Intended for healthcare professionals

Analysis And Comment Controversy

Payment for living organ donation should be legalised

BMJ 2006; 333 doi: (Published 05 October 2006) Cite this as: BMJ 2006;333:746
  1. Amy L Friedman, associate professor of surgery (
  1. 1 Section of Organ Transplantation and Immunology, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA
  • Accepted 10 July 2006

Governments seem resistant to allowing live donors to benefit from their gift. But a legalised system could solve organ shortages and be both safer and fairer

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.

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What price a kidney?


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.

Tangible benefits of living donor transplantation

In 2005, United States transplant centres reported 6562 living donor kidney transplantations.5 It is reasonable to assume that nearly all recipients who survive surgery with a functioning kidney derive tangible benefit. But it is not only recipients who benefit. Recipients of donated organs are able to live without dialysis. Thus their family members have liberalised lifestyles and may benefit from extra income if the recipient returns to work. Doctors will be paid for each transplantation. And other hospital staff, such as administrators and …

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