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Ethical debate for Organ trade
The ethical debate of organ trade rests on do people have an inherent right to sell their own organs and if so, does the potential harms of organ sales override that right. While in most democratic countries, there is an implied ethical right to what happens to your bodies, as evident by the Scheloendorff decision through the court's opinion by Justice Benjamin Cardozo, "'Every human being of adult years and sound mind has a right to determine what shall be done with his own body'"However, this autonomy is limited in organ trade as governments and some ethicist argue the potential harm of organ trade outweighs the rights on an individual. The closest legalized comparison of a right to bodily autonomy for financial gain would be prostitution. Currently 32 countries allow prostitution, none of which allows for the sale of an organ. Views on legalization of prostitution have often viewed it as an "necessary evil" and of prostitution can be legalized as long as the sex worker's human rights such as freedom of speech, travel, work, immigration, health insurance, and housing, are not deprived. Following the same logic, many argue that as long as the donors rights are respected and the trade is regulated, it would be ethically responsible for organ trade to exist.

Organ trade also raises ethical and legal concerns for healthcare providers towards the treatment of patient. Specifically, currently there is little to no guidance on how does the doctor-patient relationship change if the patient received an organ through illegal means. Further more, if organ trade is legalized, an obligation for a physician to respect the patients wish to sell an organ. In the USA, there is controversy on whether organ donation wishes are legally enforceable. The primary law governing organ donation is the Uniform Anatomical Gift Act (UAGA). However, it is widely considered inadequate as it is up to each state to regulate and uphold this law, with enforcement varying between states for body donation. To avoid lawsuits, providers would sometimes side with the next of kin and invalidate organ donation requests made by the donor.

Increased organ supply
The main argument made in favor of legalized organ sales is that it would increase the number of organs available for transplantation. Although governments have implemented other initiatives to increase organ donation – such as public awareness campaigns, presumed consent laws, and the legal definition of brain death – the wait-list for vital organs continues to grow. Further more, cadaver organ transplantation have poorer clinical outcomes as compared with live organ donations. Legalizing payments for organs would encourage more people to donate their organs. Each organ sold on a market could potentially save the life (and improve the quality of life) of its recipient. For example, patients with kidney disease who receive a kidney transplant from a living donor typically live 7 to 15 years longer than those who depend on dialysis.

Economists generally lean in favor of legalizing organ markets. The consensus of American Economic Association members is that organ trade should be allowed, with 70% in favor and 16% opposed. Another literature review, looking at the publications of 72 economic researchers who have studied organ trade, reached a similar conclusion: 68% supported legalization of the organ trade, while 21% opposed it.

Harm reduction
Other physicians and philosophers argue that legalization will remedy the abuses of the illicit trade in organs. The current ban on the sale of organs has driven both sellers and buyers into the black market, out of sight of the law. Criminal middlemen often take a large cut of the payment for the organ, leaving comparatively little money left for the donor. Because the mainstream medical establishment is barred from participating in the transplantation, the procedure typically occurs in substandard facilities and not according to best practices. Afterwards, the donors often do not receive important medical follow-up because they are afraid that their role in the crime will be discovered. There have also been reports of criminal gangs kidnapping people and illegally harvesting their organs for sale on the black market. Proponents of legalization argue that it will result in better medical care for donors and recipients alike, as well as larger payments to the donors.

Some critics challenge the proponents' assumptions that legalization will completely eliminate the black market for organs or its problems. For example, one scholar argues that once the organ trade became legalized in Iran, it did not end the under-the-table sales in organs. Instead, people made deals outside the government-sanctioned system to acquire organs from more desirable (i.e., healthier) donors.

Respect for autonomy
Many proponents argue for legalized organ sales on the grounds of autonomy. Individuals are generally free to buy or sell their possessions and their labor. Advocates of organ markets say that, likewise, people ought to be free to buy or sell organs as well. According to this perspective, prohibitions against selling organs are a paternalistic or moralistic intrusion upon individuals' freedom. Proponents acknowledge that, unlike selling a material possession such as a car, selling a kidney does carry some risk of harm. However, they note that people are able to undertake dangerous occupations (such as logging, soldiering, or surrogacy) which carry significant chance of bodily harm. If individuals are allowed to take on that risk in exchange for money, then they ought to be able to take on the risks of selling a kidney as well.

Susceptibility to Coercion
Critics often argue that organ sales should remain prohibited because any market solution will take advantage of the poor. Specifically, they fear that a large financial incentive for donating organs will prove irresistible to individuals in extreme poverty: such individuals may feel like they have no choice but to agree to sell a kidney. Under these circumstances, the decision to sell cannot be regarded as truly voluntary. Consequently, it is appropriate for the government to protect poor people by prohibiting the sale of organs.

Critics of legalization argue that proponents exaggerate the impact that a market would have on the supply of organs. In particular, they note that legalized organ sales may “crowd out” altruistic donations. In other words, people who would otherwise give their organs to relatives may decline to do so, opting instead to purchase the organ (or rely on the government to buy one) for their relatives. Proponents of markets counter that while altruistic donations might decrease slightly if organ sales were legalized, this decrease would be more than offset by the influx of organs.

Legalization of human organ trading has been opposed by a variety of human rights groups. One such group is Organs Watch, which was established by Nancy Scheper-Hughes – a medical anthropologist who was instrumental in exposing illegal international organ-selling rings. Scheper-Hughes is famous for her investigations, which have led to several arrests due to people from developing countries being forced or fooled into organ donations. Like the World Health Organization, Organs Watch seeks to protect and benefit the poverty-stricken individuals who participate in the illegal organ trade out of necessity.

Direct harms of organ selling
Some opponents of markets adopt a paternalistic stance that prohibits organ sales on the grounds that the government has a duty to prevent harm to its citizens. Unlike the "coercion by poverty" line of argumentation discussed above, these critics do not necessarily question the validity of the donors' consent. Rather, they say that the dangers posed by donating an organ are too great to allow a person to voluntarily undertake them in exchange for money. As noted previously, critics of organ sales cite research suggesting that kidney sellers suffer serious consequences of the operation, faring far worse than altruistic kidney donors. Even if one assumes that kidney sellers will have similar outcomes to donors in a regulated market, one cannot ignore the fact that a nephrectomy is an invasive procedure that - by definition - inflicts some injury upon the patient. These critics argue that the government has a duty to prevent these harms, even if the would-be seller is willing to undertake them.

A similar argument focuses on the fact that selling a kidney involves the loss of something unique and essentially irreplaceable on the part of the donor. Given the special value placed on bodily integrity in society, it is appropriate to outlaw the sale of body parts to protect that value.

Objectification
Another criticism of legalized organ sales is that it objectifies human beings. This argument typically starts with the Kantian assumption that every human being is creatures of innate dignity, who must always be regarded as an end to itself and never just a means to an end. A market for organs would reduce body parts to commodities to be bought and sold. Critics argue that, by permitting such transactions, society would reduce the seller of the organ to an object of commerce - a mere means to an ends. Assigning a monetary value to a key organ is essentially assigning a value to its bearer, and putting a price on a human being violates his or her intrinsic dignity.

Proponents of organ sales claim that this line of argument confuses the kidney with the whole person; so long as the transaction is conducted in a way that minimizes risks to the donor and fairly compensates him or her, that person is not reduced to a means to an end.

Unwanted pressure to sell an organ
Another argument against organ markets is that they will give rise to a pressure to sell organs which would harm all people (even those who did not participate directly in the market). Under the current ban on the organ trade, debtors and heads of families in the developed world face little pressure to sell their organs. If a person's creditors or dependents suggest that she sell her kidney to raise money, she could refuse on the grounds that it is illegal. In contrast, if organ sales were legalized, a destitute individual could face pressure from family and creditors to sell a kidney – and possibly endure social consequences such as scorn or guilt if she declined. Legalizing organ sales would create this unwanted pressure (and attendant disapproval) for all poor individuals, regardless of whether or not they wished to sell their kidneys. Thus a legal prohibition on selling organs is warranted to protect poor people from this undesirable pressure.

Consequences for donors
Proponents also assert that organ sales ought to be legal because the procedure is relatively safe for donors. The short-term risk of donation is low – patients have a mortality rate of 0.03%, similar to that of certain elective cosmetic procedures such as liposuction. Moreover, the long-term risks are also relatively minimal. A 2018 systematic review found that kidney donors did not die earlier than non-donors. Donors did have a slightly increased risk of chronic kidney disease and pre-eclampsia (a condition sometimes seen in pregnancy). The review found no difference in the rates of diabetes, heart disease, high blood pressure, or mental illness. Multiple studies of American and Japanese donors found that they reported a higher quality of life than the average non-donor. Proponents of organ markets argue that, given the comparative safety of donating a kidney, individuals should be permitted to undergo this operation in exchange for payment.

Critics challenge this view of transplantation as being overly optimistic. Specifically, they cite research suggesting that individuals who sell their organs fare worse after the procedure than those who freely donate their organs. Kidney sellers are more likely to have renal problems after the operation (such as hypertension and chronic kidney disease), to report reduced overall health, and to suffer from psychological side effects such as depression. Opponents of markets usually ascribe these worse outcomes to the fact that kidney sellers are drawn from the ranks of the poor; if organ sales are permitted, most sellers will be poor and can expect the same dangerous consequences. Proponents of organ markets respond by blaming these bad outcomes on the fact that kidney sellers have been forced into the black market, with minimal oversight, follow-up care, or legal protections from abuse; thus in a regulated market in the developed world, kidney sellers could expect to see outcomes more akin to those of kidney donors

Models for organ markets
Models for organ trade hinge upon the bef that does the right of people to do what they want with their own bodies include the right to sell their own organs l [28]

Erin Harris Model
Ethicists Charles A. Erin and John Harris have proposed a much more heavily regulated model for organ transactions. Under this scheme, would-be sellers of organs do not contract with would-be recipients. Instead, a government agency would be the sole buyer of organs, paying a standard price set by law and then distributing the organs to its citizens. This safeguard is designed to prevent unscrupulous buyers from taking advantage of potential donors and to ensure that the benefits of the increased organ supply are not limited to the rich. Moreover, participation in the market would be confined to citizens of the state where the market is located, to prevent the unilateral movement of organs from developing nations to the developed world. Erin and Harris's model has been endorsed by a number of prominent advocates of organ markets.

Free Market Model
Many scholars advocate the implementation of a free market system to combat the organ shortage that helps drive illegal organ trade. The organ trade's illegal status creates a price ceiling for organs at zero dollars. This price ceiling affects supply and demand, creating a shortage of organs in the face of a growing demand. According to a report published by the Cato Institute, a US-based libertarian think tank, eliminating the price ceiling would eliminate the organ shortage. In the Journal of Economic Perspectives, Nobel laureate Gary Becker and Julio Elias estimated that a $15,000 compensation would provide enough kidneys for everyone on the wait list. The government could pay the compensation to guarantee equality. This would save public money, as dialysis for kidney failure patients is far more expensive.

However, other critics state that a free market for organs would only increase already high prices for organs, creating an imbalance: only wealthy individuals would be able to purchase these organs. They also argue that such a free market system for organ trade would encourage organ theft through murder and neglect of sick individuals for financial gain. Advocates for the free market of organs counter these claims by saying that murder for financial gain already happens; sanctions against such acts exist to minimize their occurrence; and with proper regulation and law enforcement, such incidents in a legal organ trade could be minimized as well.

Other Models
The incentivized Kidney Donation Model (IKDM) exists as an intermediate between complete Free Market Model and Erin Harris Model, with strong government regulation and rewards with free market approach to donations. Currently in place in Turkey, Iran, in which a free market organ market exists which "donations" between donor and recipients are allowed. However, the government also supplements this donation with incentives such as free/discounted medical health insurance, exemptions from co payments/contribution shares, priority when receiving an organ in the future, priority when finding a job, income tax exemptions for salaried employees, and free or discounted public utilities. Currently under UNOS, USA operates similar to IKDM model in which organ donors.