On Ethics: Father upsets family with illegal purchase

March 24, 2006

DEAR ETHICIST:

My elderly father would have died without a kidney donor. He was on various recipient lists, but the wait can be years.

My father arranged the illegal purchase of a kidney from a foreign man, which required lying to immigration and hospital authorities. My loyalty is to my father but I regret his actions. What should I do?

-- ANONYMOUS

DEAR ANONYMOUS:

Your father should not have bought an organ for transplant. But if you were unable to dissuade him, then there is little you can do now.

I can understand his desperation. There are many more people in need of transplants than there are available organs. Each year thousands of people die while awaiting donors.

It is difficult to fault somebody for taking extreme measures to survive. And yet the consequences of your father's actions are grim. To permit the buying of organs is tantamount to saying those with money can harvest the organs of those without. It's tough to imagine Donald Trump selling a kidney.

In India, where organs may be bought and sold, it is indeed the poor who sell and the wealthier who buy. For a system of acquiring organs to be ethical, it must be equitable, which is not the case when one economic class is exploited for the benefit of another. And exploitation it is when the seller is not making a voluntary decision but responding to financial desperation. Thankfully, the American way of organ transplantation relies on voluntary donors.

I should add the hospital and doctors collaborating with your father should be censured and may find themselves running afoul of the law.

There is something you and your father can do now if you want to make amends for his imperfect behavior: Volunteer with one of the many organizations striving to expand the donor base.

The Ethicist appears on Fridays. Write The Ethicist at ethicist@nytimes.com.

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This article posted April 14, 2006.