The demand for life saving organ transplantation has so outpaced supply that waiting patients and transplant teams are desperate. Improved survival rates coupled with steady expansion of indications for transplantation make the organ shortage progressively severe; waiting times are now unbearably long. Although legalisation of “presumed consent” strategies has succeeded in raising organ donation rates in Spain and elsewhere,1 other proposed solutions such as voluntary reciprocal altruism2 remain cumbersome and risk excluding people with poor healthcare literacy.

What price a kidney?

Credit: ROQUE/AP PAT

Lack of donors has led to some patients contracting with organ brokers to purchase a kidney from a living donor. Because payment for organs is illegal in most countries, people may travel to the donor's homeland for the transplantation.3 Limited studies indicate possible exploitation of these paid donors, who may get minimal benefit from their purported financial compensation.4 More worrisome is our lack of knowledge about adverse outcomes they experience. If payment or reward for living donors can be made legitimate and ethically consistent with other accepted medical practices, exploitation can be prevented and both donors and recipients can be treated equitably.