In “Assessing the Likely Harms to Kidney Vendors in Regulated Organ Markets,” Julian Koplin (2014) argues that paid living kidney donation would result in physical, psychological, social, and financial harms for would-be sellers that more than offset the short-term financial benefits of selling. Koplin opposes paid living kidney donation on these grounds.
Contrary to Koplin, I argue that the best approach is not to ban sales outright. Nor is it to allow the unfettered sale of living kidneys. Instead, living kidney sales should be tolerated, within limits. The basis for a balanced approach is that the objectionable effects Koplin predicts ignore an important ethical consideration, namely, the value of regarding persons as subjects with preferences, goals, and ends. Rather than focusing exclusively on consequences, and assuming that the exchange itself carries no positive moral weight, I propose instead that how we regard others’ goals and preferences matters as much as, and sometimes more than, minimizing harms or ensuring the best possible consequences. Rather than claiming that the positive value of regarding persons as subjects is a dispensable benefit, to be assigned a finite value and balanced against costs, I propose instead that it represents a nonconsequentialist consideration that should be honored in most instances, depending on the ethically salient features of the proposed market exchange.