Should commercial organ donation be legalized in Germany? An ethical discourse.
OBJECTIVE
We evaluated the arguments pro and con concerning kidney sales from a German perspective. At present, we see social, medical, and ethical reasons why organ selling should not be legalized in Germany.


CONCLUSIONS
Legalization of organ selling would weaken the principle of solidarity within the German health system. Conversely, profit making will undermine the principle of social justice. Within the present social system in Germany, there is no economic pressure to sell an organ to save life, and there is no medical need to buy a kidney. Also, there exists the risk that opening the market for organ sales will de-motivate potential directed organ donors. Relatives would have more doubts about giving their consent to donate organs of their deceased. Moreover, the historical experience with the "action T4" of the Nazi regime sensitized German society for the categorical imperative set forth by Immanuel Kant (1724-1804), namely that man is not a means, but an end to himself. By selling one's kidney, the donor uses himself as a means and as an instrument for the end result of gaining money. With directed organ donation, the welfare of the recipient is the end result. The pending reform of the German health system needs a more communitarian sense, which will be eroded should organs be sold and no longer donated as gifts.


CONCLUSIONS
Germany's special historical experience and a deeply embedded consent toward ethical values give reason for the prohibition of organ selling in Germany.
Keller
F
F
Department of Nephrology, University of Ulm, Ulm, Germany. frieder.keller@uni-ulm.de
Winkler
U
U
Mayer
J
J
Stracke
S
S
D003365:Costs and Cost Analysis; D005858:Germany; D006801:Humans; D009927:Tissue and Organ Procurement / Q000191:economics / Q000941:ethics* / Q000331:legislation & jurisprudence*