The ethics of biomedical markets.

ARE REGULATED KIDNEY MARKETS MORALLY DEFENSIBLE? Many arguments against kidney sales focus on a range of potential harms to would-be vendors, such as exploitation and coercion. Proponents of kidney markets, in response, contend that such harms could be adequately mitigated by instituting strictly regulated market structures. In a recent Feature Article, however, Simon Rippon argues that the mere pressure to vend, wherein impoverished individuals are compelled to sell kidneys in order to pay rent or alleviate debt, raises ethical concerns that cannot be addressed through market regulation. Rippon worries that permitting regulated kidney sales would lead to the commodification of organs that fetch significant compensation, normatively transforming how we relate to our and to one another’s bodies. Luke Semrau (see page 443, Editor's choice) challenges Rippon’s argument by introducing a distinction between the “pressure to vend,” which refers to social and legal pressure specifically to sell a kidney, and “pressure with option to vend,” by which he means the general social and economic pressure that causes one to seek avenues for securing additional funds, which may (or may not) lead one to entertain selling a kidney. Semrau maintains that although the pressure to vend is subject to Rippon’s critique, pressure with option to vend escapes it. His key contention is that pressure with option to vend would not inevitably or even probably lead to a widespread pressure to vend, nor would it be likely to change how we relate to our and others’ bodies, so long as the recipients and vendors in a kidney market live in the same geopolitically restricted region. He appeals to preliminary empirical data in support of the claim that such a bounded market structure would keep rates of vending—and hence vending pressures— sufficiently low to diffuse the most serious objections yet raised to the creation of regulated kidney markets.