Popular repugnance contrasts with legal bans on controversial markets

Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda

The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment's framework as a blueprint for European research on this topic.

Kidney paired donation in developing countries: A global perspective

Purpose of review

We review the key principles of kidney paired donation (KPD) and discuss the status and unique considerations for KPD in developing countries.

Recent findings

Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices.

Summary

KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need world-wide.

The effect of fast and slow decision-making on equity-efficiency tradeoffs and moral repugnance

Fast-and-slow models of decision-making are commonly invoked to explain economic behaviour. However, past research has focused on human cooperation and generosity and thus largely overlooked situations where there are sharp conflicts between efficiency and equality, or between efficiency and more intuitive moral values (repugnance). Here, we contribute to fill this gap in the literature. We conducted a preregistered experiment (n = 1500 recruited from Prolific) to assess the effects of fast, intuitive decisions, under time pressure versus slow, deliberate decisions, under time delay, on (i) people's distributional preferences and (ii) their attitudes toward repugnant transactions. The results show increased preference for equality and decreased preference for efficiency under time pressure, but no effects on moral repugnance. Exploratory analyses revealed that most of the observed treatment effects in our data were accounted for by women. Our results provide some support for theories that associate controlled cognition with concern for efficiency, and intuitive, emotional responses with inequality aversion.

Access to infertility care and ART treatment in India: A clinician's perspective

Infertility is a worldwide problem that is increasing with time. The cause of infertility can be due to either male or female factors or both. The food, environmental, occupational and psychological factors do contribute to infertility. The infertility and the present scenario of assisted reproductive technology (ART) in India with regard to the clinics, clinicians and regulatory mechanisms in vogue are discussed. The potential of India as a reproductive tourist destination and surrogacy issues is included. The social, economic, and family problems arising as a consequence of infertility are discussed. The status of ART in India is getting improved and the gap between the West and India is expected to be minimized with the influence of regulatory mechanisms introduced through ART Act in India. The salient features that have a bearing on the infertility treatment outcomes, which are being neglected, or recent findings of research are included with special reference to possible future developments in the field of ART.

Commercial Surrogacy: An Overview

OBJECTIVE

 Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

METHODS

 This is a review of the literature published in the 21st century on commercial surrogacy.

RESULTS

 A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

CONCLUSION

 Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.

Global kidney chains

Kidney failure is among the leading causes of death worldwide, and the best treatment is transplantation. However, transplants are in short supply because of shortfalls of transplantable organs and of finances. In the United States and some other countries, kidney exchange chains have emerged as a way to increase the number of transplants; patients who have a willing donor but cannot receive that donor’s kidney can each receive a compatible kidney from another patient’s intended donor. Such programs are much better developed within the borders of wealthy countries, which is of little help to patients in countries with limited kidney transplantation or exchange. This paper proposes and analyzes a way to extend kidney exchange chains to share the benefits globally.

Kidney failure is a worldwide scourge, made more lethal by the shortage of transplants. We propose a way to organize kidney exchange chains internationally between middle-income countries with financial barriers to transplantation and high-income countries with many hard to match patients and patient–donor pairs facing lengthy dialysis. The proposal involves chains of exchange that begin in the middle-income country and end in the high-income country. We also propose a way of financing such chains using savings to US health care payers.

What makes a market transaction morally repugnant?

Many people find it morally impermissible to put kidneys, jury duty exemptions, or permits for having children on the free market. All of these are examples of repugnant transactions-market transactions that third parties want to prevent. In two studies (N = 1,554), using respondents' judgments of 51 different market transactions across 21 characteristics, we show that repugnance can be decomposed into five higher-order dimensions: moral outrage, need for regulation, incommensurability, exploitation, and unknown risk. Repugnance toward the 51 market transactions was highly consistent across two samples. Our results can help identify mismatches between public sentiments and current regulations (selling carbon emissions is currently legal but considered repugnant), anticipate responses to novel markets that have not been publicly scrutinized (often arising from technological advances, such as markets for "designer babies"), and help design less repugnant markets (e.g., by making the risks involved in a transaction known to sellers).