) create a desire for the poor sellers, most of whom do not understand the function of the kidney, but are tempted to “donate” because of the buyers’

fraudulent claim that kidney “donation” is a safe, lucrative, and noble act. Once the sellers are induced, buyers extract their organs through deception, manipulation, and without consent , and then deprive them once the scar is permanent. The deception is so extensive here that not only brokers but also most recipients do not pay the total amount they had promised to the sellers. For example, seller Monu received from his recipient as little as 40,000 Taka ($600)—one-third of the promised amount. Some buyers even use coercive force to extract organs from the sellers. For example, seller Mofiz was unable to attend the funeral of his sister, who died of a heart attack after learning that her brother had left home to sell his kidney to arrange her dowry. Mofiz was then held captive by three bodyguards at his recipient’s house and was tricked into traveling to India a few days later. In the post-transplant period, bothMofiz and his wife were physically abused and threatened with jail while he disputed the payment with his recipient (see also the above-mentioned case of seller

Sodrul). Furthermore, informed consent was completely flawed here, as buyers intentionally provide misleading and

inadequate information (e.g., the story of the “sleeping kidney”); because kidney sellers cannot act competently and voluntarily (because of extensive manipulation , not to mention the coercion of poverty ); and because sellers

gave misinformed consent. These are means of the physical violence organ buyers use to exploit their counterparts.

The bioviolence is both exploitative and unethical , as organs are deliberately removed from the economic underclass to prolong the lives of the affluent few. In this visceral violence, the wealthy recipients are

beneficiaries, while the poor sellers are mere suppliers of body parts, but at the severe cost of their

suffering. This bioviolence constitutes an abuse of human rights (the 1948 Universal Declaration of Human Rights adopted that health is a

human right), as the poor deserve proper transplant care, rather than losing organs from their underfed bodies. This bioviolence also violates

the principle of social justice, as the poor have an equal right to keep their organs inside their bodies. They need their organs for

their physical survival ; the bioviolence against them is a serious crime.

Exploitation from organ sales justifies slavery and genocide by viewing some people as less valuable than othersGeorge, 1 - Southern Railway Hospital, Perambur, Chennai, 600 023, India (Thomas, Issues in Medical Ethics, January-March, “The case against kidney sales” PubMed)

I am one of those who, according to Radcliffe-Richards et al, oppose the practice of buying kidneys from live vendors from a feeling of “outrage and disgust.” (1) These feelings are by no means irrational. They are based on a bedrock of moral principle: that no human being should exploit another. The opponents and proponents of the trade in human organs are divided by this (perhaps unbridgeable) chasm – the one side is wedded to the belief that not only are all human beings born free, but that they should stay free; the other is not so sure. The evolution of

human civilisation has witnessed several periods of gross exploitation of human beings. Slavery , the extermination of six million Jews, and today the transfer of body parts from one living human being to another, for a financial

consideration, are part of a continuum of values which sees some human beings as less valuable than others. It is this value system that those of us who oppose the sale of kidneys, seek to change . All arguments in favour of the trade are attempts to clothe , in the garb of reason, the concept that it is all right to remove a body part from a poor person and put it into a rich one . But even these arguments will not bear scrutiny and I will deal with them below.

First, the argument that the prohibition of organ sales worsens the position of the poor because it removes an option in their already deprived lives: Here the authors (1) of the paper have cleverly stated the most potent contrary argument themselves: the solution is the removal of poverty. They, however, appear to consider this a distant possibility, and in the meantime advocate the selling of kidneys as one option available to the poor to better their circumstances. It would have been useful if the authors had adduced material to show how and how long

this so-called option works. In the absence of any sustained means of livelihood, it is quite probable that the money obtained by the sale of one organ will soon be gone . What shall the seller do next? Sell another organ? An eye? A lung? And when all the paired organs are gone?

Let us accept that the risk involved in nephrectomy is not high. But is it not a fundamental tenet of medicine that the risk must be in the medical interest of the patient? What medical advantage does the donor obtain? Undoubtedly the risk is the same for those who sell and those living donors who do not sell but donate out of regard for the recipient. Radcliffe -Richards et al move from this fact to the inference that therefore there should be no difference between the two groups with surprising facility. What matters here is motive: the implicit coercion in the case of the poor who sell out of financial compulsion. Radcliffe - Richards equating of the motives of the better off, and comparing the risks of nephrectomy with the risks of dangerous sports can only be described as callous. No one prevents them from campaigning against these

sports if they are so moved, but for us activists in the Third World there are more pressing matters than looking after the well - being of the jet- set. A profile of the sellers would be revealing. It will come as no surprise that they all belong to the Third World. And it will also come as no surprise that besides the wealthy in the Third World, the potential buyers will be from the rich, white, First World and from the petroleum driven nouveau - riche! No wonder a veritable industry of philosophers has risen in these countries to justify this horrible practice. And in the honourable tradition of colonialism there will always be locals ready to aid and abet the conquerors. He who pays the piper calls the tune!

Radcliffe-Richards et al (1) seem fixated on the belief that legalising and controlling the trade in human organs will protect the exploited . The situation in other fields shows that this is naïve indeed . In Hamburg, legal commercial sex workers throng the glittering Reeperbahn, while in the sad, sordid, shadowy bylanes the illegal commercial sex workers have no shortage of clients. This in a country where social conditions ensure much closer adherence to the rule of law than is the case in most developing countries, which are the main source of people willing to sell their organs. In India, child labour is a reality. Poverty is the main reason for its existence. The efforts of numerous groups have succeeded in making it illegal. Have they removed an “option” for the poor? After all, the poor consciously send these children to work. Would it be a good idea to legalise the practice and control it on the theoretical basis that

it would improve the lot of these unfortunate children? There are many reasons why such trades will always be open to exploitation. The most potent one is that the victims are poor and voiceless while the beneficiaries are generally

rich and powerful.

The argument that organ selling is acceptable because some services are available to the rich, which are not available to the poor, is extremely strange. Do the authors believe that the presence of undesirable practices justifies adding a few more? What will the limit be? Who will decide how many more are to be allowed? No prizes for getting it right. The answer is: the rich and powerful. Permit whatever is in their interest. They can always hire a motley crew of philosophers and technicians to justify it and make it possible.

Why is altruism necessary in organ donation? It is because it will ensure the absence of exploitation. It is nobody’s case that

unless some useful action is altruistic it is better to forbid it altogether. Altruism removes the profit - making element. It will help ensure that organ transplantation is done in the best possible way and thereby achieve the best

possible medical result. It will also ensure that no vital organ is removed from a living person. On the other hand, trade in kidneys definitely puts one on the slippery slope to selling vital organs as documented elsewhere. (2) Here, the authors utilise the familiar stratagem of positing and demolishing imaginary weak arguments against their stated position, while ignoring the real and powerful argument.

1NC T 1Topical affirmatives must legalize at both the federal and state level- “The United States” is a collective termAmerican Civil Procedure: A Guide to Civil Adjudication in US Courts, Edited by John Bilyeu Oakley, Professor of Law at the University of California, Davis, and Vikram D. Amar, Professor of Law and Associate Dean for Academic Affairs of the School of Law of the University of California at Davis, Kluwer Law International, 2009, page 19

Although it is commonplace today to refer to “the United States” as a single entity and as the subject of statements that grammatically employ singular verbs, it is important to remember that “ the U nited

S tates ” remains in many important ways a collective term . The enduring legal significance of the fifty states that

together constitute the United States, and their essential dominion over most legal matters affecting day-to-day life within the United States,

vastly complicates any attempt to summarize the civil procedures within the United States. Within the community of nations,

the U nited S tates is a geopolitical superpower that acts through a federal government granted constitutionally specified and limited powers . The organizing principle of the federal Constitution ,1

however, is one of popular sovereignty, with governmental powers distributed in the first instance to republican institutions of government organized autonomously and uniquely in each of the fifty states. Although there are substantial similarities in the organization of state governments, idiosyncrasies abound.

VOTE NEG – splitting it up topical actors makes thousands of agents with different advantages. No way to predict.

1NC DA 2TPA will pass – has the votes. But Obama’s capital is key – pushing nowTHE HILL 2 – 19 – 15 [Pritzker expects fast-track to pass Congress, http://thehill.com/policy/finance/233285-pritzker-expects-fast-track-to-pass-congress]

Obama administration officials are acknowledging the challenge of passing trade promotion authority (TPA) as

they ramp up efforts to build broad support .

Commerce Secretary Penny Pritzker said Thursday that getting a fast-track measure through Congress has always proven difficult and that this time around won't be any different.

"These are never easy votes so let’s not think it’s different or there’s some circumstance now that’s different than before,” she said in a call with reporters.

"Trade promotion legislation is a hard vote to get passed because takes a lot of explanation as to what it is,” she said.

Still, Pritzker is confident that a fast-track measure, despite widespread opposition from Democrats in

Congress, will pass , most likely by a small margin .

Pritzer said she has been talking to Republicans and Democrats who were involved in previous TPA battles and understands what is needed to get push a measure through Congress.

The last TPA bill passed in 2002, only by a few votes in the House.

Earlier in the day, Agriculture Secretary Tom Vilsack said that a TPA vote is a “close call,” according to press reports.

Pritzker and Jeff Zients, director of the White House National Economic Council, said the lobbying effort to convince

lawmakers and Americans continues in earnest and will succeed on TPA and the broader trade agenda.

Zients, who has led the White House’s campaign to get Cabinet members talking to Democrats about gaining their support,

reiterated President Obama's message that trade will create more and better paying jobs while boosting the nation’s overall growth.

He argued that exports are essential to growing the U.S. economy and that "trade agreements like the Trans-Pacific Partnership can boost wages and help protect American workers."

Obama administration officials used Minnesota as an example of how trade can work, especially for smaller businesses.

The Commerce Department reported on Thursday that last year merchandise exports from the state hit a record $21.4 billion, helping bring the U.S. total to a $2.35 trillion record for goods and services exports.

Pritzker, as well as other Cabinet officials, has been on the road hawking the trade agenda to small- and medium-sized business. She recently zipped through the West Coast cities of San Francisco, Seattle and Portland making the sell.

The plan is political suicideCalandrillo 4 [Steve Calandrillo (Law Prof—U of Washington); George Mason Law Review, Vol. 13, pp. 69-133, 2004; “Cash for Kidneys? Utilizing Incentives to End America's Organ Shortage”]

REAL REFORMS: UTILIZING INCENTIVES TO END THE NATION’S ORGAN SHORTAGE

Despite the above analysis, any form of legalized human organ market would be far from a utopian solution: it

would be political suicide to propose, entail significant administrative costs to establish and monitor , and

remain morally distasteful to many Americans . While such markets havebeen debated without much progress in the past, far

less attention has been paid to dozens of other monetary and nonmonetary incentives that could be employed. Taking an incentive- based approach would avoid imposing risk on living donors, dramatically expand the pool of available organs, and shock the conscience far less than allowing living-seller markets.190

Solves global trade collapseKati Suominen 14, Visiting Assistant Adjunct Professor at UCLA Anderson School of Management, Adjunct Fellow at CSIS, Ph.D. Political Economy from UC San Diego, Aug 4 2014, “Coming Apart: WTO fiasco highlights urgency for the U.S. to lead the global trading system,” katisuominen.wordpress.com/2014/08/04/coming-apart

Two threats are emerging. The first is disintegration of the trading system . The core of the system until the mid-1990s, the WTO is utterly dysfunctional : deals require unanimity among 160 members, making any cantankerous player like India a veto. Aligning interests has been impossible, turning all action in

global trade policymaking to free trade agreements (FTAs), first kicked off by the North American Free Trade Agreement (NAFTA) in 1994. By now, 400 FTAs are in place or under negotiation. FTAs have been good cholesterol for trade, but the overlapping deals and rules also complicate

life for U.S. companies doing global business. One single deal among all countries would be much preferable to the “spaghetti bowl” of FTAs, but it is but a pie in the sky. So is deeper liberalization by protectionist countries like India.¶ The U.S.-led talks for “mega-regional” agreements with Europe and Asia-Pacific nations, the Trans-Atlantic Trade and Investment Partnership (TTIP) and Trans-Pacific Partnership (TPP), are the

best solution yet to these problems . They free trade and create uniform rules among countries making up two-

thirds of the world economy . Incidentally, they would create a million jobs in America. Yet both hang in balance thanks to inaction on

Capitol Hill to pass the Trade Promotion Authority ( TPA ), the key piece of legislation for approving the mega-deals, now stuck in a bitter political fight as several Democrats and Tea Party line up in opposition. TPA is key

for the Obama administration to conclude TPP and TTIP talks : Europeans and Asians are unwilling to

negotiate the thorniest topics before they know TPA is in place to constrain U.S. Congress to voting up or down on these deals, rather than amending freshly negotiated

texts.¶ The second threat in world trade is the absence of common rules of the game for the 21st century global digital economy. As 3D printing, Internet of Things, and cross-border ecommerce, and other disruptive technologies expand trade in digital goods and services, intellectual

property will be fair game – why couldn’t a company around the world simply replicate 3D printable products and designs Made in the USA? Another problem is data protectionism – rules on access and transport of data across borders. Europeans are

imposing limits on companies’ access to consumer data, complicating U.S. businesses’ customer service and marketing; emerging markets such as Brazil and Vietnam are forcing foreign IT companies to locate servers and build data centers as a condition for market access, measure that

costs companies millions in inefficiencies. A growing number of countries claim limits on access to data on the grounds of “national security” and “public safety”, familiar code words for protectionism.¶ Digital protectionism risks

balkanizing the global virtual economy just as tariffs siloed national markets in the 19th century when countries set out to collect revenue and promote infant industries – a self-defeating approach that took well

over a century to undo, and is still alive and well in countries like India. The biggest losers of digital protectionism are American small businesses and consumers leveraging their laptops, iPads and smart phones to buy and sell goods and services around the planet.

Trade policymakers however lag far behind today’s trade , which requires sophisticated rules on IP, piracy, copyrights, patents and

trademarks, ecommerce, data flows, virtual currencies, and dispute settlement. The mega-regionals , especially the TTIP, are a perfect venue to start this process. ¶

Disintegration of trade policies risk disintegrating world markets . Just as after World War II, the global trading system

rests in America’s hands . Three things are needed.¶ The first is the approval of TPA, which unshackles U.S. negotiators to finalize TPP and TTIP. Most interesting for U.S. exporters, TPP and TTIP almost de facto merge into a superdeal: the United States and EU already have bilateral FTAs with several common partners belonging in TPP – Peru, Colombia, Chile, Australia, Singapore, Canada, and Mexico to

name a few. What’s more, gatekeepers to markets with two-thirds of global spending power, TPP and TTIP will be giant magnetic docking stations to outsiders; China and Brazil, aiming to revive sagging growth, are interested. Once this happens, the TTIP-TPP superdeal will cover 80 percent of

world’s output and approximate a multilateral agreement – and have cutting-edge common trade rules that could never be agreed in one Big Bang at the WTO.

Causes global hotspot escalation---trade solvesMiriam Sapiro 14, Visiting Fellow in the Global Economy and Development program at Brookings, former Deputy US Trade Representative, former Director of European Affairs at the National Security Council, “Why Trade Matters,” September 2014,

http://www.brookings.edu/~/media/research/files/papers/2014/09/why%20trade%20matters/trade%20global%20views_final.pdfThis policy brief explores the economic rationale and strategic imperative of an ambitious domestic and global trade agenda from the perspective of the United States. International trade is often viewed through the relatively

narrow prism of trade-offs that might be made among domestic sectors or between trading partners, but it is important to consider also the impact that increased trade has on global growth, development and security. With

that context in mind, this paper assesses the implications of the Asia- Pacific and European trade negotiations underway , including for

countries that are not participating but aspire to join. It outlines some of the challenges that stand in the way of completion and ways in which they can be addressed. It examines whether the focus on “mega-regional” trade agreements comes at the expense of broader liberalization or acts as a catalyst to develop higher standards than might otherwise be possible. It concludes with policy recommendations for action by governments, legislators and

stakeholders to address concerns that have been raised and create greater domestic support.¶ It is fair to ask whether we should be concerned about the future of international trade policy when dire

developments are threatening the security interests of the United States and its partners in the Middle East, Asia, Africa and Europe. In the Middle East,

significant areas of Iraq have been overrun by a toxic offshoot of Al-Qaeda, civil war in Syria rages with no end in sight, and the Israeli-

Palestinian peace process is in tatters . Nuclear negotiations with Iran have run into trouble, while Libya and Egypt

face continuing instability and domestic challenges. In Asia, historic rivalries and disputes over territory have heightened tensions across the region, most acutely

by China’s aggressive moves in the S outh C hina S ea towards Vietnam, Japan and the Philippines. Nuclear-armed North Korea

remains isolated, reckless and unpredictable. In Africa, countries are struggling with rising terrorism, violence and corruption. In Europe, Russia continues to foment instability and destruction in eastern Ukraine. And within the European Union, lagging economic recovery and the surge in support for extremist parties have left people fearful of increasing violence against

immigrants and minority groups and skeptical of further integration.¶ It is tempting to focus solely on these pressing problems and defer less urgent issues—such as forging new disciplines for international trade—to another day,

especially when such issues pose challenges of their own. But that would be a mistake. A key motivation in building greater domestic and international consensus for advancing trade

liberalization now is precisely the role that greater economic integration can play in opening up new avenues of opportunity for promoting development and increasing economic prosperity. Such initiatives

can help stabilize key regions and strengthen the security of the United States and its partners.¶ The last century provides a powerful example of how

expanding trade relations can help reduce global tensions and raise living standards. Following World War II, building stronger

economic cooperation was a centerpiece of allied efforts to erase battle scars and embrace former enemies. In defeat, the economies of Germany, Italy and Japan faced ruin and people were on the verge of starvation. The United

States led efforts to rebuild Europe and to repair Japan’s economy. A key element of the Marshall Plan, which established the foundation for unprecedented growth and the level of European integration that

exists today, was to revive trade by reducing tariffs.1 Russia, and the eastern part of Europe that it controlled, refused to participate or receive such assistance. Decades later, as the Cold War ended, the

United States and Western Europe sought to make up for lost time by providing significant technical and financial assistance to help integrate central and eastern European countries with the rest of Europe and the global

economy. ¶ There have been subsequent calls for a “Marshall Plan” for other parts of the world,2 although the confluence of dedicated resources, coordinated support and existing capacity has been difficult to replicate.

Nonetheless, important lessons have been learned about the valuable role economic development can play in defusing tensions , and how opening markets can hasten

growth. There is again a growing recognition that economic security and national security are two sides of the same coin. General Carter Ham, who stepped down as head of U.S. Africa Command last year, observed the close connection between increasing prosperity and bolstering stability. During his time in Africa he had seen that “security and stability in many ways depends a lot more on economic growth and opportunity than it does on military

strength.”3 Where people have opportunities for themselves and their children, he found, the result was better governance, increased respect for human rights and lower levels of conflict.¶ During his confirmation hearing last year, Secretary John Kerry stressed the link between economic and national security in the context of the competitiveness of the United States but the point also has broader application. Our nation cannot be strong abroad, he argued, if it is not strong at home, including by putting its own fiscal house in order. He asserted—rightly so—that “more than ever foreign policy is economic policy,” particularly in light of increasing competition for global

resources and markets. Every day, he said, “that goes by where America is uncertain about engaging in that arena, or unwilling to put our best foot forward and win,

unwilling to demonstrate our resolve to lead , is a day in which we weaken our nation itself.”4¶ Strengthening

America’s economic security by cementing its economic alliances is not simply an option, but an imperative . A strong nation needs a strong

economy that can generate growth, spur innovation and create jobs. This is true, of course, not only for the United States but also for its key partners and the rest of the global trading system. Much as the United States led the way

in forging strong military alliances after World War II to discourage a resurgence of militant nationalism in Europe or Asia, now is the time to place equal emphasis on shoring up our collective economic security. A failure

to act now could undermine international security and place stability in key regions in further jeopardy.

1NC DA 3Plan wrecks doctor-patient trust – collapses health care and solvencyCaplan, 14 - Department of Medical Ethics and Director, Center for Bioethics, University of Pennsylvania (Arthur, Contemporary Debates in Bioethics, ed: Caplan and Arp,. Google books)

Second, Cherry argues that medicine is a business: "Medicine is a commodity: its goods and services are bought and sold, valued over against other goods and services, are the subject of economic choices, and are given a monetary equivalence. Hospitals, physicians, and other healthcare workers demand payment for services rendered." Therefore, he concludes, we can have doctors paid and patients paid to undergo

surgery to take out their organs for no reason other than profits. Medicine is a business, but it is also a profession —one

that relies on trust. If commercial concerns are seen as overwhelming the protection of patient

interests, then medicine will not long be able to function . If doctors do useless tests on patients solely to make money, then patients come to distrust recommendations for tests. If doctors will remove your kidney,

cornea, lobe of liver, or limbs solely so that you and they may turn a buck, patients soon will come to completely distrust

their doctors. Transplantation depends upon trust —to obtain organs such as hearts and lungs, people must believe their loved ones are truly dead before removal. Trust in that the surgeon will not give you an inferior or infected organ just to get a paycheck . Trust in that you cannot bribe your way to access to

an organ ahead of those in greater need. There is nothing that will destroy trust more in transplant than showing that doctors are quite willing to harm their patients—especially those who are poor or vulnerable— solely and only for money.

Impact is bioterrorJacobs, 5 – MD; Boston University professor of medicine [Alice, director of Cardiac Catheterization Laboratory and Interventional Cardiology, "Rebuilding an Enduring Trust in Medicine," Circulation, 2005, circ.ahajournals.org/content/111/25/3494.full#xref-ref-3-1, accessed 8-18-14]

To be sure, we will learn about the emerging science and clinical practice of cardiovascular disease over the next four days. But there is an internal disease of the heart that confronts us as scientists, as physicians, and as healthcare professionals. It is a

threat to us all—insidious and pervasive—and one that we unknowingly may spread. This threat is one of the most critical issues facing our profession today. How we address this problem will shape the future of medical care.¶ This issue is the

erosion of trust.¶ Lack of trust is a barrier between our intellectual renewal and our ability to deliver this

new knowledge to our research labs , to our offices, to the bedside of our patients, and to the public . Trust is a vital, unseen, and essential element in diagnosis, treatment, and healing. So it is fundamental that we understand what it is, why it’s important in medicine, its recent decline, and what we can all do to rebuild trust in our profession. Trust is intrinsic to the relationship between citizens around the world and the institutions that serve their needs: government, education, business, religion, and, most certainly, medicine.¶ Albert Einstein recognized the importance of trust when he said, “Every kind of peaceful cooperation among men is primarily based on mutual trust.”1 In our time, trust has been broken, abused, misplaced, and violated. The media have been replete with commentaries, citing stories of negligence, corruption, and betrayal by individuals and groups in the public and private sectors, from governments to corporations, from educational institutions to the Olympic Organizing Committee. These all are front-page news. Perhaps the most extreme example is terrorism, in which strangers use acts of violence to shatter trust and splinter society in an ongoing assault on our shared reverence for human life.¶ Unfortunately, we are not immune in our own sphere of cardiovascular medicine. The physician-investigator conflicts of interest concerning enrollment of patients in clinical trials, the focus on medical and nursing errors, the high-profile medical malpractice cases, the mandate to control the cost of health care in ways that may not be aligned with the best interest of the patient—all of these undermine trust in our profession. At this time, when more and more public and private institutions have fallen in public esteem, restoring trust in the healthcare professions will require that we understand the importance of trust and the implications of its absence.¶ Trust is intuitive confidence and a sense of comfort that comes from the belief that we can rely on an individual or organization to perform competently, responsibly, and in a manner considerate of our interests.2 It is dynamic, it is fragile, and it is vulnerable. Trust can be damaged, but it can be repaired and restored. It is praised where it is evident and acknowledged in every profession. Yet it is very difficult to define and quantify.¶ Trust is easier to understand than to measure. For us, trust may be particularly difficult to embrace because it is not a science. Few instruments have been

designed to allow us to evaluate it with any scientific rigor. Yet, trust is inherent to our profession, precisely because patients

turn to us in their most vulnerable moments, for knowledge about their health and disease. We know trust when we experience it: when we advise patients in need of highly technical procedures that are associated with increased risk or when we return from being away to learn that our patient who became ill waited for us to make a decision and to discuss

their concerns, despite being surrounded by competent colleagues acting on our behalf.¶ Many thought leaders in the medical field understand the importance of trust.3 When asked whether the public health system could be overrun by public panic over SARS and bioterrorism, Centers for Disease Control and Prevention Director Julie Gerberding replied, “You can manage people if they trust you. We’ve put a great deal of effort into improving state and local

communications and scaled up our own public affairs capacity…we’re building credibility, competence and trust.”4¶ Former

Health and Human Services Secretary Donna Shalala also recognized the importance of trust when she said, “If we are to keep testing new med icines and new approaches to curing disease , we cannot compromise the trust and willingness of patients to participate in clinical trial s . ”5¶ These seemingly intuitive concepts of the importance of trust in 21st century medicine actually have little foundation in our medical heritage. In fact, a review of the early history of medicine is astonishingly devoid of medical ethics. Even the Codes and Principles of Ethics of the American Medical Association, founded in 1847, required patients to place total trust in their physician’s judgment, to obey promptly, and to “entertain a just and enduring sense of value of the services rendered.”6 Such a bold assertion of the authority of the physician and the gratitude of the patient seems unimaginable today.¶ It was not until the early 1920s that role models such as Boston’s Richard Cabot linked patient-centered medical ethics with the best that scientific medicine had to offer,6 and Frances Weld Peabody, the first Director of the Thorndike Memorial Laboratory at the Boston City Hospital, crystallized the ethical obligation of the physician to his patient in his essay “The Care of the Patient.”7 In one particularly insightful passage, Peabody captures the essence of the two elements of the physician’s ethical obligation: He must know his professional business and he must trouble to know the patient well enough to draw conclusions, jointly with the patient, as to what actions are indeed in the patient’s best interest. He states: “The

treatment of a disease may be entirely impersonal: The care of the patient must be completely personal. The significance

of the intimate personal relationship between physician and patient cannot be too strongly emphasized, for in an extraordinarily large number of cases both diagnosis and treatment are directly dependent on it.”

Truly, as Peabody said, “The secret to the care of the patient…is in caring for the patient.”7¶ This concept that links the quality of the physician-patient relationship to health outcomes has indeed stood the test of time. Trust has been shown to be important in its own right. It is essential to patients , in their willingness to seek car e , their

willingness to reveal sensitive info rmation, their willingness to submit to treatment, and their willingness

to follow recommendations . They must be willing for us to be able.

ExtinctionSandberg, 8 -- Oxford University Future of Humanity Institute research fellow [Anders, PhD in computation neuroscience, and Milan Cirkovic, senior research associate at the Astronomical Observatory of Belgrade, "How can we reduce the risk of human extinction?" Bulletin of the Atomic Scientists, 9-9-2008, thebulletin.org/how-can-we-reduce-risk-human-extinction, accessed 8-13-14]

The risks from anthropogenic hazards appear at present larger than those from natural ones. Although great progress has been made in reducing the number of nuclear weapons in the world, humanity is still threatened by the possibility of a global thermonuclear war and a resulting nuclear winter. We may face even greater

risks from emerging technologies. Advances in synthetic biology might make it possible to engineer pathogens capable

of extinction-level pandemics . The knowledge, equipment, and materials needed to engineer pathogens are more accessible than those needed to build nuclear weapons. And unlike other weapons,

pathogens are self-replicating , allowing a small arsenal to become exponentially destructive. Pathogens have been implicated in the extinctions of many wild species. Although most pandemics "fade out" by reducing the density of susceptible populations, pathogens with wide host ranges in multiple species can

reach even isolated individuals . The intentional or unintentional release of engineered pathogens with high transmissibility, latency, and lethality might be capable of causing human extinction . While such an event seems unlikely today, the likelihood may increase as biotechnologies continue to improve at a rate rivaling Moore's Law.

1NC CP 1Text: The fifty states should, through the National Conference of Commissioners on Uniform Law, amend the Uniform Anatomical Gift Act to require routine recovery of cadaveric organs in the event of brain death, allowing limited religious opt-out.

Solves supply better and avoids exploitation DASpital, 7 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Routine Recovery of Cadaveric Organs for Transplantation: Consistent, Fair, and Life-Saving” CJASN March 2007 vol. 2 no. 2 300-303, doi: 10.2215/CJN.03260906)

Transplant candidates and the people who care for them know only too well that there is a severe shortage of acceptable organs. As a result, in the United States alone, approximately 19 people on the transplant waiting list die every day (1). Compounding this tragedy is the fact that

many potentially life-saving cadaverica organs are not procured (2). Clearly, our organ procurement system fails to meet our needs. Recognition of this failure has led to several radical proposals designed to increase the number of organs that are

recovered for transplantation, including legalization of organ sales (3) and offering priority status to people who agree to

posthumous organ recovery (4). But before reaching for a new approach, we need to ask first, “What is wrong with our current cadaveric organ procurement system?”

The Need for Consent: Widely Accepted but Sometimes Deadly

We believe that the major problem with our present cadaveric organ procurement system is its absolute requirement for consent. As such, the system’s success depends on altruism and voluntarism. Unfortunately, this approach has proved to be inefficient. Despite tremendous efforts to increase public commitment to posthumous organ donation, exemplified most recently by the US Department of Health and Human Services sponsored Organ Donation Breakthrough Collaborative (5), many families who are asked for permission to recover organs from a recently deceased relative still say no (2). The result is a tragic syllogism: nonconsent leads to nonprocurement of potentially life-saving organs, and nonprocurement limits the number of people who could have been saved through transplantation; therefore, nonconsent results in loss of life.

In an attempt to overcome this consent barrier while retaining personal control over the disposition of one’s body after death, several countries have enacted “opting-out” policies, sometimes referred to (erroneously, we believe) as presumed consent (6). Under these plans, cadaveric organs can be procured for transplantation unless the decedent—or her family after her death—had expressed an objection to organ recovery. Although there is evidence that this approach increases recovery rates, perhaps by changing the default from nondonation to donation (7,8), the recent Institute of Medicine (IOM) report on organ donation concluded that a presumed consent policy should not be adopted in the United States at this time (8). One of the most important concerns noted by the IOM committee is the results of a 2005 survey in which 30% of the respondents said that they would opt out under a presumed consent law. The IOM report also pointed out that in the United States there seems to be a lack of public support for this approach, that the organ donation rate in the United States currently exceeds that of many countries with presumed consent policies, and that in most of these countries the family of the decedent is still consulted (8). It should also be noted that even opting-out countries do not have enough organs to meet their needs, and for people who remain unaware of the plan, presumed consent becomes routine recovery in disguise.

Given that some people do not want to donate, it is clear that whether we follow an opting-in or an opting-out approach, life-saving organs are and will continue to be lost because of refusals. In other words, the requirement for consent, whether explicit or presumed, is responsible for some deaths. But isn’t this the price that we must pay to show respect for people after they die? We believe that the answer is no.

The view that consent is an absolute requirement for cadaveric organ recovery has long been accepted as self-evident, and few experts in the field have seen the need to justify it. We agree that the premortem wishes of the deceased regarding the postmortem disposition of his or her property should generally be respected. However, we believe that the obligation to honor these (or the family’s) wishes is prima facie, not absolute, and that it ceases to exist when the cost is unnecessary loss of human life, which is often precisely what happens when permission for

organ recovery is denied. Therefore, given the current severe organ shortage and its implications for patients who are on the waiting list, we propose that the requirement for consent for cadaveric organ recovery be eliminated and that whenever a person dies with transplantable organs, these be recovered routinely (9–11). Consent for such recovery should be neither required nor sought. In our opinion, the practical and ethical arguments for this proposal are compelling.

Routine Removal: Consistency with Other Socially Desirable but Intrusive Programs

One of the major reasons for insisting on consent is to show respect for autonomy, a major principle of biomedical ethics. However, Beauchamp and Childress (12) pointed out that as important as this principle is, it “has only prima facie standing and can be overridden by competing moral considerations.” One such consideration occurs when society is so invested in attaining a certain goal that is designed to promote the public good that it mandates its citizens to behave in a manner that increases the probability of achieving that goal, even though many of them would prefer not to act in this way. Silver (13) pointed out the legitimacy of this approach in his discussion of an “organ draft”: “The sense behind the coercive power of democratic governments is to move society forward by public decree where individuals will not, by private volition, act in their own best interests.” Examples of such situations include a military draft during wartime, taxation, mandatory vaccination of children who attend public school, jury duty, and, perhaps most relevant to routine removal of cadaveric organs, mandatory autopsy when foul play is suspected. Although some people may not like the fact that they have no choice about these programs, the vast majority of us accept their existence as necessary to promote the common good. Routine removal of cadaveric organs would be consistent with this established approach, and it would save many lives at no more (and we believe much less) cost than these other mandated programs. Furthermore, had we been born into a world where cadaveric organ removal for transplantation were routine, it is likely that few if any people would question the policy, just as few of us question mandatory autopsy today. And while most of us will never need a transplant, nonrecipients would also benefit from the plan in the same way that people who never file a claim benefit from the security of having insurance. It should also be noted here that, as discussed below, a person’s autonomy is lost after death.

Recovering Cadaveric Organs without Consent: Life-Saving and Fair

Few would argue against the view that routine removal of usable cadaveric organs would save many lives. Under such a program,

recovery of transplantable organs should approach 100%. It is unlikely that any program designed to increase consent

rates could even come close. Although the expected high efficiency of routine recovery is its major raison d’être, it also has several other

advantages. Routine recovery would be much simpler and cheaper to implement than proposals designed

to stimulate consent because there would be no need for donor registries , no need to train requestors, no

need for stringent governmental regulation, no need to consider paying for organs , and no need for permanent public education campaigns . The plan would eliminate the added stress that is experienced by some families and staff who are forced to confront the often emotionally wrenching question of consent for recovery. Delays in the removal of transplantable organs, which sometimes occur while awaiting the family’s decision and which can jeopardize organ quality, would also be eliminated.

A final advantage of routine posthumous organ recovery is that it is more equitable than are systems that require consent. All people would be potential contributors, and all would be potential beneficiaries . No longer could one say, “Thank you,” when offered an organ but say, “No,” when asked to give one; such “free riders” would be eliminated.

And concern about exploitation of the poor, as sometimes arises during discussions of organ sales, is

not an issue here .

Case

1NC ShortagesPlan crushes donations—hurts overall supplySheila M. Rothman 6, Professor of Public Health in the Division of Sociomedical Sciences the Joseph L. Mailman School of Public Health at Columbia University, Assistant to the Deputy Director of the Center for the Study of Society and Medicine at the Columbia College of Physicians & Surgeons at Columbia University, and David J. Rothman, professor of Social Medicine at Columbia University College of Physicians and Surgeons, President of the Institute on Medicine as a Profession, 13 Feb 2006, “The Hidden Cost of Organ Sale,” American Journal of Transplantation, 6(7); 1524-1529, http://www.societyandmedicine.columbia.edu/organs_challenge.shtml

Advocates think it self-evident that market incentives will yield more organs for transplantation. ‘People are more likely to do

something if they are going to get paid for it’ (6). And sellers will not drive out donors . Whatever financial incentives exist, siblings and parents will continue to donate to loved ones.¶

These expectations , however, may be disappointed . Since the 1970s, a group of economists and social psychologists have

been analyzing the tensions between ‘extrinsic incentives’ —financial compensation and monetary rewards, and ‘intrinsic incentives’ —the moral commitment to do one’s duty . They hypothesize that extrinsic

incentives can ‘ crowd out’ intrinsic incentives , that the introduction of cash payments will weaken moral

obligations . As Uri Gneezy, a professor of behavioral science at the University of Chicago School of

Business, observes: ‘ Extrinsic motivation might change the perception of the activity and destroy the

intrinsic motivation to perform it when no apparent reward apart from the activity itself is expected’ (7–12). Although the case for the ‘hidden

costs of rewards’ is certainly not indisputable, it does suggest that a market in organs might reduce altruistic donation and overall supply .¶ Perhaps the most

celebrated analysis of the tension between intrinsic and extrinsic incentives is Titmuss’ work in blood donation. His book, The Gift Relationship (1971), argued that the ‘commercialization of blood represses the expression of altruism (and) erodes the sense of community’. Payment undermined the altruistic motivations of would-be blood donors. Titmuss supported his hypothesis by comparing blood donation in the United States and the United

Kingdom. Analyzing data from England and Wales over the period 1946–1968, where the sale of blood was prohibited, Titmuss found that the percentage of

the population who donated blood and the amount of blood donated steadily increased . By comparison, in the United

States, where the sale of blood was allowed, donations declined . Because U.S. data were more fragmentary, Titmuss drew as best he could on a variety of

sources, including surveys, municipal statistics and comments by medical experts and blood bank officials. Nevertheless, he confidently concluded: The data, ‘when analyzed in microscopic fashion, blood bank by blood bank area by area, city by city, state by state’, revealed ‘a generally worsening situation’ (12).

Physician opposition crushes solvencyD.L. Segev 10, associate professor of surgery and epidemiology at the Johns Hopkins University School of Medicine, and S.E. Gentry, Associate Professor, Mathematics, US Naval Academy, “Kidneys for Sale: Whose Attitudes Matter?” American Journal of Transplantation Volume 10, Issue 5, pages 1113–1114, May 2010, http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2010.03085.x/full

First, nothing else is relevant until physicians support organ sales . And , right now, they don’t . In a recent survey

of the American Society of Transplant Surgeons, only 20% of transplant surgeons—those actually doing the transplants—supported cash

payments for deceased or live donation (2). Similar lack of support was found among physicians from other societies

as well (3). Clearly an organ market will not be much of a market with so few willing to perform the transplants or refer the patients . And a rift in the transplant community resulting from a marginally

supported organ market will likely be much more detrimental to organ transplantation in the United States than

any putative increase in donation from establishing financial incentives (4). As such, those seeking to better

understand the viability of organ markets should focus first on the physicians .

Organ banks backlashGabriel Danovitch 8, M.D., Prof of Clinical Medicine and Nephrology at UCLA, and Francis Delmonico, MD, Clinical Prof of Surgery at Massachusetts General Hospital, “The prohibition of kidney sales and organ markets should remain,” Current Opinion in Organ Transplantation Volume 13(4), August 2008, p 386–394

Many organ banks will not willingly participate in a commercial system of organ sales. An algorithm of alternatives arises by

that decision. The ‘regulated’ system could attempt to force organ banks to comply by making this a requirement as a governmental condition of participation. The

proponents of the market system should anticipate a bitter and protracted legal battle in the unlikely event

that this was the government's decision. Once several of the nearly 60 organ banks in the U nited S tates refuse to

participate, chaos is set into motion . What if the patients of Massachusetts go to New York to be on the list and the patients on the New York

list complain that they are being disadvantaged by patients of Massachusetts swelling the ranks of the list? Not all transplant centers will

comply with organ sales because not all transplant surgeons and physicians will participate as

enablers of the transaction . The government does not tell physicians how to practice medicine. Subscribing to organ sales will not be a condition of licensure. What happens next?

No shortage – their impacts are exaggerated, donations increasingSegev, 10 -- Johns Hopkins professor of surgery

[Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of Public Health, Department of Mathematics, United States Naval Academy, "Terminology Influences Many Aspects of the Market/Incentives Debate," American Journal of Transplantation, 2010, 10, 2375, ebsco, accessed 8-27-14]

In seeking more precise terminology, we wish to clarify two other terms critical to this debate. Carefully examining the kidney

waiting list reveals that the 'tremendous organ shortage' is widely distorted , with totals on the waiting list inflated by

inactive candidates who are not eligible for a transplant (approximately one-third of the list ). For exam- ple, between 2002 and 2007, McCullough and colleagues showed that the active kidney waiting list grew by only 10%, indicating a near steady-state of new eligible

regis- trants and transplants for them, while the inactive kidney waiting list grew by 282% (2). Furthermore, live donation rates are often

said to have 'stalled' since 2004. However, living donation rates tripled in the preceding 15 years (3). The level donation rates since 2004 suggest sustainability of these historic highs in donation . Some areas of living donation have seen exponential growth in the last few years . Nondirected donation grew from 2 in 1998 to 56 in 2002 to 137 in 2009 (4,5). Paired donation grew from 3 in 2000 to 39 in 2004 to 419 in 2009 (5,6). These donors do not comprise a large proportion of the living donor pool at this early stage and so do not con- tribute to a visible overall rise in kidney donation. As they continue to increase, however, these sources of donors will likely play a more obvious role in the future. In fact, the rise in living donation between 2008 and 2009 is partly attributable to these novel modalities.

Tech solves A. Xenotransplantation- new discoveriesMoline, 14 – Truth Atlas editor

[Aaron, "Xenotransplantation Could Solve Organ Crisis," 5-23-14, truthatlas.com/xenotransplantation-could-solve-organ-crisis/, accessed 8-28-14]

Xenotransplantation Could Solve Organ Crisis

Scientists are trying to resurrect a project, decades in development, that could potentially alleviate the dire shortage of implantable organs in

humans. It’s called xenotransplantation, and it means altering the organs of other animals into becoming functional in a

human body, providing an endlessly renewable source of hearts and other organs to those critically ill and still waiting for a

viable donor. It isn’t exactly a new idea to use animal organs to replace damaged human ones. After all, we share a common internal design with many different animals, and some are nearly identical to our own. Recently, the discovery that human and pig skin are very similar has led to the use of animal-based skin grafts that have saved the lives of burn victims worldwide. However, our powerful immune systems, which are poised to attack any foreign object from any source, including human donors, remain an obstacle to using internal organs from these same

animals for xenotransplantation. Now, a new project has demonstrated that such an operation is indeed possible by

successfully implanting a pig heart within the body of a baboon. While this may sound like mad science, it is the first step in developing a method to give these organs to the people who need them most. Of course, this achievement could not have been accomplished without a substantial effort from scientists at the US National Heart, Lung and Blood Institute in Bethesda, Maryland. They first observed the method by which the primate body rejected the new organ. Two different sets of protections exists within our bodies and those of the baboons to keep foreign organs out. The first is a system of detection, which the scientists fooled by masking the organ, modifying its genome not to produce the molecule that signals the immune system. The second is the weaponry with which the immune system attacks these invaders, which had to be shielded against with the genetic introduction of a new protein that bolsters the organ’s defenses. The next step was to correct the problems that arose over time when an animal lived with a mismatched heart. They noticed a tendency for blood clots to form in both donated hearts and kidneys, both of which pose serious risks to the animal. A third genetic modification was needed: the addition of a human

anti-clotting substance called thrombomodulin to keep the organ healthy over time. The results have been an astounding

increase in the efficacy of xenotransplantation . Hearts that once gave out after 6 months now last 2 years, providing the

foundation of the technology that one day could provide the organs patients desperately need . As the global population ages, the demand for these organs will only rise as the supply ebbs. When that day arrives, we may need to rely on our porcine friends to give us a heart.

Plan kills the industry at its baseMORTENSEN 05 BA, MA, LLB, BCL, LLM at the Institute of Comparative Law of McGill University [Melanie J. Mortensen, In the Shadow of Doctor Moreau: A Contextual Reading of the Proposed Canadian Standard for Xenotransplantation, university of ottawa law & technology journal]

It seems anomalous to provide the heading “alternatives” to xenotransplantation, since it would seem to imply that xenotransplantation is a

foregone conclusion. Instead, I wish to emphasize the fact that human-organ transplantation is the accepted practice, whereas xenotransplantation is simply an alternative to this practice since the Canadian government has already

committed to increasing the levels of organ donation. The Ontario government recently proposed an initiative with

regard to better procurement requests on the part of doctors when dealing with patients and the families of patients. These

developments are encouraging. Nevertheless, it has been argued that human donors will never provide enough transplantable

organs to meet the demand, even if procurement rates improve.121 It is tragic that there is an organ shortage, but there must be better

efforts concentrated on improving access to human organs because they are currently the more biologically sound choice. Indeed, as discussed above, even if organ-donation rates were to increase, there would still likely be problems with hyperacute and chronic rejection of the organ, as well as with the reoccurrence of the disease that caused the necessity for the organ transplant in the first place.122 The Canadian government’s initiatives toward reducing the need for organ transplants by focusing on the treatment of disease

represent another positive step that could help to avoid the need for difficult biotechnology products

such as xenotransplants . There should be more stringent controls on the development of xenotransplantation within Canada in light

of the complications of this science and in light of the unpromising outcome for patients at present in comparison to the potential

reduction of organ shortages that might follow the improvement in the procurement of organ donations, the reduction of both human-transplant rejection and the severity of diseases that give rise to organ failure, as well as the development of more effective artificial replacements.

B. 3D printing- new tech is a quantum leap forwardGilpin, 14 -- TechRepublic staff writer, citing Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at the Cardiovascular Innovation Institute at Louisville

[Lyndsey, "New 3D bioprinter to reproduce human organs, change the face of healthcare," Tech Republic, 8-1-14, www.techrepublic.com/article/new-3d-bioprinter-to-reproduce-human-organs/, accessed 8-28-14]

New 3D bioprinter to reproduce human organs, change the face of healthcare

Researchers are only steps away from bioprinting tissues and organs to solve a myriad of injuries and illnesses. TechRepublic has the inside story of the

new product accelerating the process. If you want to understand how close the medical community is to a quantum leap

forward in 3D bioprinting, then you need to look a t the work that one intern is doing this summer at the University of Louisville. A team of doctors, researchers,

technicians, and students at the Cardiovascular Innovation Institute (CII) on Muhammad Ali Boulevard in Louisville, Kentucky swarm around the BioAssembly Tool (BAT), a square black machine that's solid on the bottom and encased in glass on three sides on the top. There's a large stuffed animal bat sitting on the machine and a computer monitor on the side, showing magnified images of the biomaterial that the machine is printing. This team stands at the forefront of research in 3D bioprinting, as they methodically take steps toward printing a working

human heart. As part of this work, the team is also pioneering breakthroughs in printing human stem cells -- a move that could

remove the raging ethical dilemmas associated with stem cells and potentially take regenerative medicine to new heights. The combination of these stem cells and 3D bioprinting is going to help repair or replace damaged human organs and tissues, improve surgeries, and ultimately give patients far better outcomes in dealing with a wide range of illnesses and injuries. But, there are problems with BAT -- as advanced as it is from its surprising background as a military project. It's way too slow and printing anything with it is a tortuously manual process. The printhead runs on a three-axis robot that doesn't handle curves very well. No one at the lab knows the limitations and challenges of BAT better than a summer intern named Katie, an undergrad from Georgetown University. She's in Louisville as part of a summer program for the Howard Hughes Medical Institute that exposes students to cutting edge research and lets them participate in groundbreaking work. Katie's not sure what she wants to do when she finishes her bachelor's degree in mathematics but she has thrown herself into her work at the CII with full intensity this summer. A big part of what Katie does is build intricate scripts to tell BAT what to print. It's similar to a computer programmer writing in assembly language to give a computer system an exact set of instructions. It's an incredibly laborious process and it involves Katie going back and forth with Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at CII and one of the leaders of the 3D bioprinting project. "What's interesting is Katie's background in

mathematics," said Hoying, "which is really essential here because it's basically a geometry problem." But Hoying and his team are about to get a new 3D bioprinting solution that will accelerate their work so significantly that what has taken Katie half the summer will soon take half a day, according to Hoying. This new solution's hardware, BioAssemblyBot (BAB), runs as a six-axis robot that is far more precise than BAT. The real difference, however, is in the software: Tissue Structure Information Modeling (TSIM), which is basically a CAD program for biology. It takes the manual coding out of the process and replaces it with something that resembles desktop image editing software. It allows the medical researchers to scan and manipulate 3D models of organs and tissues and then use those to make decisions in diagnosing patients. And then, use those same

scans to model tissues (and eventually organs) to print using the BAB. "It's a big step forward in the capability and technology of bioprinting," said Hoying, "but what someone like me is really excited about is now it enables me to do so much more." Hoying went back to the example of his highly-capable intern, Katie. "Katie has spent half the summer just understanding and scripting up and doing this," he said. "Now if Katie can do that in half a day, I can do more biology, I can do more experiments. I can explore new cell combinations.... In that same half a summer I could have explored different structures, different cell-[to]-cell combinations, experiment here growing them up, etc. Where she's taking half the summer to understand the geometry, script it out, test it... with the BAB and the TSIM, I would have finished a handful of experiments." Bioprinting's new robot BAB and TSIM are an integrated package built by Advanced Solutions, a private biotech company located in suburban Louisville. The new solution officially launches today -- Friday, August 1, 2014 -- and Hoying's CII is not the only lab ready to jump on it. In fact, Hoying is concerned that demand could be so strong that it could interfere with his facility getting one as soon as he would hope, although that seems unlikely considering Hoying was an important collaborator and consultant for Advanced Solutions in creating the product. While the lab where Katie and Dr. Hoying run their experiments is downtown next to the hospitals and cutting edge medical facilities, the Advanced Solutions office is about 20 miles east, tucked away in a suburban office park that's also home to a tree care service, a construction company, a dental association, a US Postal Service branch, and a handful of small healthcare companies. The building that houses Advanced Solutions sits just down a hill off Nelson Miller Parkway, and less than 1000 feet from the I-265 interstate highway. From the outside, there's little indication that the single story brick structure houses a team of 65 people who are working on a hardware and software solution that could revolutionize modern medicine. Advanced Solutions has been around since 1987. During most of the time since then, it has been a software provider building solutions on top of Autodesk for specific industries. But, in October 2010, Advanced Solutions CEO Michael Golway took an alumni tour of the CII -- since Golway is a University of Louisville alum and the university is a key partner of the facility. Golway told TechRepublic, "At the end of the presentation, Dr. Stu Williams passionately summarized the CII business model and I was not only impressed by the CII innovation, team of researchers and focus on cardiovascular solutions but intrigued by the possibilities that Advanced Solutions engineering know-how could contribute in a positive and profound way to helping his team. I followed back up with Dr. Williams one-on-one and we became fast friends." That began the journey that would lead to the integrated solution that Golway and his team devised to meet the needs of Williams, Hoying, and researchers and hospitals throughout the world. "Over the course of 2.5 years we would periodically meet and I learned about some of the technological workflow challenges that slowed his team from advancing the biology research to achieve the Total Bioficial Heart," Golway said. "Dr. Williams and eventually Dr. Hoying also invested time in learning more about the Advanced Solutions team and our capabilities. After 2.5 years of building a terrific working relationship, listening, learning and collaborating I brought forward an engineering design concept for Dr. Williams and Dr. Hoying to consider that was intended to solve the tissue design technology problem." Hoying and Williams, who is the division chief of the bioficial heart program at the CII, are both widely respected cell biologists who came to Louisville from Arizona to work together. They were obviously impressed that Golway's solution could get them closer to their goal of creating that "Total Bioficial Heart." Golway continued, "In March 2013, Advanced Solutions Life Sciences, LLC was formed as a wholly owned subsidiary of Advanced Solutions, Inc. to engineer, fabricate and commercialize the technology in support of that initial concept design. Today the BioAssemblyBot and [the] TSIM software integrated solution are the work product from that endeavor." Beyond the launch of his company's

product, Golway views this work as part of a larger trend of digitizing the medical and biological space, which is destined to unleash other new advances

as well. "What's been really interesting to me is that we're on a trajectory here where we're really treating biology as more of an information technology," Golway said. "That's incredibly exciting to us because IT grows exponentially -- instead of just the hardcore traditional discovery that biology has been tracking on, if we can translate that into IT we can take that

experimentation and rapidly start looking at optimization. How to combine cell types in a way to create cell types and structures. The exponential curve is alrea dy there but this technology allows you to take the next step."

C. Organ cloning- tech exists nowAronson, 13 -- Organ Transplant Initiative founder

[Bob, "Artificial and Bioengineered Organs Can End the Shortage," 2-10-13, https://bobsnewheart.wordpress.com/category/ending-the-organ-shortage-solutions/, accessed 8-28-14]

In June 2011, an Eritrean man entered an operating theater with a cancer-ridden windpipe, People had received windpipe transplants

before, but this one was different. His was the first organ of its kind to be completely grown in a lab using the patient’s own cells. The windpipe is one of the latest successes in the ongoing quest to grow artificial organs in a lab . The goal is

deceptively simple: build bespoke organs for individual patients by sculpting them from living flesh on demand. No-one will have to wait on lengthy

transplant lists for donor organs and no-one will have to take powerful and debilitating drugs to prevent their immune systems from rejecting new body parts. Scaffolds for Tissue Repair energy pulsar Researchers are making use of advances in knowledge of stem cells, basic cells that can be transformed into types that are specific to tissues like liver or lung. They are learning more about what they call scaffolds, compounds that act like mortar to hold cells in their proper place and that also play a major role in how cells are recruited for tissue repair. Tissue engineers caution that the work they are doing is experimental and costly, and that the creation of complex organs is still a long way off. But they are increasingly optimistic about the possibilities. Bioartificial Liver Boston company HepaLife is working on a “bioartificial” liver using a proprietary line of liver stem cells. Once the patient’s blood is separated into plasma and blood cells, a external bioreactor unit with those stem cells inside can reduce levels of toxic ammonia by 75% in less than a day. Bioartificial Hand Smarenergy coming from a handtHand is a bioadaptive hand that can actually feel. Its 40 sensors communicate back and forth directly with the brain using nerve endings in the arm. The hand sends its sensory input to the brain, and the brain sends instructions for movement to the hand. The result? It can pick up a plastic water bottle without crushing it, or pour a drink without spills. BioLung MC3 BioLung is a soda-can-shaped implantable device that uses the heart’s pumping power to move blood through its filters. It’s designed to work alongside a natural lung, exchanging oxygen from the air with carbon dioxide from the bloodstream. So far, it’s been tried on sheep, where six of the eight animals on the BioLung machine survived for five days. Human trials are expected within the next couple of years. 3D Organ Printing Organ printing, or the process of engineering tissue via 3D printing, possesses revolutionary potential for organ transplants. The creation process of artificial tissue is a complex and expensive process. In order to build 3D structures such as a kidney or lung, a printer is used to assemble cells into whichever shape is wanted. For this to happen, the printer creates a sheet of bio-paper which is cell-friendly. Afterwards, it prints out the living cell clusters onto the paper. After the clusters are placed close to one another, the cells naturally self-organize and morph into more complex tissue structures. The whole process is then repeated to add multiple layers with each layer separated by a thin piece of bio-paper. Eventually, the bio-paper dissolves and all of the layers

become one. Using the patient’s own cells as a catalyst, artificial organs may soon become mainstream practice among

treatment centers worldwide. As the health of the nation delves down to record negatives, organ printing may be the establishment’s answer to a number of

preventable conditions. The above alternatives to human organs are but the tip of the iceberg. Medical science and tech nology are on the verge of incredible breakhroughs that will extend life and, at some point, end the need for human organ donation, anti-rejection drugs and maybe even invasive surgery.

1NC—TraffickingDoesn’t get rid of the black marketMichael Hentrich 12, 19 Mar 2012, “Health Matters: Human Organ Donations, Sales, and the Black Market,” http://arxiv-web3.library.cornell.edu/pdf/1203.4289v1

Contemporary sociologists including Michele Goodwin in Black Markets: The Supply and Demand of Body Parts (2006) have

criticized the present system, pointing out that where there is a gift-relationship procurement system, a thriving black market also exists. Goodwin also argues that poor African American communities are especially ill-served by black markets. There are

simply no guarantees that either regulation or marketization would alleviate black market use rates

and supply-side shortages. Consider that a black market prospers even in Iran where the government regulates

kidney pricing; black market use there (even for kidneys) has not been eliminated or even substantially

limited .

The plan is insufficient – there is strong demand for organs outside the U.S. Shimazono 7 – Yosuke, Assistant Professor in Medicine @ Osaka University, “The state of the international organ trade: a provisional picture based on integration of available information” http://www.who.int/bulletin/volumes/85/12/06-039370/en/ The organ-exporting countries

Other forms of international organ trade There are other forms of international organ trade that demand attention. In some cases, live donors have reportedly been brought from the Republic of Moldova to the United

States of America, or from Nepal to India.7,8 In other cases both recipients and donors from different countries move to a third country. More than 100 illegal kidney transplants were performed at St. Augustine

Hospital in South Africa in 2001 and 2002; most of the recipients came from Israel , while the donors were from eastern Europe and Brazil. The police investigation in Brazil and South Africa revealed the existence of an

international organ trafficking syndicate.9 These cases may involve human trafficking for the purpose of organ transplantation. Unlike cell tissues, no confirmed report on transplant organs being trafficked after their removal was found in this survey.

A regulated market of organs can’t solve the black market or organized crime Delmonico et al 2 – Francis L., M.D. – Massachusetts General Hospital, Robert Arnold, M.D – University of Pittsburgh, Nancy Scheper-Hughes, Ph.D. – University of California Berkeley, Laura A. Siminoff, Ph.D – Case Western Reserve University School of Medicine, Jeffrey Kahn, Ph.D, M.P.H., - University of Minnesota, Stuart J. Youngner, M.D. – Case Western Reserve University School of Medicine, “ETHICAL INCENTIVES — NOT PAYMENT — FOR ORGAN DONATION,” N Engl J Med, Vol. 346, No. 25, http://eml.berkeley.edu/~webfac/held/delmonico.pdf

A REGULATED MARKET SYSTEM Since the current system of altruistic organ donation has not met the demand for organs, some critics suggest that the way to resolve this problem is to turn to a market approach that would permit the sale of human organs .41'44 However, the ethical principle that one should not sell one's body applies whether the market is

regulated or left to the vicissitudes of capitalism.45 A system regulated by a government agency (e.g., the Department of

Health and Human Services) would probably not be the only source of organs for sale . In fact, the futility of trying

to reg- ulate payments to donors is suggested by worldwide experience . In the current global market,

prices vary depending on the region and the social status and sex of the donor . For example, in Bombay, India, the

current price for a woman's kidney is said to be S 1,000; in Manila, the Philippines, the price for a man's kidney may

be closer to $2,000; and in urban Latin America, a kidney can be sold for more than $10,000. Such are the payments

allegedly made to the vendor; payments to the broker are an additional expense that can drive the cost of the organ even higher. Payments have allegedly exceeded $200,000 for arrangements in which the

financial transaction occurred in another country and the transplantation was performed in the U nited

S tates.18 Brokering in the U nited S tates according to market criteria of donor suitability would probably be

no different. If the current prohibition against the sale of organs were rescinded, there would be little legal

or ethical justification for preventing persons from bypassing the regulated system and using other

means to obtain a better price for an organ from a more medically suitable donor . The Internet can be used to secure the best price for any commodity. A federally regulated system would have to outlaw Internet bidding and set a controlled price for certain types of donors or continuously modify the price.

Beard is entirely wrong – we cite him. -squo system is working

-crowd out

Capron, 14 – this evidence is responding directly to Beard who is cited in the footnotes - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)

Free-market economists are quick to pronounce that the organ transplantation policies based on the

noncommercial model followed by most countries over the past three decades “have failed.” 153 This seems a rather

blinkered assessment of a system that has extended and improved millions of lives while also providing a

dramatic affirmation of human generosity and solidarity. There is no question that more organs are needed, but were all countries to adopt the “best practices” used by the organ-procurement programs with the highest rates of

donation, a huge increase in transplantation would be possible without resort to paying for organs .

Indeed, during the first decade of this century, a concerted effort by the Department of Health and Human Services led to an increase of more

than twenty-five percent in the rate of donation in the United States.154 Moreover, if only a small fraction of the amount that would need to be spent to purchase organs in a “regulated market” were instead used to improve the present system, further substantial increases in the rate of donation would be possible. But what of the

claim that it is self-evident that paying for organs would increase the net rate of donation?155 The extensive

literature on “crowding out” suggests that many people who are willing to donate in a voluntary, unpaid system would cease doing so once paid donation became an accepted practice.156 It is not simply that

one does not want to be played for a fool (by giving away what others are paid for), but that the nature of the act changes when it is not experienced by the donor, and seen immediately and universally by others, as something that is generous and ennobling. This change would be especially pronounced if, as is likely to be the case, most organ

vendors were understood to be acting out of financial desperation. Although today’s most highly motivated donors—those who are giving a kidney to a close relative—might be expected to be immune to such a change, this has been found not to be the case.

[R]ecently, when the U.S. rules for allocating deceased donor kidneys were changed to give children on the waiting list greater access to deceased adult donors’ kidneys, parental donations fell by a larger amount, so that overall fewer pediatric kidney transplants are being done while some potential adult recipients

have been deprived of a kidney that went to a child instead.157 Likewise, the ready availability of vended kidneys and liver lobes would leave most potential recipients disinclined to ask a relative or friend to donate . Who would want to ask for such a gift from a loved one when his or her need for an organ can be met without imposing any burden on that person and without enmeshing oneself in all the psychological and moral complexities that arise in “the gift relationship”?158 Summarizing observational and experimental research over many decades by economists and social psychologists, Sheila and David Rothman conclude that “although the case for the ‘hidden costs of rewards’ is certainly not indisputable, it does suggest that a market in organs might reduce altruistic donation and overall supply.”159

(Footnote 153)

153. T. RANDOLPH BEARD , DAVID L. KASERMAN & RIGMAR OSTERKAMP, THE GLOBAL ORGAN SHORTAGE: ECONOMIC CAUSES, HUMAN

CONSEQUENCES, POLICY RESPONSES 1 (2013).

Impact FramingThe aff is equally uncertain---the causal effect on the organ shortage is unpredictableJulia D. Mahoney 9, John S. Battle Professor of Law, University of Virginia School of Law, “ALTRUISM, MARKETS, AND ORGAN PROCUREMENT,” Law and Contemporary Problems Vol 72:17, http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1535&context=lcp

That the arguments for refusing to compensate organ sources are unpersuasive does not mean that instituting financial rewards would necessarily prove to be a good policy choice. Introducing financial incentives raises significant challenges, not least among them overcoming the potential hostility of procurement professionals, bioethicists, and others who fiercely espouse the principle of altruistic donation. Compounding such resistance are formal and informal constraints on

financial incentives.77 Removing , modifying, or declining to enforce the formal constraints—that is, the laws and

regulations prohibiting compensation for organ source s — will not automatically dissolve the

informal constraints of organizational practice and social norms .¶ That said, there is reason to suspect that informal

institutional limits on financial incentives are malleable.78 At the very least, some forms of financial incentives might prove both effective and acceptable. But, in

assessing potential institutional modifications, we are hampered by our limited knowledge of how

societal attitudes change. A nother stumbling block is our rudimentary understanding of the

organizational framework that encourages and supports altruism in the context of organ donation .79¶ It is worthwhile to

examine the four most prominent financial-incentive proposals and assess their feasibility. Any such analysis is necessarily preliminary ,

for the long-standing , strict proscriptions against compensating organ sources make it hard to predict how procurement organizations and professionals, prospective donors, the general public, and others will react to policy innovations.80

Precautionary approach key Mark Jablonowski 10, Lecturer in Economics at the University of Hartford, “Implications of Fuzziness for the Practical Management of High-Stakes Risks,” International Journal of Computational Intelligence Systems, Vol.3, No. 1 (April, 2010), 1-7,

“Danger” is an inherently fuzzy concept. Considerable knowledge imperfections surround both the probability of high-stakes exposures , and the assessment of their acceptability. This is due to the complex and dynamic nature of risk in the modern world. ¶ Fuzzy thresholds for danger are most effectively established based on natural risk standards. This means that risk levels are acceptable only to the degree they blend with natural background levels. This concept reflects an evolutionary process that has supported life on

this planet for thousands of years. By adhering to these levels, we can help assure ourselves of thousands more. While the level of

such risks is yet to be determined, observation suggest that the degree of human-made risk we

routinely subject ourselves to is several orders of magnitude higher . ¶

Due to the fuzzy nature of risk , we can not rely on statistical techniques. The fundamental problem

with catastrophe remains, in the long run, there may be no long run . That is, we can not rely on results

“averaging out” over time. With such risks, only precautionary avoidance (based on the minimax’ing

of the largest possible loss ) makes sense. Combined with reasonable natural thresholds, this view allows a very workable

approach to achieving safe progress.

2NC

CP

2NC Solves DemandThe CP procures almost 100% of organs with no risk of abuseSpital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time Has Not Yet Come” Cambridge Quarterly of Healthcare Ethics (2005), 14, 107–112)

The most important advantage of conscription is that under this plan, the efficiency of organ procurement

should approach 100% , which would dramatically increase the number of organs available for transplantation. As previously noted, it is highly unlikely that any other approach could do nearly as well. As a result of the increased availability of organs that conscription would provide, the lives of many more patients with end-stage organ failure could be improved and extended.

Another advantage of conscription is that this system would be much simpler and less costly than other approaches to organ procurement. Under this plan there would be no need to search for the best approach for obtaining consent, no need for expensive, labor-intensive educational programs designed to encourage more people to say yes, no need to

train requestors to obtain and document consent, no need to maintain donor registries, and no need for complex regulatory mechanisms to prevent abuse as would be required were financial incentives allowed .

A third advantage of conscription is that because permission from the family would no longer be sought, this plan would eliminate the added stress that devastated families now endure when asked to consider organ donation in the midst of the grief and shock that follow the sudden

death of a loved one. Furthermore, delays in organ recovery that result from the current need to wait for family approval, and that jeopardize the quality of organs, would be eliminated .

A final advantage of conscription is that, in contrast to other approaches to organ procurement, it satisfies the principle of distributive justice , which refers to equitable sharing of burdens and benefits by members of the community. Under

conscription, all people who die with usable organs would contribute to the cadaveric organ pool—there would be no more “free riders ” 1—and all people would stand to benefit should they ever need an organ transplant. This contrasts with our current system in which people can refuse to donate and yet compete equally for an organ with generous people who choose to give.

They’re conflating the shortage which is an annual rate with the size of the waiting list---we provide enough organs to create an annual surplus which in turn reduces the waitlist over timeDavid Kaserman 2, PhD in Econ from the University of Florida, “Markets for Organs: Myths and Misconceptions,” 18 J. Contemp. Health L. & Pol'y 567 (2002), http://scholarship.law.edu/cgi/viewcontent.cgi?article=1222&context=jchlp

For over three decades, there has been a severe and chronic shortage of cadaveric human organs suitable for transplantation . The ongoing shortage of kidneys, hearts, livers, lungs, and other solid organs has significantly hampered the ability of physicians to bring improved life-saving transplant technology to patients suffering from a variety of debilitating and often fatal diseases. As a result, thousands of individuals die each year because of the failure to obtain a suitable organ in time.' Thousands more are forced to undergo dialysis and other unpleasant but life-sustaining treatments while waiting for an organ (or death, whichever comes first). It is

noteworthy that this shortage of transplantable organs is not attributable to an inadequate supply of

potential organ donors . While estimates of the actual number of deaths that occur each year under

circumstances that would allow for removal and transplantation of cadaver organs vary widely, all

such estimates reveal a substantial pool of potential organ donors who, for a variety of reasons, fail

to supply the needed organs.2 A review of these estimates conservatively suggest s that organ donations

could at least double , given the existing number of potential donors . The failure of the current procurement

system to collect a larger portion of the cadaveric organs that are potentially available has spawned an extensive literature proffering a variety of proposals to alter the existing system in various fundamental and not-so-fundamental ways. Among these proposals, perhaps the most promising is a lifting of the legal ban on cadaveric organ purchases and sales that is contained in the 1984 National Organ Transplant Act, which would allow markets to form and organ prices to rise to their equilibrium, market-clearing levels.3 To an economist, this proposal provides an obvious and straightforward approach to resolving the organ or any other shortage. To many of the commentators on medical policy issues who are contributing to the literature in this area, however, the organ market proposal is highly suspect and has been challenged on both ethical and economic grounds.4 Significantly, most, if not all, of these challenges appear to be founded upon rather blatant misconceptions involving some very fundamental economic issues.5 While errors involving economic concepts may be inevitable in a literature that has been dominated by non-economists, correction of such errors is nonetheless necessary if policy discussions and ultimate decisions are to be founded upon accurate information. The somewhat limited purpose of this paper is to identify and correct some of the more prominent economic misconceptions involving the organ market proposal that currently plague the literature in the hope that the resulting increased clarity will help to elevate the level of the ongoing debate. While I certainly do not intend or expect this discussion to transform readers into economists, the clarifications offered in this article should improve the overall understanding of the organ market proposal and how it can work to resolve this tragic shortage. II. MISCONCEPTION 1: DEFINITION AND MEASUREMENT OF THE SHORTAGE Perhaps the most fundamental misconception surrounding discussions of the organ shortage involves the very definition of the term "shortage," and the corresponding measurement of the magnitude of that shortage. Specifically, several authors writing in this area have mistakenly interpreted the number of patients on a transplant waiting list as a direct measure of the size of the shortage of a particular organ. Such a view fails to recognize the crucial distinction between stocks and flows that is routinely emphasized in economic analysis. Economists define a shortage as a condition in which the quantity of a product demanded exceeds the quantity supplied at the existing price! To appreciate what this definition implies for the organ shortage, two fundamental aspects of the concepts of supply and demand must first be understood. First, both of these concepts refer to schedules relating the quantities bought and sold to various prices paid and received. That is, the term "demand" means a schedule, which may be expressed in the form of a table, graph, or equation that shows the quantities that will be purchased at all possible prices. A specific quantity, at some point along that schedule, is then referred to as the "quantity demanded" at the specified price. Similarly, "supply" is a schedule that indicates the quantities that will be placed on the market for sale at all possible prices. "Quantity supplied" refers to a single point along that schedule. Thus,

the present shortage of transplantable organs is equal to the quantity demanded minus the quantity supplied at the current price of organs. Under the existing U.S. organ procurement policy, that price is zero. Second, and extremely important for the

discussion here, the quantities referred to in the definitions of both supply and demand are flows, not stocks. In other words,

these quantities are expressed as some number of units of the product per some interval of time . To say that the quantity

demanded or supplied of product X is 100 units at a price of $10 per unit is meaningless unless we specify the time period over which these 100 units will be purchased or sold.Obviously, the demand and supply of a product will vary substantially depending upon the time interval over which they are defined. This second point is crucial to understand, as it has been the source of considerable confusion in debates about the

organ shortage and alternative policies formulated to resolve it. Specifically, participants in these debates often have

explicitly or implicitly confused the number of patients on transplant waiting lists, which is a stock,

with the concept of a shortage , which is a flow .8 The size of the waiting lists for transplantable organs

represents the accumulation of the excess demands (shortages) of all preceding periods, adjusted for the

attrition that occurs from patients dying during the specified time interval. As such, observed waiting lists greatly

exaggerate the magnitude of the actual organ shortage on an annual (or any other time period) basis. To

illustrate this important distinction, data from the United Network for Organs Sharing (UNOS) indicates that the waiting list for kidneys stood at 42,364 patients in 1998 .9 However, the actual annual shortage of kidneys is not equal to this number. Rather, the shortage is approximated by the increase in the number of people on the waiting list over the preceding year's figure. It is that number-the annual change in the waiting list-that indicates the amount by which the quantity demanded in 1997 exceeded the

quantity supplied in that year. With UNOS reporting 38,236 people on this list in 1997, the actual shortage in that year was only

4,128 (42,364 minus 38,236) kidneys, or just over 2,000 donors , if there is no adjustment for attrition due to deaths of patients

on the list.'0 Note that this number is less than ten percent of the number of patients on the waiting list." FOOTNOTE 8. See Evans et al.,

supra note 2, at 239; Randall, supra note 6, at 1223; Siminoff & Leonard, supra note 4, at 20. All of these articles appear to confuse

waiting lists with shortages. That confusion , in turn, appears to lead these authors to conclude

mistakenly that the potential supply of cadaveric donors is insufficient to eliminate the organ

shortage at any conceivable collection rate (i.e., at any rate up to 100%). END FOOTNOTE Obviously, if 4,128

additional kidneys had been supplied in 1997, the waiting list would have remained stable at 38,236. That

is, the backlog would not have grown. Further, if 42,364 kidneys had been supplied in 1998, the entire waiting list that had built up over all prior years of shortages could have been eliminated completely in a single year. Then, if that number of kidneys continued to be supplied in

subsequent years, an extremely large surplus would materialize immediately. Of course, given the backlog of patients on the waiting list,

an annual surplus is highly desirable for some period into the future in order to reduce that list over 12 time. Once the

backlog is eliminated by this series of surpluses, however, a simple clearing of the annual demand for

kidneys will be sufficient to prevent future backlogs from developing. Clarification of this issue is important, because it

directly affects the perceived ability of any policy change to eliminate the shortage under the constraint provided by the existing pool of

potential organ donors. Specifically, if one mistakenly views the shortage as being equal to the waiting list, one

might then conclude ( incorrectly ) that complete resolution of the shortage is not feasible under any policy

option. 3 In addition, overestimation of the shortage by reference to the waiting list would lead to a gross overestimate of the price that would be required to equilibrate the market.1 4 Such an overestimate, in turn, would cause an underestimation of the cost effectiveness of the organ market proposal. As a result, unbiased evaluation of that proposal requires a correct definition and measurement of the shortage as a flow rather than a stock.

Since deceased donors are dead, they can give both of their kidneys and a host of other organs---the actual potential supply is 40 thousand kidneys a year and 20 thousand each for other organsTheodore Silver 88, J.D., M.D., Assistant Professor of Law at Touro College and the Jacob D. Fuchsberg Law Center, “The Case for a Post-Mortem Organ Draft and a Proposed Model Organ Draft Act,” 68 B. U. L. Rev. 681 (1988), http://digitalcommons.tourolaw.edu/cgi/viewcontent.cgi?article=1181&context=scholarlyworks

25 Although approximately two million people die annually in the United States, most of their cadaveric organs are not suitable for transplant .

BUREAU OF CENSUS, U.S. DEP'T OF COMMERCE, STATISTICAL ABSTRACT OF THE UNITED STATES 1986, (table 81) (1986). Transplantable organs must come

primarily from brain-dead patients whose breathing and cardiac activity have been artificially maintained . When the heart stops and respiration ceases, oxygen deprivation quickly renders organs unsuitable for transplantation. Telephone conversation with Dr. James Cerilli, Direc-tor of Transplantation, University of Rochester School of Medicine (Jan. 1989). Because organs must come from brain-dead bodies whose respiration and circulation have been artificially maintained after death, donors must, first of all, die in hospitals. About one-half of Americans do so. Bart, Macon, Whittier, Baldwin & Blount, Cadaveric Kidneys For Transplantation: A Paradox of Shortage in the Face of Plenty, 31 TRANSPLANTATION 379-81 (1982) (indicating that 60% of people who die in the United States die in hospitals); Cooper, supra note 10, at 417 (noting that in a study in

Washington state, nearly half of the recorded deaths occurred in hospitals). Medical wisdom also dictates that donors must be relatively young

and free from disease impinging on the organ to be salvaged . Though estimates vary, it appears that about two

percent of the approximately one million patients who die annually in U nited S tates hospitals satisfy

these criteria . See, e.g., Mertz, The Organ Procurement Problem: Many Causes, No Easy Solution, 254 J. A.M.A. 3258 (1985); Russel & Cosimi, Transplantation, 301 N. ENG. J. MED.

470-79 (1979); Cooper, supra note 10, at 416-20 (estimating the potential kidney donors in Washington as 0.0032% of the population per year); Bart, Prevalence ofCadaveric Kidneysjbr Transplantation, in AMERICAN ASSOCIATION OF TISSUE BANKS: PROCEEDINGS OF THE 1977 ANNUAL MEETING 124-30 (K. Sell, V. Pewy & M. Vincent eds. 1977). If two percent of one million

cadavers are suitable donors, then the potential supply of single kidneys , a paired organ, is approximately 40,000 . The

potential supply of hearts, livers, and lung pairs is approximately 20,000 . This estimate is consistent

with that of the Task Force on Organ Transplantation which suggests that the potential pool of organ

donors is between 17,000 and 26,000 annually , although they recommend further study. TASK FORCE 1986 REPORT, supra note 7, at 35.

AT: Do BothThe CP alone creates a legal bright line. The perm is the worst of all worlds – mixing sales with conscription blurs the line, wrecks public trust or the ability to create social change in the medical system, subjects the government to costly litigation that inhibits organ use and institutionalizes exploitation and human rights abusesNeri, 2 - Rebecca M. Neri, Esq., J.D. 2002, Syracuse University 2002; B.A. 1999, Hobart and William Smith College. Ms. Neri is the Digest Form and Accuracy Editor and is an Associate of Devorsetz, Stinziano, Gilberti, Smith & Heintz in Syracuse, New York (“New Organ Donations” 10 Digest 67, lexis)

3. Entering Into a Discussion about the Body as a Commodity - As mentioned briefly above, subjecting corpses to traditional

property reasoning, and consequently, to judicial resolution creates a blanket disincentive to individuals, [*77]

families, and members of the transplant community, including doctors, donors, and transplant centers, to participate in organ donation . Essentially, the total costs, in terms of money, time and emotional expenditures, simply do not outweigh the benefits (i.e., a family knowing their gift let some stranger live). Additionally, requiring the government to set prices for organs offends public policy because it

permits the government to participate in organ selling and requires the government to set a value scale for each organ procured. Economically, the government and the people cannot afford to purchase the organs needed to satisfy

the deficit, nor can either afford to be tied up in litigation while the organ's value dies with its body . In this sense,

discussing the body as property inhibits the goal of increasing organs by increasing the amount of

red tape one must go through to donate . Nationalization (or the creation of a public right) of human cadaveric organs could

also result in serious human rights violations. n46 A simple, more efficient way of thinking that embraces societal problems surrounding organ donation, while shaping public sentiment must take the place of considering the body as property.

Initiating market responses to this problem is not the simple, more efficient way of thinking. Despite this, many argue that a market approach to organ donation could indeed remedy transactional costs as well as eliminate the need for litigation over governmental takings. Additionally, these market advocates feel financial incentives are the most efficient means of remedying the organ shortage. For example, in a recent work David Jefferies proposes that "the most effective way to increase the supply of organs will involve limited commercialization of bodily components." n47 In his view, the law should provide for the use of a "middleman" who has the authority to contract for organs and could halt potential abuses. n48 Upon the death of a willing and contracted donor, doctors would remove the organ(s), and then the appropriate consideration for the organ would change hands. n49 Jefferies then proposes that an organ procurement network set up an altruistic-based distribution system, rather than one conditioned on wealth. n50

This proposal is not an answer to the inefficient means of organ procurement. As will be shown in Section Three, infra, market theories are

inefficient and costly. First, contracting for body parts will require more litigation to establish rules, interpret the rules, and to enforce the rules, requiring efforts of all [*78] branches of government and the private sector. n51 Second, a

contracting scheme exacerbates public fears , rather than reshaping them towards a better awareness

of death , in that a contract for your organs might breed paranoia that someone is trying to "snatch"

the "goods" prematurely .

III. Critique of the Market Alternatives

As stated above, applying a market strategy to remedy the current organ deficit is neither a more efficient, nor a more practical remedy to the

organ deficit problem. A market in organs creates paranoia rather than destroys societal fear, and as such, does not

incorporate the goal of shaping a new public sentiment . Though it might eventually alleviate the organ deficit, the

selling or contracting of organs would invite human rights abuses , such as body snatching , despite

retaining the specter of individual autonomy and public control. This section makes the case that a market remedy for the

organ shortage would present more obstacles to meeting the demands for organs. Specifically, this part argues that a market strategy denies the power of substantial societal value systems (such as common notions of ethics and human rights), and favors a select part of the population. After discussing current market proposals and the particular faults of the trendy market cure, the discussion will turn to why market theories are incapable of reshaping the societal preference towards organ donation.

A. The Trend of Market Solutions

Many scholars have proposed market systems as a cure for the organ deficit. n52 Specifically, those in favor of creating an organ market have argued that since altruistic systems have failed to produce the necessary organs, self-interest in consideration might provide the adequate incentive to donate. n53 Their basic argument is that

in the market, the supply would be self-regulating because rising demand would raise the price of tissues in short supply and produce incentives for individuals to sell their organs; these prices would ensure that enough organs would be available to meet demand. n54

With the demand for organs being met through a market system, these scholars argue that the market is the most efficient system of resource allocation, and that the market would alleviate the imbalance of how benefits and burdens between the donor and recipient are distributed. n55 Thus, economically speaking, [*79] Pareto efficiency is attained - the exchanges are consensual, voluntary, and utility is maximized. n56

Variations to the basic supply and demand model have also been proposed. For example, Lloyd Cohen argues for a "futures market" to cure the organ deficit. n57 Specifically, Cohen proposes that "healthy individuals be given the opportunity to contract for the sale of their body tissue for delivery after death." n58 Some would offer alternative methods of exchange, namely, promises to donate organs in exchange for health insurance, tax breaks, death benefits, public recognition of the donation, or a bartering system to secure other necessities. n59

Regardless of the economic model proposed or the mode or currency of exchange, each purports to disburse ethical and human rights concerns that arise from the notion of selling one's organs. The most cited fear about creating a market in organs is the exploitation of the weak, elderly, poor, and the power the market gives to the wealthy. n60 Another important ethical problem a market must deal with is whether thinking of the body as a commodity is even appropriate. n61 All proponents of a market system insist that heavy regulation and the creation of strict criteria for both the procurement and allocation of organs would remedy ethical concerns. n62

Any market system proposed will surely exploit the poor. First, any market theory that relies on the availability of something to

exchange, and the willingness of participants to exchange necessarily inhibits the participation of the poor. The poor, by virtue of their economic state are not in a position of bargaining power. The poor do not have anything to give to enable

the receipt of an organ, and they are easy targets for unscrupulous organ harvesters who would offer them a

" meal for their left eye ." The tension of economic hardship hardly provides an optimal market scheme of voluntary and consensual

exchanges.

Additionally, market systems that require heavy regulation are neither economically nor politically efficient. Regulation necessitates a degree of complex rules, requiring judicial and legislative interpretation. In turn, market regulation of this sort also becomes the embodiment of a recognized property right in one's body. As mentioned above, inviting the body to interpretation as property brings its own set of ethical problems, as well as problems for procuring organs. By entering the body into the stream of commerce, people would most likely seek enforcement of property rights to their body, including rights to privacy, [*80] control, and transferability. People might also fear the possibility that their bodies could escheat over to the state once their body becomes a commodity in the stream of commerce. The remedy to this result would be regulation, which in turn forecloses on individual autonomy.

In sum, the free market alternatives to the current system of altruism create rather than destroy social and ethical barriers to efficient organ procurement. This section attempted to illustrate that although the exchange of organs on the free market appears to provide individuals with a great degree of control over the disposition of their bodies, such control is dampened. That damper is created in the face of ethical concerns relating to the exploitation of the poor, and the end result of having to provide for property rights in the body.

B. Market Models Fail to Shape a Preference to Donate

Market paradigms purport to shape individual preferences to donate by insisting that people act in their own best interest. In other words, a market paradigm attempts to create specific opportunities for the public so that the beneficial, logical preference for the individual is to donate their organs. n63 In this sense, using a market strategy to provide organs must show that donating outweighs social costs associated with selling organs. n64 This part proffers that the basic supply and demand market paradigm in which money is exchanged for organs is ineffective in providing the public with the means to effectively weigh the social costs and benefits of donating organs. In this sense, the prevailing societal preference under a market system would continue to deplete the organ supply. Thus, any proposed market cure fails as a viable option to correct the current organ shortage.

Humans generally act in their own best interest, though, for the most part, they align with the sense of greater social values. Indeed, some individuals act in accordance with what one author has termed, "socially responsible reasoning," which take humans beyond being purely selfish actors. n65 Markets do not function on exchange alone; they inevitably encompass institutional values, such as social preferences. n66 However, the prevailing social preference of a market in human organs might very well be corrupt at its core, and thus, incapable of providing a structure that weighs the personal costs against the social benefits to organ donation.

The corruption lies not in the potential for market abuses, but rather in the existing social consciousness of the population. As mentioned above, the six [*81] most popular reasons people give for not donating organs are: "hastiness of organ retrieval and a feeling that declaration of death and immediate subsequent removal of organs interferes with the family's expression of grief; mutilation; fatalism and superstition; religion; age and ignorance." n67 If the greater social value of organs is to prevent their being interred without harvesting and to save lives, then the market must arrange itself around enabling people to weigh their cost or fear concerning donation. But how is a market to do this when, in fact, the incentive is merely valued in fiscal terms? How can a market theory, which relies on the wealth of its participants more so than the social justice of its actors effectively push social mores towards weighing the benefits of giving over the cost of facing ones personal fears? It simply cannot. Though any market incentive might push people towards realizing that money is preferable in exchange for needed organs, the market incentive simply fails to account for the underlying fears of the people concerning donation.

The market cannot provide a structure in which ordinary people can rationally weigh costs and benefits of organ donation, because the market

lacks sufficient grounding in the irrational fears concerning donation. A pure incentive program that replaces altruism with cash , or other

necessities is inadequate as it falls short of effectively replacing existing social fears connected with donating organs after d eath . If there really is to be any increase in the organ supply, the answer lies in

reshaping society not through a free market and property system, but rather, through structuring

discussion around changing social values at their core .

IV. The Conscription Cure: Mandatory Cadaveric Organ Donation

The general will is always right, but the judgment that guides it is not always enlightened. It is therefore necessary to make the people see things the way they are<elip>to point out to them the right path they are seeking. Some must have their wills made to conform to the reason, and others must be taught what it is they will. From this<elip>would result the union of judgment and will in the social body. From that union comes the harmony of the parties and the highest power of the whole. n68

Earlier in this article, it was suggested that neither the current altruistic organ donation, nor trendy market proposals that seek to cure the organ deficit work. n69 It has also been suggested that assigning property concepts to bodily organs, such as control, transferability and privacy would neither efficiently deal with the organ shortage, nor incorporate a means of social change. In this section, it [*82] will be proved that

mandatory organ conscription is the most efficient way to cure the deficit and reshape social values .

Specifically, this part first discusses the doctrine of conscription, the details how conscription purports to embrace social values and fears in such a way that will mold society into accepting cadaveric organ conscription.

For the purposes of this article, the discussion will focus on the general policy of a conscription plan. Specific legislation would be needed to implement such a plan, but I leave those details for later investigation. In doing so, I briefly touch on presumed consent laws, because they closely relate to the goal of curing the organ deficit, and are a step on the same path as mandatory conscription.

A. Presumed Consent: A Step in the Right Direction

This section discusses the presumed consent system for organ procurement. Under this system, the presumption is that unless otherwise expressed and recorded, the decedent has consented to the removal and donation of all needed organs after his or her death. n70 In the European Union, this practice appears favored over other market remedies because a market approach seems "inconsistent with the EU objective of a high level of consumer protection [and] the negative opinion of the European Parliament on commercialization or organs<elip>." n71

Ideally, presumed consent systems eliminate the need to seek out the donative intent of the deceased through his family or other means. Despite this intent, some European countries still insist on inquiring into the wishes of the family, while other countries immediately remove organs at the point of death unless there is clear evidence the deceased desired otherwise. n72

Regardless of the standard employed, the European system is still more effective than the current altruistic system of the United States. n73 Practically speaking, the European model has its advantages: no need to carry donor cards, no need for last minute decision-making, and no need to ask for permission from families to harvest. This system also preserved the semblance of respect for individual autonomy as individuals are on notice to object to harvesting. n74

This system is not without its imperfections. In practice, most physicians seeking donation still inquire into the family's wishes. n75 It also does not embrace [*83] the moral objections families or individuals have regarding donation. n76 In other words, those who objected for moral or

social reasons under the system of volunteerism will probably still object under the presumed consent system. Thus, the goal of substantially increasing organ donation (as well as reducing transactional barriers) is not accomplished.

B. The Principles of Conscription

This section discusses the virtues of conscription. A general policy towards conscription of organs would empower every medical provider to harvest "every cadaveric organ suitable for transplantation without regard to any contrary wishes expressed by the decedent while he lives or

by surviving relatives after he dies." n77 A system that permits the removal of all necessary organs at death by medical providers is also the most efficient means of producing the necessary supply of organs. A blanket rule such as this reduces judicial and legislative deliberation over the interpretation of the rule, and demolishes the barriers created by thinking of the body as property. Conscription would not require a "promotional campaign, compensation to donors, or even attempts to gain permission from donors and their families." n78 Conscription would also remove some medical liability issues: specifically, doctors would no longer be liable for failing to obtain consent, nor would they have to be burdened by seeking out consent before donations could be made. n79

Other plans, such as the current volunteerism and the proposed market structures also purport to retain individual autonomy as well as to operate within the framework of the Constitution. For example, advocates of volunteerism suggest that permitting individuals to choose whether to donate encourages charity and generosity. n80 Under this system, generosity and charity drive donating; conflicts between family and individual autonomy are eradicated; and individual autonomy is retained despite the degree of legitimate coerciveness, as it implements greater social good and common will. n81 It is not individual autonomy in the sense of choice, rather, it is individual autonomy in the sense that with enough organs available, a person's capabilities are increased should a personal need for organs arise. Thus one can live freely and have a more productive life. n82

Some would argue that choice is the touchstone of American freedom, and choice includes the right to direct the disposition of one's body. Yet, in times [*84] of national crisis (or even potential crisis) the population must be directed to join into the greater social good; it is for this reason there is a military draft, as well as prohibitions against assisted suicide. n83 The law has always provided for legitimate yet coercive means of shaping public attitude towards a greater public good. Conscription of organs is not unlike these examples.

C. The Plan: How Conscription Shapes Social Values

Conscription merely purports to erase all notions of familial and individual property rights in dead bodies. In doing so, the body will not and cannot be commodified, nor will it escheat over to the state. Instead, conscription will provide the medical community with the resources it

needs to fulfill a need for organs. Conscription is the most efficient bright line rule the legal system can offer the public and the medical field. As stated in the introduction to this paper, discussions regarding religious objections to conscription are outside the scope of this paper.

Ethically, understanding what it is that the public values and fears most about donating their organs will be crucial to initiating social change towards conscription. Such values include the ability to grieve, individual autonomy, superstition, fear of mutilation, fear of desecration, unwarranted governmental intrusion and religious objection. Arguably, conscription neither denies nor promotes any of these common fears: families will not have to face the decision of whether to donate, and for all intents and purposes, bodily forms stay intact after select organs are harvested; individual freedom is retained in the sense that human growth potential and aligning with a common good will be promoted; and under conscription, the government relinquishes control to the transplant community.

Conscription also alleviates the fear of exploiting the poor, and the over representation of wealthy recipients who have greater bargaining

power. Conscription does not favor the wealthy, nor does it prey on the poor. Conscription creates no hold-out power for those whose organs are desperately needed.

V. Conclusion

There is a desperate need for organs in America. Patients lose their freedom and ability to live up to their potential: instead, thousands awaiting

transplantable organs are dying needlessly as thousands more healthy, viable organs are interred. Social values and ideologies , as

they stand today, can be flexed and molded into a new ideology: one of ultimate giving . Conscription provides the

cure for the needless deaths; though the rule is radical, it is appropriately coercive. The conscription cure is able to flex social

values into new values , such as placing the highest priority in life on saving lives .

Perm is net negative even if sales are a last resort – it causes global defection from the organ regimeBudiani-Saberi, 9 - Dr. Budiani-Saberi is the Executive Director of the Coalition for Organ-Failure Solutions (COFS). She is a medical anthropologist and has conducted extensive research on organ trafficking, including longitudinal follow-up studies and outreach on commercial living organ donors, assessing health, economic, social and psychological consequences (Debra, “Advancing Organ Donation Without Commercialization: Maintaining the Integrity of the National Organ Transplant Act” https://www.acslaw.org/publications/issue-briefs/advancing-organ-donation-without-commercialization-maintaining-the-integ-0)

The OTPA‘s introduction of material incentives to organ donation would undermine these other important initiatives and the potential they have to enhance organ supplies. Material incentives,

even as a final resort , should not be considered , particularly when there are significant strides to be accomplished in advancing deceased and altruistic donation. Slavish devotion to market-based solutions should not distract Congress‘s attention from these attainable solutions.

V. Conclusion

Transplants are said to be the most social of therapies. They rest on public trust in medicine. Transplant commercialism and organ trafficking worldwide have exploited social vulnerabilities to obtain organs for transplant. Although operating in various models, these practices inevitably target the impoverished and lead to inequity and social injustice.

OTPA‘s aim to permit compensated organ donation is contrary to the global movement to oppose

commercial transplantation. The United States‘ transplant policies are important references for the

rest of the world and are influential in shaping consideration of material incentives in countries that would not necessarily commit to regulation or best practices in donor care .

As illustrated at the beginning of this paper, Yuri resorted to selling a kidney when his poor living conditions became especially destitute and the reward particularly appealing. Those conditions drove him to the donation and he regretted the decision afterwards. Existing transplant commercialism operates in countries that are, by definition, different from the United States. Although proponents of compensated donation suggest that the experience would be different in the U.S., individuals are similarly likely to resort to a donation when compensation includes rewards such as comprehensive health care for life, health and life insurance, disability and survivor benefits or educational benefits. Like the cash payment to Yuri, these forms of compensation are considered to significantly enhance the life of an individual who cannot afford these basic needs.

The United States must join the international community to rebuild, not compromise , trust in transplants. This is especially important at this moment when markets have failed economic and social needs in global and historical dimensions and altruism has become especially priceless. Guided by the WHO resolution on organ transplants and the Istanbul Declaration, transplant practices can advance standards of greater social equality rather than exploit people in poverty. There are many opportunities to advance organ donation in the U.S. without subjecting individuals to experiences such as Yuri‘s.

Legalization of organ sales causes organ trafficking---it promotes inconsistent norms and undermines enforcement mechanismsDelmonico 11 (Francis L., Director of the Renal Transplantation Unit – Massachusetts General Hospital, Medical Director – New England Organ Bank, “The Declaration of Istanbul Is Moving Forward by Combating Transplant Commercialism and Trafficking and by Promoting Organ Donation”, American Journal of Transplantation, 12(3), 515-516)

The commentary by Drs. Ambagtsheer and Weimer provide an interesting criminological reflection regarding the Declaration of Istanbul in which they question whether efforts to prohibit organ trade have been either realistic or effective since its widespread adoption (1). They challenge the link of organ trafficking to transplant commercialism and drawing comparison from other demand crimes, speculate that the regulation of commercialism would be feasible and justified in the prevention of trafficking. However, the proposal to curtail trafficking by the regulation of monetary payments for organs is not convincing. Organ trafficking is indisputably linked to commercial profits and distinguishable from

other demand crimes. The prohibition of both transplant commercialism and trafficking is required as

essential to provide the criminological mechanism for detection and enforcement efforts . The ultimate value of the Declaration of Istanbul as effective policy exists not only in its prohibitionist stance but also in its promotion of effective donation and transplantation systems to reduce the demand for transplant tourism that gives rise to organ commercialism and trafficking .

Transplant commercialism is linked to organ trafficking:

The Declaration of Istanbul defines transplant commercialism as a policy or practice in which an organ is treated as a commodity, including being bought or sold or used for material gain. The recommendation of Ambagtsheer and Weimer to disassociate transplant commercialism from organ trafficking is belied by the international realities (1). Organ trafficking exists only in the realm of commercialism —the intent to make profit . Profit is what propels brokers to prey upon refugees from the Sudan and victims of tsunami catastrophes or other vulnerable groups to sell their kidneys .

The regulation of monetary payments for organs is not feasible and cannot be justified :

Financial incentives for organ donation that provide monetary gain cannot be regulated . Public policy that promotes such incentives becomes veiled programs of organ sales. Once a scheme that offers money as the motivation for “donation” becomes the policy or tolerated practice in one country, it leads to the development of competitive schemes in other countries. Countries are indeed soliciting thousands of patients to travel to foreign destinations for medical care. But transplant tourism is different than medical tourism because of the documented harm that occurs to paid donors. To cite programs that aim at “harm reduction for prostitution” as the basis for supporting payments for organs debases organ donation as a medical procedure and is contradicted by the harm that continues by “regulated” programs of prostitution.

AT: Hughes This evidence doesn’t assume the CP – gotta be brain dead – China just kills the people.Hughes 9

J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School. “You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models” 2009. http://www.vanderbilt.edu/jotl/manage/wp-content/uploads/hughes-final_x.pdf

Unscrupulous states extend nationalization of cadavers to take advantage of state control over executed prisoners’ bodies to remove their organs.120 China and Serbia have both been alleged to harvest

executed prisoners’ organs, China at a rate of two to three thousand organ removals per year . 121 Under

Chinese law, an executed prisoner’s organs may only be removed if the prisoner’s body is not

claimed, if the prisoner has consented, or if the prisoner’s family has consented.122 Evidence suggests, however, that executions may be scheduled around transplants and carried out in a way that keeps the donor alive until the organ is removed.123

AT: Backlash

CP Is not about prisoners and not about violation of the 8th amendment.

Hughes 9

J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School. “You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models” 2009. http://www.vanderbilt.edu/jotl/manage/wp-content/uploads/hughes-final_x.pdf

While nationalization serves as a useful example of an extreme system , this Note does not give it serious consideration as a means of addressing the organ shortage in the United States and abroad. At the very least, nationalization

may be assumed to be both politically unpalatable and, in the case of prisoners, a violation of the

Eighth Amendment prohibition against cruel and unusual punishment. 124

Religious safeguards inev but nobody bothers using themSpital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time Has Not Yet Come” Cambridge Quarterly of Healthcare Ethics (2005), 14, 107–112)

Another concern is that allowing people to opt out on religious grounds could greatly reduce the efficacy of the program if many objectors would claim this exemption regardless of their religious

beliefs. But this is unlikely if a strong burden of proof of religious objection is required of those who attempt to invoke this exclusion, as was true for conscientious objectors to military service . Furthermore, because conscription of cadaveric organs would cause little if any harm, it is likely that

for many objectors the benefit of getting out of the program would not be worth the effort required to do so.

AT: CP LinksNo?DOI 08 (declaration of Istanbul http://www.multivu.prnewswire.com/mnr/transplantationsociety/33914/docs/33914-Declaration_of_Istanbul-Lancet.pdf)

2. Legislation should be developed and implemented by each country or jurisdiction to govern¶ the

recovery of organs from deceased and living donors and the practice of transplantation ,¶ consistent

with international standards .

a. Policies and procedures should be developed and implemented to maximize the¶ number of organs available for transplantation, consistent with these principles;

b. The practice of donation and transplantation requires oversight and accountability by¶ health authorities in each country to ensure transparency and safety;

c. Oversight requires a national or regional registry to record deceased and living donor¶ transplants;

d. Key components of effective programs include public education and awareness, health¶ professional education and training, and defined responsibilities and accountabilities for¶ all stakeholders in the national organ donation and transplant system.

3. Organs for transplantation should be equitably allocated within countries or jurisdictions to¶ suitable recipients without regard to gender, ethnicity, religion, or social or financial status.¶ a. Financial considerations or material gain of any party must not influence the application¶ of relevant allocation rules.

4. The primary objective of transplant policies and programs should be optimal short- and¶ long-term medical care to promote the health of both donors and recipients.

a. Financial considerations or material gain of any party must not override primary¶ consideration for the health and well-being of donors and recipients.

5. Jurisdictions, countries and regions should strive to achieve self-sufficiency in organ¶ donation by providing a sufficient number of organs for residents in need from within the¶ country or through regional cooperation.

a. Collaboration between countries is not inconsistent with national self- sufficiency as long¶ as the collaboration protects the vulnerable, promotes equality between donor and¶ recipient populations, and does not violate these principles;

b. Treatment of patients from outside the country or jurisdiction is only acceptable if it does¶ not undermine a country’s ability to provide transplant services for its own population.

6. Organ trafficking and transplant tourism violate the principles of equity, justice and respect for human dignity and should be prohibited. Because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should be prohibited. In Resolution 44.25, the World Health Assembly called on countries to prevent the purchase and sale of human organs for transplantation.

a. Prohibitions on these practices should include a ban on all types of advertising (including electronic and print media), soliciting, or brokering for the purpose of transplant commercialism, organ trafficking, or transplant tourism.

b. Such prohibitions should also include penalties for acts—such as medically screening donors or organs, or transplanting organs—that aid, encourage, or use the products of, organ trafficking or transplant tourism.

c. Practices that induce vulnerable individuals or groups (such as illiterate and impoverished persons,

undocumented immigrants, prisoners, and political or economic refugees) to become living donors are incompatible with the aim of combating organ trafficking, transplant tourism and transplant commercialism.

AT: Property RightsNOTA has nothing to do with property rights… this is just awkward for everyone involved 1AC author Ghosh 14 Samantak Ghosh, PhD, an associate who focuses his practice on intellectual property matters. "The Taking of Human Biological Products." California Law Review Vol. 102 Issue 2 Article 3 http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=4230&context=californialawreview

1. Legal Restrictions on the Use of Human Biological Materials Do Not Dissolve Individuals’ Property Rights in Those Materials

Among the laws restricting the use of human biological materials, the National Organ Transplant Act (“NOTA”), which prohibits the sale of human organs, is perhaps the most prominent. But the scope of NOTA’s restrictions is more limited than it appears superficially. Although the law limits the right to sell human body parts, this prohibition is restricted to organs as “[n]o State or Federal statute prohibits the sale of blood, plasma, semen, or other replenishing tissues if taken in nonvital amounts.”100 For instance, the Ninth Circuit in Flynn v. Holder held that NOTA did not prohibit compensation for bone marrow stem cells obtained from donors’ blood because once stem cells were in the bloodstream, they were a “subpart” of blood, not bone marrow.101 The ruling allowed a nonprofit organization to compensate donors by providing “$3,000 in scholarships, housing allowances, or gifts to charities.”102 Interestingly, although the court upheld the constitutionality of NOTA under rational basis review, it appeared unpersuaded by the rationale underlying NOTA.103 The court noted that the reasons behind the law were “in some respects vague, in some speculative, and in some arguably misplaced,” and recognized “strong arguments for contrary views.”104 Choosing not to seek Supreme Court review of the Flynn decision, the federal government implicitly acknowledged the validity of the limits that the Ninth Circuit placed on NOTA’s scope.105

Even assuming for argument’s sake that NOTA’s prohibitions applied to all bodily materials, not just organs, these restrictions do not

completely eliminate the alienation rights associated with property. Prohibition on sale is not the same

as prohibition on alienation . After all, one can still donate organs . Furthermore, the right to sell is not such an

essential attribute of property rights that, in its absence , all other property rights dissolve . It is not

necessary that the same bundle of rights attach to all property . For policy reasons, the law may limit the exercise

of certain rights, but that does not make the object of those limitations nonproperty . There are many examples of state regulation of the right to dispose or alienate personal property, but none has been considered to wipe out

personal property’s character as property. For instance, public health and safety laws restrict the ways that items such as food, drugs, and explosives are manufactured, distributed, and sold .106 These limitations on the right to

use and dispose of personal property at a certain time and space and in a certain manner, however, are not inconsistent with the notion of

their being property . Another example of a sale restriction is found in state codes like the California Fish and Game Code, which prohibits a sportsman

from selling caught fish but not from donating it.107 No one, however, would argue that the fish caught by the sportsman is not his property. Similarly, prescription

drugs possessed by the person to whom they are prescribed can neither be sold nor given away.108 These alienation restrictions do not

undermine the proposition that these articles are property . Likewise, human biological materials are no less

property merely because their disposal and alienation are restricted .

Shortage

Medical Backlash turnOur ev is more qualified and every market has lapsed into predatory behaviorDanovitch and Delmonico 8 – *Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA; **Harvard Medical School, Massachusetts General Hospital Transplant Center (Gabriel M. and Francis L., Current Opinion in Organ Transplantation, 13:386–394, “The prohibition of kidney sales and organ markets should remain”)

The idea that a commercialized system of organ sales can supplement or even replace the noncommercial

donation system that has been the core of transplant practice since its inception is not new. Kidneys and livers are bought and sold in

several regions of the world, and though it might be tempting to think that the evils that are associated with such commercialization will necessarily escape a ‘regulated’ market in the United States, we will show that such an intention is not attainable. The market experiments done in other countries that have attempted to ‘regulate’ the market for organs have been unsuccessful in fixing prices, excluding the activities of brokers or addressing the health of paid donors. We will review the current international reality of organ sales both of the proposed ‘regulated’ and existing ‘unregulated’ variety and consider how a commercialized system would impact solid organ transplantation in the

United States. The commercialization of organ donation is fraught with danger : danger to paid donors ; danger to their

recipients ; danger to patients in need of nonrenal transplants from deceased donors; and danger to the role of transplant professionals as stewards of the whole organ transplant endeavor. The trust of the public and the legacy of transplantation are at risk if organ markets are sanctioned in the United States or the rest of the world.

Global nature of supply means the plan causes a race to the bottomJ. Mark Raven-Jackson 2K; CBS Business, LawNow, Oct-Nov, 2000; Xenotransplantation: a regulatory beast of burden, http://findarticles.com/p/articles/mi_m0OJX/is_2_25/ai_n25027587/pg_4/

It is complicated for nations to regulate xenotransplantation in order to protect the xenotransplant recipient, public health, and donor animals. All

regulatory efforts will be in vain if other nations end up adopting weaker regulations or no regulations at all. Countries that adhere to these lower standards have the potential of becoming xeno-

havens for unscrupulous surgeons and researchers . Daniel Salomon, a member of the board of the American Society of Transplant Physicians, a body that has long waged war on the trafficking of human organs in developing countries, states that the prospects of xeno-havens scares him.

Salomon states that the regulations that are now being developed in industrialized countries will create a strong incentive for poorer countries to traffic in xenotransplants. The big risk is that recipients will receive disease laden organs from endangered primates and there will be no way to monitor their movement or interaction with the general public.

Egg sales and surrogacy prove they won’t substantially expand vendors even if prices escalateCaplan, 14 - Department of Medical Ethics and Director, Center for Bioethics, University of Pennsylvania (Arthur, Contemporary Debates in Bioethics, ed: Caplan and Arp, p. 63)

I t is hard to imagine many people in wealthy countries eager to sell their organs either while alive or

upon their death. In fact, even if compensation is relatively high , few will agree to sell (Rid et al., 2009). That has been the experience with markets in human eggs for research purposes and with paid

surrogacy in the United States— prices have escalated , but there are still relatively few sellers (Baylis & McLeod, 2007).

2nc black market – no tradeoff Wouldn’t solve tourism because people want cheap organsSaberi, medical anthropologist and PhD, 2009

(Debra, “Advancing Organ Donation Without Commercialization: Maintaining the Integrity of the National Organ Transplant Act”, June, https://www.acslaw.org/sites/default/files/Budiani%20Saberi%20and%20Golden%20Issue%20Brief.pdf)

Finally, it would not be possible to completely regulate a market in organs domestically when , as with other

commodities, global prices /rewards would vary . State compensation for organ donation is still unlikely to satisfy demand because patients who opt to shorten their wait-time and can afford to go abroad for an

organ will continue to do so. Insomuch as patients might bear a portion of the financial burden for a

compensated donation, they would also have reason to go where prices were affordable. The

proposals in OTPA would not ameliorate these dynamics that facilitate organ trafficking .

Several other countries besides the U.S. are large consumers of imported organs Shimazono 7 – Yosuke, Assistant Professor in Medicine @ Osaka University, “The state of the international organ trade: a provisional picture based on integration of available information” http://www.who.int/bulletin/volumes/85/12/06-039370/en/ The organ-exporting countries

The organ-importing countries The term “organ-importing countries” is used here to refer to the countries of origin of the

patients going overseas to purchase organs for transplantation. A report by Organs Watch , an organization based at the

University of California, USA, identified Australia , Canada , Israel , Japan , Oman , Saudi Arabia and

the USA as major organ-importing countries .19 Yet transplant tourism has become prevalent in many

other countries of all continents and regions . Data are available through surveys conducted by health authorities and

professional societies in these regions (Table 2). It should be noted that in some countries the number of patients going overseas for kidney transplantation outweighs the number of patients undergoing kidney transplantation locally. More detailed data available from Malaysia and Oman show the shifting destinations of overseas organ transplantation (Fig. 1, Fig. 2 and Table 3). Although it is premature to undertake a substantial analysis of this issue

because comparable data from other regions are not available, these data suggest a heavier reliance on overseas

transplantation and transplant tourism in Asia and the Middle East than in other regions . For

example, in Canada and the U nited K ingdom (where, respectively, 1027 and 1914 domestic renal transplants were performed in 2005)26,27 it is estimated by local experts that around 30 to 50 patients undergo overseas commercial kidney transplants.28,29

European clients drive illicit markets that the plan can’t solve Walsh 5 – Declan, the Guardian's correspondent for Pakistan and Afghanistan from 2004 to 2011, “Transplant tourists flock to Pakistan, where poverty and lack of regulation fuel trade in human organs” http://www.theguardian.com/world/2005/feb/10/pakistan.declanwalshcc

Despite such qualms, relentless demand keeps the trade alive. One source in the medical industry said he

was expecting a South African " transplant tourist " later this month; another said three Bulgarians

recently passed through. Most of Pakistan's clients come from the Middle East , many with the

blessing of their own governments. Although paid-for transplants are illegal in Saudi Arabia, the

Islamabad embassy actively assists citizens who seek one in Pakistan . The embassy doctor, Eissa al-Harthi,

said he visited patients in hospital and helped to iron out any difficulties, and sometimes his government footed part of the

bill. Pakistan's gov ernment has spoke n for years of legislating to regulate kidney transplants , but the

idea remains little more than a vague proposal.

AT: RegsIllicit organ economies will circumvent legal and regulated markets Torrey 14 – Trisha, M.A. in Education @ Elmira College, “Organ Trafficking and Transplant Tourism” http://patients.about.com/od/healthcarefraud/a/Organ-Trafficking-And-Transplant-Tourism.htm

This "transplant tourism" is surging in popularity, even in the United States, for at least three reasons. First, because the numbers of people who need organs is growing. Second, because the transplant lists, such as those determined by UNOS in the United States are getting longer and longer. And third, because the world economic crisis is forcing people to look at ways they can make money. Selling their

organs can put food on the table. Except for transplants that take place in Iran where human organ sales are

condoned, organ trafficking is illegal. However, according to a number of news media sources and the

W orld H ealth O rganization, you'll find plenty of advertising in print and online, offering to buy or sell

an organ , usually a kidney. Those sales , and the transplantation, take place while authorities turn a

blind eye.

Illicit economies will undercut the price of the national organ market Scheper-Hughes 6 – Nancy, Professor of Medical Anthropology and Director of Organs Watch, “Is It Ethical for Patients with Renal Disease to Purchase Kidneys from the World’s Poor?” PLOS Medical Journal, October 2006 | Volume 3 | Issue 10 | e349

Wouldn't a regulated system be better than the current state of racketeering in human kidneys?

Perhaps, but how can a national government set a price on a healthy, but destitute, human being's body part

without compromising essential democratic and ethical principles that guarantee the equal value of

all human lives? Any national regulatory system would have to compete with global black markets

that establish the value of human organs based on consumer - oriented prejudices . In today's kidney market. Asian kidneys are "worth less" than Middle Eastern kidneys and American kidneys worth

more than European ones. The circulation of kidneys transcends national borders , and international

markets will coexist and compete aggressively with any national, regulated systems. Surgeons whose

primary responsibility is to provide care should not be advocates of paid self-multilation by anonymous strangers even in the interest of saving lives.

2nc crowdout turnBest empirical evidence goes negativeOliver Decker 14, PhD, Member of the Faculty of Medicine at the University of Leipzig and Reader at the Faculty of Philosophy at the Leibniz University Hannover, former Visiting Professor for Social and Organizational Psychology at the University of Siegen, Commodified Bodies: Organ Transplantation and the Organ Trade, google books

Thus some critics of the market solution begin less with the ethical than with the factual consequences. According to their prognosis, the latter undermine the

desired remedy for the shortage of raw materials by completely commodifying the human body . The crucial

example of the counterproductive effect of a market solution on the allocation of organs is blood

donation . An investigation of blood donations showed that “where the sale of blood was allowed, donations

declined ” (Tittmus 1971). This sociopsychological finding helps us answer the question as to how a

commercialization of the body affects the willingness to donate out of altruistic motives . The

answer is clear : an “ erosion of motivation ” (Archard 2002, 87) was the result of the commercialization of trade in

blood and can also be expected to be the result in the event of a legalization of trade in organs . From

the Chicago Business School itself comes a serious objection to an incentive system or an organ market: “Extrinsic

motivation might change the perception of the activity and destroy the intrinsic motivation to perform it when no apparent reward from the

activity itself is expected” (Gneezy and Rustichini 2000a, 792). In an experiment in a kindergarten, parents were fined for being late in picking up

their children after school. But the result was only that most of the parents were late in picking up their children, because

now a service was demanded of them . Even after the experiment was terminated and the fine was no longer levied, the parents continued to come late. In

principle, according to the rationale for the experiment, a service that up to that point had been provided by the children’s caregivers at no cost was now offered in exchange for money, as a commodity. This was the investigator’s conclusion: when a morally motivated act is replaced by a commercial motivation, this alters the demand and character of the service, and the moral barriers fall: “Once a commodity, always a commodity” (ibid., 791). The consequence for trade in organs: if it is begun, it must be done right, because there is no going back: “Pay enough or don’t pay at all” (Gneezy and Rustichini 2000b). There are

many such “hidden costs of organ sale” (Rothmann and Rothmann 2006, 1525). In each case it seems clear that the relationship to other people

is in fact changed : “the body parts of others become a good to which claims can be made, and the organ donor becomes a simple bearer of exchange

value” (Schneider 2007, 120).

1NR

CP

Add OnCourts won’t uphold property rights—judicial formalism blocks solvencyMichele GOODWIN, Professor of Law and Director of the Health Law Institute at DePaul University

College of Law, ‘6 [“Formalism and the Legal Status of Body Parts,” The University of Chicago Legal Forum, 2006 U Chi Legal F 317, Lexis]

The models discussed in Part I demonstrate that entrenched formalism in a rapidly expanding biotechnological era

will stymie meaningful development of common law jurisprudence on the ownership, dispensation, and remedies involving body parts . Without judicial adaptation to an evolving society in which

litigation involves body parts, plaintiffs will never prevail . n125 A common element of the three very different

scenarios presented in the above models is that absent a finding that deems the body as "property," plaintiffs will be barred from recovery--even in the more disturbing cases that involve the most egregious breaches of medical trust and ethics.

Formalistic rule making (or the lack thereof ), conflicts with reasoned, evolved decisionmaking. It fails to acknowledge and respond to the shifting of culture, society, and biotechnology. n126 Such rule making, "to put it baldly," according to the Honorable Mary Schroeder, is to devise "pontifical formulas which relieve courts of the burden of reasoned decisionmaking." n127

The law too must evolve to address the nuanced byproducts of biotechnology. Legislative and judicial indifference to the ways in which biotechnology interferes with individual liberties, however, poses several serious problems.

1. Illusory negative rights.

For example, presumed consent legislation tramples individual autonomy while purportedly designed to promote health and safety. However, that worthy goal is defeated through surreptitious tissue harvesting exclusively from unsafe victims, including those whose deaths resulted from homicides, poisonings, and other catastrophic means. n128 Failure to collect social history [*347] data increases the likelihood that insalubrious tissues will enter the marketplace and harm those whom the statutes are designed to protect. n129 The opt-out provision, as discussed earlier, is more illusory than real. n130 The fact that there isn't a national or state registry, except in Iowa, where one can opt-out of tissue donation is a significant barrier.

States that enacted presumed consent laws failed to take secondary measures to give full meaning to an individual or her family's choice to decline extraction. Their failure to do so unquestionably contributes to legal and social backlash against presumed consent policies. n131 Thus, without a more serious effort to capture assent or dissent, the opt-out provision is meaningless. Even in some instances when families refused to donate, state actors successfully claimed immunity for the "accidental" taking of tissues used for a legitimate state purpose. n132 Why then, has formalism dominated judicial response to nonconsensual tissue taking and the collateral outgrowths of biotechnology (in other words, Model C)? [*348]

2. Episodic or collective.

Judges tend to view biotechnology cases involving body parts episodically and not collectively. n133 Viewed narrowly, Mr. Moore seems to be one lone individual--a single plaintiff--with an isolated case. His disease is rare and the defendants are located in Los Angeles--their reach falls short of all other Moore-like patients at California's borders. It appears the instance will not be repeated and the means justify the utilitarian ends; Moore pays the emotional costs for a private industry gaining competitive strength and furthering scientific understanding and possibly engineering treatment options for a broader class of individuals affected by leukemia. Here the California justices are responding to a nationalist principle, an American advantage. Were the company that collaborated with Dr. Golde a foreign corporation, they may well have reached a different conclusion. Thus, the case is not simply about the random expansion of biotechnology, but specifically American technology. n134

3. Formalism entrenched.

Formalists necessarily ignore exogenous sources, instead choosing to concentrate on adhering to traditional norms, n135 lest they be viewed as

unmindful of their role, radical or even judi [*349] cially activist. In essence, judges do not believe it is their role to change the law to respond to biotechnology. They would argue that it is the legislature's role to introduce new meaning to the law; the courts simply sort out the statutory "mishmash." n136 Judge Guido Calabresi

suggests that the formalist approach "does not contemplate the introduction of new or modified values into the scheme as part of their role." n137 Thus the court's function to hear the new biotechnology cases with an objective ear is usurped not by judicial indifference to plaintiffs, but

rather a defense "of the values it finds embedded in the system." n138 In strictly adhering to formalism, judges ignore the independence of the bench and its secondary function, which is to sort out the mishmash. Obsequious loyalty to doctrine necessarily inures heightened blindness to external factors, and in the face of

biotech nological harms to plaintiffs, may undermine the perception of the judiciary as an

independent, fair, competent arm of the government .

Although Calabresi suggests that today's formalists "take a bow to exogenous values," Models A-C (and there are many more) do not support

that conclusion. Rather, the refusal to tamper with almost biblically derived notions of the body by

introducing new values, recognizing alternative paradigms and hermeneutics, suffocates the law . Thus,

while the law of body parts could be a robust representation of nuanced thinking on a very complex issue, instead it appears weak, ragged, and arbitrary .

Exploitation

1NR impact overviewDon’t be held hostage to the rhetoric of ‘saving lives’ – they only count the lives of the affluent few while authorizing the systematic extermination of the poor. The practical reality is it serves to conceal the violence Moniruzzaman, 12 - Department of Anthropology and Center for Ethics and Humanities in the Life Sciences Michigan State University (Monir, ““Living Cadavers” in Bangladesh: Bioviolence in the Human Organ Bazaar” MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 26, Issue 1, pp. 69–91, DOI: 10.1111/j.1548-1387.2011.01197.x)

Although vested interest groups silence the organ trade, some liberal bioethicists have proposed that a regulated organ market would be an efficient way to save the lives of dying patients (Cherry 2005; Friedman and Friedman 2006;

Hippen 2005; Matas 2008; Radcliffe-Richards 1996; Taylor 2005; Veatch 2000). In my opinion, these bioethicists generate a

symbolic violence (if unconsciously) by emphasizing “saving lives” of the affluent few, while allowing

bioviolence against impoverished kidney sellers . A regulated organ market is not an “Aladdin’s lamp” that by itself would eliminate widespread deception, manipulation, and misinformed consent,

or ensure justice, equity, and rights to kidney sellers; rather, it would escalate the bioviolence for

stripping organs from the poor majority at the high cost of their bodily and social suffering . It would

rationalize, institutionalize, and normalize the bioviolence , which is extremely discriminatory against the economic underclass. Not

surprisingly, 85 percent of the Bangladeshi kidney sellers I interviewed spoke against an organ market; many of them proclaimed that selling a kidney is an “irrevocable loss”; if they had a second chance in life, they would not sell their kidneys.

In summary, the bioviolence against kidney sellers is seriously problematic, even though organ transplant saves many lives. As the

transplant industry flourishes, the structural violence against the poor becomes widely

institutionalized . The physical violence for extracting organs from their bodies is increasingly

routinized . However, it is justified by a symbolic violence that masks organ trade by the rhetoric of

“saving lives.” Meanwhile , bioviolence against the poor remains concealed to promote the personal interests of vested beneficiaries. The bioviolence that is entrenched in the transplant enterprise, as well as other emerging biotechnologies, needs to be fully exposed to strike against the exploitation of the poor. This is the time to write a transplant manifesto that is grounded in social justice, and that promotes humanitarian ethics.

That causes massive structural violence and worse health outcomes for vendors and buyersEmily Kelly 13, Executive Comment Editor for the Boston College International & Comparative Law Review, “International Organ Trafficking Crisis: Solutions Addressing the Heart of the Matter,” http://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=3324&context=bclr&sei-redir=1

Transplant tourism and organ trafficking have pervasive negative effects . 57 Organ trafficking exploits poor individuals who are desperate to make money for survival.58 Because profit-motivated facilitators negotiate most transactions, donor compensation is often extremely low.59 For example, kidney donors frequently receive less than one-third of the price that

recipients pay for the organ, despite initial promises of higher payment.60 Furthermore, donors rarely receive adequate health

care after the transplant, generating negative health outcomes that impede their ability to work and

worsening their long-run financial and physical condition .61 As a result, donors rarely succeed in paying off

the very debts that often lead them to sell an organ in the first place.62¶ In addition, studies have exposed the

negative sociological and psychological effects of organ sales .63 Kidney vendors frequently express regret and

disgrace associated with the decision to sell a body part.64 Communities with high rates of organ sales also shame donors , leading

many to conceal their decision out of embarrassment.65¶ With regard to recipients, the dangers of receiving medical care in

developing countries can outweigh the benefits of life-saving transplant tourism .66 Because governmental

disease control agencies do not monitor underground organ trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV .67 Tragically, transplant tourists also have “ a higher cumulative incidence of

acute [ organ ] rejection in the first year after transplantation.”68¶ Transplant tourism also harms global public health policies.69 Most

notably, the underground market impedes the success of legal organ donation frameworks.70 For example, Thai patients have difficulty accessing health care because local doctors are preoccupied with the lucrative practice of treating transplant tourists.71 In 2007, China banned transplant tourism because wealthy foreigners—rather than the 1.5 million Chinese on the waiting list—received an overwhelming amount of organ transplants.72 ¶ Grisly tales of transplant tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to altruistic donation upon death out of fear that their bodies may be exploited. 73 This further contributes to the global organ

shortage and exacerbates the underlying causes of OTC trafficking.74 Additionally, transplant tourism and broader medical tourism

facilitate the spread of antibiotic-resistant bacteria .75 Because such bacteria are frequently found in

hospitals, tourists are easily exposed and transmit these unique strains across borders upon returning to their home countries.76 As a result of these effects, transplant tourism has drawn increasing attention to the root of the problem: organ shortages.77

AT: DOI Fails

The new Convention against Trafficking passed by the Council of Europe solves legal gaps in the current anti-trafficking frameworkLopez-Fraga et al, 14 - European Committee on Organ Transplantation, European Directorate for the Quality of Medicines & HealthCare, Council of Europe (Marta, “A needed Convention against trafficking in human organs” The Lancet, 7/4, doi:10.1016/S0140-6736(14)60835-7)

The Convention against Trafficking in Human Organs ,7 and 8 soon to be adopted by the Council of

Europe, provides a solution to these problems by identifying distinct activities that constitute “trafficking in human organs”, which

ratifying states are obligated to criminalise. The central concept is “the illicit removal of organs”, which consists of removal without the free, informed, and specific consent of a living donor; removal from a deceased donor other than as authorised under domestic law; removal when a living donor (or a third party) has been offered or received a financial gain or comparable advantage; or removal from a deceased donor when a third party has been offered or received a financial gain or comparable advantage.

Additionally, the Convention criminalises the use, preparation, preservation, storage, transportation, transfer, receipt, import, and export of illicitly removed organs and the solicitation or recruitment of organ donors or recipients, where carried out for financial gain or comparable advantage. The promising, offering or giving of any undue advantage to or the request or receipt of any undue advantage by health-care professionals, public officials, or people who direct or work for private institutions for the illicit removal of organs or for the use of organs that have been illicitly removed are also criminalised. The Convention calls for states to employ preventive measures, cooperate internationally in investigation and prosecution (including extraditing accused people), and protect witnesses and especially victims (including through civil

damages). Implementation will be monitored and facilitated by a Committee of the Parties. Importantly, the Convention has international scope, because it is open to any nation and not restricted to the 47 Council of Europe member states .

The Convention is intended to complement the provisions included in other international instruments criminalising human trafficking for organ removal. The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons9 defines human trafficking as an action (“the recruitment, transportation, transfer, harboring or receipt of persons”) that occurs by means of “threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person”. Among the purposes identified by the Protocol is “removal of organs”. In Europe, human trafficking for organ removal is also included in the Council of Europe Convention on Action against Trafficking in Human Beings10 and the European Union Directive 2011/36/EU on Preventing and Combating Trafficking in Human Beings and Protecting its Victims.11 These instruments are important in countering the use of the human body to “give rise to financial gain”, as prohibited under the Convention on Human Rights and Biomedicine.12

Yet the legal instruments intended to combat human trafficking for organ removal leave gaps because sometimes the three components of this problem (action, means, and purpose) are difficult to prove.13 Establishing an illegal means can be problematic, since force or fraud are not always used and the “abuse of a position of vulnerability” is somewhat ill defined. Likewise, when sellers take the initiative, by contacting potential recipients or intermediaries, prosecutors can struggle to show that the person has been trafficked, even if the seller was driven to act by poverty or other desperate needs. Moreover, human trafficking for organ removal does not encompass commercial transactions involving organs from deceased persons, nor the diversion of properly obtained organs for illicit use by physicians providing transplant services to patients who do not qualify to receive them within national programmes or at facilities that serve so-called transplant tourists.

The new Convention fills these gaps. It provides an explicit basis for prosecution of broker s, even if the

means they use do not amount to human trafficking. It criminalises both corrupt officials who abuse their position within the organ donation system, and health-care professionals and others who remove, transfer, or use an organ if they know that the donor has not given valid consent or was offered payment. Physicians are likewise liable under the Convention for removing organs from deceased donors knowing that no valid authorisation was obtained or that payment was offered to obtain permission from the family. Under the new Convention, states can choose not to prosecute recipients who have purchased an organ, although recipients would be liable under instruments regarding human trafficking for organ removal if they knew that the organ came from a victim of human

trafficking. People who sell an organ under circumstances of human trafficking for organ removal are entitled to protection as victims. If human trafficking is not involved, states can choose to prosecute sellers under the Convention.

In conclusion, the Convention will be a seminal international legal instrument that for the first time

reaches illicit transplant practices that currently escape prosecution . By complementing each other, this Convention on trafficking of human organs and the instruments on human trafficking for organ removal provide a comprehensive legal framework to prevent and combat transplant activities that violate basic human rights. The worldwide problem of organ trafficking can only be addressed through concerted action at global level. Therefore, we urge all countries to quickly become Parties to the Convention.

Physician norms are developing against trafficking – they’ll strengthen the international framework and spur wider adoptionEfrat, 15 - Lauder School of Government, Diplomacy and Strategy, Interdisciplinary Center (IDC) Herzliya (Asif, “Professional Socialization and International Norms: Physicians against Organ Trafficking” Forthcoming, European Journal of International Relations (2015), academia.edu)

Why establish a shared professional position? Why wasn't the government track sufficient? First, intraprofessional activity was needed to create change on the ground, that is, induce healthcare professionals to cease their direct or indirect participation in the organ trade. Organ trafficking, after all, is not perpetrated by state agents, but by private actors:

organ brokers and , crucially, transplant professionals . Yet governments are often reluctant to police professional communities and interfere with their internal workings. Instead, they allow professionals autonomy in establishing and enforcing their ethical requirements and use the state's enforcement power only in the most serious, publicly visible cases (Friedson, 1975). Given the low visibility of the organ trade and its negative effects, governments were unlikely to make the efforts necessary for eliminating this practice. A fundamental change on the ground required the medical profession to establish its own standards and provide a clear framework for distinguishing between ethical and unethical conduct. Such a framework would identify physicians' involvement in commercial transplantations as a transgression; it would also empower ethically compliant physicians to put pressure on their transgressing colleagues and on hospital administrators: exhortations against commercial transplantations would be more potent if backed by global professional standards.4

A predominant anti-commercialism view within the profession was also necessary for changing governments' attitude to transplantation and ending their tolerance of the organ trade. To eliminate the trade, governments had to address the persistent shortage of organs that was the trade's cause. The WHO thus encouraged governments to increase deceased organ donations through educational initiatives, and by providing the medical and administrative infrastructure for maximizing donations (Delmonico et al., 2011). The intraprofessional endeavors were a necessary reinforcement of the WHO's government-focused efforts, since physicians are key actors in healthcare policymaking (Immergut, 1990). In reforming transplantation policies, governments were likely to consult local physicians and make sure that they approved of the proposed changes. Local physicians' endorsement of the efforts against organ trafficking would have facilitated government support for these efforts; by contrast, resistance on the part of local physicians would likely have hindered the change of government policy.5 Furthermore,

since organ trafficking is a crime involving healthcare professionals, the medical community had to put its own house in order before urging governments to act. The medical community's denunciation of organ trafficking and commitment to its eradication would in turn legitimize the community's demands from governments. Armed with global professional standards, the community's call for government action would be more forceful and credible.

In short, combating the organ trade requires standards that are developed, owned, and endorsed by the medical profession. Such standards are meant to express the prevailing ethical view of the transplant

community, identify those defying this view , and provide leverage for pressuring them . These

standards are also a tool to mobilize the community for political action and convince governments that eliminating the organ trade is necessary and feasible . Socialization aimed at establishing and spreading professional norms thus had to take place in tandem with the efforts to socialize states. How did the anti-trafficking norm manage to gain wide adherence among transplant professionals?

Transplant professionals are the vital internal link to stopping trafficking since they do the black market transplants (also provides extra impact to physician backlash on case)Scheper-Hughes, 14 - is Professor of Medical Anthropology at the University of California, Berkeley (Nancy, “Human traffic: exposing the brutal organ trade” New Internationalist, May, - See more at: http://newint.org/features/2014/05/01/organ-trafficking-keynote/#sthash.MMhZ7cHk.dpuf

Convicted brokers and their kidney hunters are easily replaced by other criminals – the rewards of their crimes ensure that. Prosecuting

transplant professionals , on the other hand, would definitely interrupt the networks . Professional sanctions – such as loss of licence to practice – could be very effective. Outlaw surgeons and their colleagues co-operate within a code of silence equal to that of the Vatican. International bodies like the UN and the EU need to take concerted action on the legal framework in order to prosecute these international crimes.

2nc link walla. Purely economic approach to organ sales overlooks the cultural and social factors that increase exploitation. Even if the plan is effective in the US – the global effects of their model spur massive exploitationHentrich, 12 – independent researcher (Michael, “Health Matters: Human Organ Donations, Sales, and the Black Market” http://arxiv-web3.library.cornell.edu/abs/1203.4289

The implications of permitting the sale of organs also differs by country based on levels of wealth and

cultural norms. The same policy decisions made in the U nited States and Kenya would have vastly

different results . Global policy decisions about organ transplant made purely on a homogenous economic analysis could well be misguided by failing to account for cultural norms and differing social conditions (Kaserman 2002). In developing countries the formal institutions involved with organ transplant are also less advanced . There are fewer doctors in the related areas and fewer transplant organizations through which to organize a legal market. These conditions combine to leave developing countries open to poorly regulated markets, abuse of donors and sellers, and the existence of a black market for organs obtained in ways that may not be fair and legal (Goodwin 2006).

AT: Iran IndictCrowdout doesn’t occur in Iran solely because the major deceased donor program prohibits salesCapron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)

160. A.H. Rizvi, A.S. Naqvi, N.M. Zafar & E. Ahmed, Regulated Compensation Donation in Pakistan and Iran, 14 CURRENT OPINION IN ORGAN

TRANSPLANTATION 124, 127 (2009) (arguing that paying for kidneys has forestalled development of deceased-donor programs, which are needed for other solid organ transplant programs). The deceased donation that occurs in Iran, which is sometimes cited to show that reliance on paid donors does not depress deceased donation,

actually results from the rejection of the national norm by one major center:

Shiraz Organ Transplant Centre is the largest centre [in] Iran performing liver and kidney transplant from deceased donors. They

started their programme with kidney transplantation based on live altruistic donors without any

monetary consideration in the name of compensation. They maintained their policy for several years and finally their credibility took

them to becoming one of the largest centres of deceased liver transplantation in Middle East and today they are performing the highest number of deceased transplants.

E-mail from Dr. Anwar Naqvi, Professor & Coordinator, Centre of Biomedical Ethics & Culture, Sindh Inst. of Urology & Transplantation, to author (July 19, 2013, 5:17 AM) (on file with author).

AT: Treaty Fails And there’s been major progress in hotspots globally – only the aff threatens to reverse itEfrat, 15 - Lauder School of Government, Diplomacy and Strategy, Interdisciplinary Center (IDC) Herzliya (Asif, “Professional Socialization and International Norms: Physicians against Organ Trafficking” Forthcoming, European Journal of International Relations (2015), academia.edu)

The transplant community managed to place organ trafficking on the political agenda and bring

governments to take measures against it – including in countries that had been the centers of organ

trafficking and transplant tourism. Legislative changes in the Philippines in 2008-9 nearly eliminated incoming

transplant tourism , and Pakistan's transplant legislation has considerably reduced the number of commercial transplants performed there (Rizvi et al., 2011; Padilla, Danovitch, and Lavee, 2013). Israel has stopped the official funding of transplant tourism , instead taking action to increase local organ donations (Lavee et al., 2013). Similar

changes in policies and practices have occurred in various other countries (Abraham et al., 2012; Danovitch et

al., 2013). The transplant community brought about these reforms by building support for a set of professional ethical standards and using

them as a foundation for a political advocacy campaign. The pressure from local and international physicians, reinforced by media coverage of the organ trade, resulted in major policy changes and a reduction of the organ trade.

The picture, however, is not entirely rosy, since socialization and coercion may influence some professionals but not others. While

the principles of the Declaration of Istanbul have received broad support, there are still voices within the transplant community who

call for a regulated organ market , defying the norm that requires altruistic donations. Some profit-seeking physicians

continue to perform commercial transplantations, notwithstanding the social pressure and persuasive influence of the transplant community. In Egypt, the 2010 prohibition on organ trafficking has seen little enforcement in the unstable political environment that followed the 2011 revolution. In China, the transplant community's efforts have had a limited effect. High-ranking Chinese officials have indeed brought attention to the community's repudiation of the practice of using organs from executed prisoners, and the Chinese authorities have stated their intention to cease this practice and develop an ethical organ-donation system. But while steps in this direction have been made (Wang, 2012), the use of organs from executed prisoners persists.

While the organ trade has not yet been eliminated, the international community has certainly made

important progress toward achieving this goal . Previously indifferent to organ trafficking and transplant

tourism, governments have come to recognize these practices as problems and have taken measures to curb them. Underlying this change of political norms is the move toward shared professional norms within the international medical

community. The socialization of transplant professionals has laid the foundation for the socialization of

states .

AT: Regulations Solve Regulations are circumvented Capron et al, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “Organ Markets: Problems Beyond Harms to Vendors”, American Journal of Bioethics, October, Volume 14, Number 10, 2014)

Further, in all settings where kidneys have been market commodities, the act of selling a kidney is seen as debasing, something that a person

would do only if he or she had no other means of survival. A regulated market won’t change that. Indeed, it is likely that means

would arise to circumvent the intended limitations on the incentives, such as financial entrepreneurs arranging for poor kidney sellers to obtain a lesser sum in cash in exchange for the money deposited into a retirement account for them. From the viewpoint of transplant programs, this would have the advantage of producing more kidneys (since in all societies the poor are the readiest source of organs), but very

unjustly and by making a mockery of the notion of a “regulated” market .

It’s far more likely no regulation would emerge because it would be seen as a barrier to effective salesCapron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)

The alternative—which true believers in inducements should embrace— would be a genuine market with prices set by the forces of supply and demand that reflect the point at which individual sellers would part with an organ and individual buyers would part with their money to

obtain one. The market would qualify as “regulated” because of other non-price-based rules aimed at protecting donors against abuse s , such as requirements regarding postoperative care of organ donors. On the demand side, reliance on a true market would effectively upend the present allocation system, because successful buyers would be those who not only place a higher value on receiving an organ transplant but also have a greater ability to pay (whether from their own wealth or generous medical-insurance coverage). The result would be

differentiation not only among the purchasers , with willingness to pay determining one’s place in line, but also among the sellers , with the most desirable organs commanding a higher price . Although some market proponents might not be bothered by this outcome, others have suggested that it should be avoided by keeping organ donors and recipients anonymous to each other and by having the latter pay into the fund that supports the organ-procurement system rather than directly to their donor.118 Yet such a system would produce both market inefficiencies and strategies to get around them, of the sort previously described.119

On the supply side of a true market in organs, one must begin with the question of whether, in this era of trade liberalization, there would be any ground for restricting donation to domestic sellers . The aversion in certain circles to letting people from other countries come to the United States to work really has no relevance to organ sales, because the persons involved would be coming into the country solely as the delivery vehicles for their kidneys (or liver lobes), and would return to their country of origin once their cargo had been unloaded. This was indeed the vision of Dr. Jacobs, whose projected International Kidney Exchange, Ltd. was intended to be a setting where U.S. patients could exchange their funds for the kidneys of willing donors from Latin America.120 But why should such an institution not have a more global reach than that, when it is already apparent that thousands of Pakistanis, Indians, Filipinos, and other impoverished “would be vendors” of the world, when allowed “to decide for themselves about their own best interests,”121 are willing to exchange a kidney for a relatively modest sum of money?

The argument for allowing payments for organs rests on the principle of utility (that the greatest good consists in saving or, in the case of kidney transplants, extending and improving, human life) and the principle of liberty (that freedom of contract must be protected). Yet these principles provide no grounds for erecting impediments to patients, physicians, or indeed health systems seeking potential organ sellers anywhere in the world. As philosopher Janet Radcliffe Richards argues,

“If it is presumptively bad to prevent sales altogether, because lives will be lost and adults deprived of

an option some would choose if they could, it is for the same reason presumptively bad to restrict the selling of organs.”122 Thus, if restrictions are to be placed on markets, principles other than utility and liberty must justify them. Such justification can be found in the three basic principles of medical ethics: justice, beneficence, and autonomy.123

Regulation won’t spill over internationally – guarantees massive exploitationGlazer, 11 - Sarah Glazer is an American journalist based in London. She is a Contributing Writer for the Washington, D.C.-based magazines CQ (Congressional Quarterly) Researcher and CQ Global Researcher (CQ Global Researcher, “Organ Trafficking”, v5 n 14, 341-366)

“A government- regulated program will not end the black market ,” argues Debra Budiani-Saberi, executive director of the Cairo, Egypt- and Washingtonbased Coalition for Organ-Failure Solutions, which works with organ sellers victimized by the black market

trade. “People will go where the price is cheaper, and it will always be cheaper somewhere .”

“Under the circumstances, where developing countries have almost no mechanism of regulation, to think that

the government could run a regulated [market] program is idiotic ,” says Farhat Moazam, chairperson of the Sindh

Institute’s Centre of Biomedical Ethics and Culture. She points out that even in the United States a Brooklyn kidney broker was arrested in a 2009 FBI sting in New Jersey after allegedly arranging for purchased kidneys to be transplanted at reputable U.S. hospitals for years without being discovered.

Market supporters Matas and Hippen, however, say they are proposing a regulated market only for the United States — and perhaps Western Europe — where law enforcement is more trustworthy. And by satisfying demand in wealthy countries, the trafficking in poorer countries almost could be eliminated, they argue.

However, Danovitch doubts such a market could be contained within U.S. borders . In the age of Twitter,

he predicts , “Within three seconds flat there will be twice the U.S. price offered in Singapore or somewhere else.” International bodies such as the WHO and U.N. and pillars of the medical world, such as the U.S.-based Institute of Medicine, all oppose the payment idea, largely on moral grounds. 25 “Most people wouldn’t want to live in a society where the government paid the poor to be organ supplies,” Budiani- Saberi says.