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

Payment for living organ donation

EDITOR- I read with interest the article ‘Payment for living organ
donation should be legalised’ by Friedman A L.(1) Whilst I entirely
concur with her findings but I may add that I am personally aware of a
regular flow of patients from the United Kingdom to the so called Renal
Belt comprising of underdeveloped countries (2+3) and largely with poor

The banning outright the purchase of organs has encouraged not only
an illegal black market of organs but also the exploitation of the poor in
underdeveloped countries through transplant tourism mostly originating
from the western countries. The argument that prohibiting the purchase of
organs shall prevent the rich benefiting and prevent harm to the poor has
not proven true. The rich do still benefit by purchasing the organs and
evading the law by travelling abroad for transplantation. The law in the
UK has been tinkered firstly by the Unrelated Live Organ Transplant
Authority (ULTRA) to authorise the ‘emotional transplants’ and now by the
Human Tissue Authority (HTA) by allowing ‘paired transplants’. Such
transplants will probably result in not more than 40-50 kidney transplants
per annum(4) and will not have any impact on the UK waiting list. However
this kidney swap between genetically unrelated persons and strangers is
akin to a barter trade, which is, undoubtedly, the oldest form of

As of 31st December 2005 there were 7,526 patients in the UK on the
Organ Transplant waiting list, of whom 90% were awaiting a kidney
transplant. This is the highest number ever of patients on the kidney
transplant waiting list. It is envisaged that by 2020, no country running
a State Health Service will be able to bear the costs of dialysis
treatment for all its patients and rationing is distinctly

So long as the prohibition on the purchase of organs for
transplantation remains, the poor of the third world countries shall
continue to be exploited by rich patients. Therefore, ways and means need
to be found to combat this wrongful exploitation of the poor in third
world countries. One solution I agree is to allow the regulated sale of
organs but purchased through a governmental organisation such as HTA, at
least on an experimental basis (6). However, cross border trade should be
prohibited this is to avoid exploitation of low income countries(7).

An eminent jurist once said: Laws should be made to make ethics but
ethics should not make laws.

Rasheed Ahmad MB; MSc; FRCP.

Emeritus Consultant Nephrologist

‘Shalamar’, Woolton Park, Liverpool L25 6DU



1.Friedman A L.
Payment for living organ donation should be legalised.
BMJ 2006;333:746-748.

2.Ahmed M J,Shiu K, Macdougall A, Cairns H, Mamode N.
An audit of 30 UK patients wh acquired the live donor
renal transplants abroad. The Renal Association Meeting Abstracts 2004 (Spring)69.

3.Higgins R, West N, Fletcher S. Kidney Transplantation in patients travelling from the UK to India and Pakistan. Nephrol Dial Transplant 2003;18:851-852.

4.Dyer C. Paired Kidney Transplants to start to start in the UK. BMJ 2006;332:989.

5 Ahmad R. Shortage of donor kidneys for transplantation. Web BMJ 2004;
6 Op.cit.n.1.

7 Ahmad R. Thinking the unthinkable:selling kidneys. Web BMJ 2006;>

Competing interests:
None declared

Competing interests: No competing interests

11 October 2006
Rasheed Ahmad
Emeritus Consultant Nephrologist
L25 6DU