Changing Views on Organ Prohibition

I spoke recently at the Kidney and Urology Foundation of America on using incentives to increase organ donation.  Also speaking was Nancy Scheper-Hughes, the courageous UC Berkeley detective/anthropologist responsible for busting international rings of organ traffickers.

Scheper-Hughes is well known as an opponent of kidney vending, especially because it has often involved the exploitation of poor people in the developing world (fyi, there is no question that exploitation has occurred even if you take the view, as I do, that payment per se is not exploitation.)  In her impassioned talk, Scheper-Hughes presented many pictures of poor people with large scars.  

Thus, I was very surprised that Scheper-Hughes favors a trial of compensation for deceased donation and is even supportive of a trial for compensated live donation saying:

"There are penalties for buying, selling and brokering the sale of organs in this country, but still it goes on, often with an attitude of 'don't ask, don't tell.' I believe that if the laws are not going to be followed, then the laws should change. First, though, a controlled study must take place, in an ethical manner, with a sample of volunteer organ donors being compensated appropriately."

As with alcohol and drug prohibition, many people who do not favor organ sales are coming to recognize that a regulated market or compensation system could be preferable to an illegal market.

Addendum: My powerpoint slides Using Incentives to Increase Organ Donation, cover the problem and some potential solutions which are being adopted around the world.  Also included at the end are some slides especially designed for teaching this material in a principles of economics class.


Forgive my ignorance, but how much of the problem (shortage) would be solved simply by adopting a no give-no take rule as you mentioned is done in Israel (if I remember)? This seems to me the first step, and only subsequently should we work out a legal market for organ sales, no?


I'm too lazy to find it now but I've seen research indicating that nudges like that will dramatically affect the organ donor signup rates but not the actual donation rates.

(Because simply moving a kind of presumed-consent practice doesn't eliminate all the other hurdles of legal and cultural norms (like consulting with the family and letting their wishes at the time of death override one made without thought twenty years earlier when signing up for a driver's license).)


Not enough people die with young organs. Plus just because you call something a "nudge" does not justify stealing.

Why is a no-give/no-take rule the first step when compensation is the obvious ultimate solution?

Why are organs the only barter-only good in our economy?

No one is saying you can't hold onto your liver for the highest bidder.

Just as no one says you can't sell your blood.

But, we have voluntary blood donation programs and market blood donation programs.

And, I would bet that voluntary programs take the stress off pay as you flow programs.

There can be legal conflicts over whether registering intent is enough to qualify you as an organ donor or whether a doctor must still ask your family’s permission. Many people never favor organ sales are coming to recognize that a regulated market or compensation system could be preferable to an illegal market.

If you think it's no biggie, read this:

It is an evolving process, but the process is evolving in the wrong direction.

Justua, Here is a link summarizing state laws regarding first person consent:

I have a simple proposal that would encourage people to volunteer to be organ donors: "Front-of-the-line" preference in the event that they ever need an organ.

In practice that would mean that the waiting-list for organs would still be prioritized based on medical necessity and matching suitable donors, but the "first-in-first-out" component of the priortization would be based on the earlier of: a) the date the need was diagnosed, or b) the date the individual had signed their donor card.

I expect this system would create a rush of willing donors, without the need for financial compensation.

You've got to be kidding or you have a black sense of humor.

You place this post just after the post entitled India's Black Markets in Everything.

Andy, may or may not displace goodwill exchanges. It's an empirical and design question.

Blood donation v. skid row plasma centers.

Presumed consent bill in NY legislature, OR What Happened to My Liver:

"Nearly a dozen members of the Assembly seeking reform in New York’s organ donation system joined forces Tuesday to announce the introduction of two bills that they say would tremendously improve the state’s donation network, which according to a National Donor Designation Report Card ranks last in the nation.

The two bills would work together, the first making New York the only state in the nation to adopt the model of “presumed consent.† Under the policy, physicians could remove organs from a suitable donor over the age of 18 without consulting or seeking consent from the family. The second bill would be an “opt out clause,† giving any individual the right to opt out of the presumed consent system for any reason they want. The law essentially shifts the default position from non-donation to donation.

10,000 New Yorkers are currently on donation lists, making up ten percent of the national waiting list. Almost 500 people in New York die every year while on waiting lists."

If we're going to presume people are organ donors unless they opt out, we should also give people a reason to NOT opt out. Donated organs should be allocated first to those who haven't opted out. People who opt out of organ donation should go to the back of the transplant waiting list. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will save more lives by convincing more people to register as organ donors. It will also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

David J. Undis
Executive Director

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