Intended for healthcare professionals

Student Education

Cash for kidneys: right or wrong?

BMJ 2005; 331 doi: (Published 01 October 2005) Cite this as: BMJ 2005;331:0510369
  1. Robert P Jones, fifth year medical student1,
  2. Crispin T Hiley, fifth year medical student1,
  3. R W G Johnson, consultant transplant surgeon2
  1. 1Manchester University
  2. 2Manchester Royal Infirmary

Crispin Hiley and coauthors look at some of the key arguments surrounding the legalisation of organ sales

Fifty years have elapsed since Dr Joseph Murray completed the first successful kidney transplant1 Advances in immunosuppression and surgical technique have allowed many people with end stage renal disease to enjoy a vastly improved quality and quantity of life with a renal transplant. However, problems do exist, and in the United Kingdom only a third of those on the waiting lists received a kidney transplant in 2003.2

The United States, China, India, and Brazil perform the largest number of transplants each year, despite having widely different healthcare systems. What they all have in common is that waiting lists continue to grow. Consequently, specialists are looking for ways of increasing the number of available organs. Alternative approaches such as xenotransplantation are being investigated, but they will increase the supply only some time in the future.

The only way to increase the number of organs available now is to increase the number of human donors. A “presumed consent” system for organ donation used successfully in Austria and Belgium has been rejected by other nations including Britain.3 Financial reward for donation may increase the number of those willing to do so.

The idea of selling an organ may initially cause some revulsion, but denying people lifesaving treatment requires better reasons than our own squeamishness. Selling semen and eggs are not uncommon phenomenons; is selling a kidney such a large moral distance from that?

For: Payment would reduce the number of people on chronic dialysis

Any incentive to donate will increase supply. For some people, knowing that they are saving a life is enough. To increase supply, why not adopt an incentive that everyone appreciates money? For a variety of reasons, people who would not normally consider an altruistic living or post mortem donation may …

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