Kidney For Sale; The Case for Compensating Donors



Let me begin by quoting Sally Satel M.D., Kidney transplant recipient and Resident Scholar American Enterprise Institute: (Kidney for Sale, Lets Legally Reward the Donor,pubID.29515/pub_detail.asp)


“America faces a desperate organ shortage. Today, more than 78,000 people are waiting for a kidney transplant; only one in four will receive one this year, while twelve die each day waiting for help. Not surprisingly, many patients are driven to desperate measures to circumvent the eight-year waiting list—renting billboards, advertising in newsletters, or even purchasing organs on the global black market. Altruism (the current system where one donates an organ through the goodness of their heart) is an admirable but clearly insufficient motivation for would-be donors.


According to the International Society of Nephrology, kidney disease affects more than 500 million people worldwide, or 10 per cent of the adult population. With more people developing high blood pressure and diabetes (key risks for kidney disease), the picture will only worsen.


There are nearly two million new cases of the most serious form of kidney disease–renal failure–each year. Unless patients with renal failure receive a kidney transplant or undergo dialysis–an expensive, lifelong procedure that cleanses the blood of toxins–death is guaranteed within a few weeks”


The argument against paying people for their organs (living donors of kidneys and livers) is that the practice would prey on the poor.  Supposedly only people who are in desperate need of money would sell their organs.  “The rich or reasonably well off,” the argument goes, “Don’t need the money so few of them would become donors under such a system.”  Additionally, wealthy people could buy organs from the poor but the poor could not afford to buy organs if they needed them.  So the question;  “Is it ethical to compensate people for their organs?”  My answer is, probably not — if the exchange is simply cash from the recipient to the donor for a kidney.  But what if there are other considerations?  Dr. Satel offers some interesting options:

“My colleagues and I suggest a system in which compensation is provided by a third party (government, a charity or insurance) with public oversight. Because bidding and private buying would not be permitted, available organs would be distributed to the next in line–not just to the wealthy. Donors would be carefully screened for physical and psychological problems, as is currently done for all volunteer living kidney donors. Moreover, they would be guaranteed follow-up care for any complications.


Many people are uneasy about offering lump-sum cash payments. A solution is to provide in-kind rewards–such as a down payment on a house, a contribution to a retirement fund, or lifetime health insurance–so the program would not be attractive to people who might otherwise rush to donate on the promise of a large sum of instant cash.   The only way to stop illicit markets is to create legal ones. Indeed, there is no better justification for testing legal modes of exchange than the very depredations of the underground market.”


Dr. Satel goes on to say that, “Momentum is growing. In the British Medical Journal, a leading British transplant surgeon called for a controlled donor compensation program for unrelated live donors. Within the past year, the Israeli, Saudi and Indian governments have decided to offer incentives ranging from lifelong health insurance for the donor to a cash benefit. In the United States, the American Medical Association has endorsed a draft bill that would make it easier for states to offer non-cash incentives for donation.”

  • Dr. Satel and her colleagues call on Congress to reform the 1984 National Organ Transplant Act (NOTA), which makes it a felony to provide material reward for an organ. The authors suggest that:

 • Congress should amend NOTA so that existing criminal penalties for selling and brokering organ sales between individuals do not apply to any economic incentives offered by federal, state, or local governments. Such a revision would not require any such incentives; it would simply allow states and federal agencies to undertake experimental incentive programs.


• Compensation to prospective donors could take the form of health insurance, tax credits,

tuition vouchers, or contributions to tax-free retirement accounts.


• Rigorous protections for the safety of donors would be created.


• Because the compensation would be provided by the government, every patient in need

would benefit, regardless of income.”


The issue of paying for human organs is controversial to say the least but that does not mean it can’t or won’t work.  Iran, which is usually not a good example for much of anything, allows for such a program and the result reportedly is that their waiting list has sharply declined and in some cases it has diminished entirely. 



What we need in the United States is an open dialogue free of emotional outbursts that would allow for a small pilot program to test the concept.  We need universal agreement on the need to elminate organ transplant waiting lists, much like the commitment the National Kidney Foundation made to eliminating the kidney waiting list within ten years.   We must also agree, though, that the altruistic approach that we’ve tried for the last quarter of a century does not work.  Every year the number of people who die while waiting for a transplant grows, yet we continue to cling to the notion that if we work a little harder more people will become donors.  Well, everyone has worked very hard and we are still losing the battle.  As I have written before about the United Network for Organ Sharing (UNOS) which regulates the entire process, “It’s not working and it is time we tried something that will work, we must stop the dying.”  We’ve got to do something new and a pilot program somewhere in the United States would be a great way to start.  What have we got to lose?


Please comment in the space provided or email your thoughts to me at  And – please spread the word about the need for more organ donors.  There is nothing you can do that is of greater importance.  If you convince one person to be a donor you may have saved or affected 50 or more lives.


Please read and comment on my World Wide Issues blogs on   Also…visit and join my Facebook site, Organ Transplant Patients, Friends and You at  OR — my Facebook home page 

About Bob Aronson

Bob Aronson is a former journalist, a Minnesota Governor's Press Secretary and talk show host. For nearly a quarter of a century, he led the Aronson Partnership, a Minnesota-based communications consultancy that prepared corporate and government executives for crisis situations, regulatory testimony, media interviews and Presentations. Among his clients were all three U.S. Mayo Clinic locations, 3M, general Mills, CH2M Hill, the U.S. Department of Energy and scores more. In 2007 bob had a heart transplant after suffering from idiopathic dilated cardiomyopathy for 12 years. Shortly after he got his new heart he founded the now 4,300 member Facebook support group, Organ Transplant Initiative. At the same time, he established the Bob's Newheart blog where he has posted nearly 300 columns on organ donation, transplantation and other health related issues. The Viewpoint blog was started in late 2016 and bears the name of the Radio Talk show Bob did from 1966 until 1974, when he resigned to become Minnesota Governor Rudy Perpich first Press secretary. Bob and his artist wife Robin, live in Jacksonville, Florida with their two dogs, Reilly and Ziggy. Bob is also a woodworker and makes all of the furnishings for Robin's art festival booth. He also makes one of a kind jewelry or "memories" boxes that he donates to select transplant patients, caregivers, donor families and others who have somehow contributed to making life easier for the ill, the elderly and the less fortunate. Bob is in the final stages of editing two full-length novels that will be available on Kindle when ready for release sometime in early 2017. One is a sci fi novel about an amazing discovery near Roswell, New Mexico and you will be surprised to find it has nothing to do with the Roswell story everyone knows. It features a woman scientist who investigates impact craters for the U.S. Department of the Interior, Dr. Rita Sylvester and her female student intern. The other book is a political thriller that introduces a new hero to the genre, Fargo Dennison.

Posted on March 17, 2009, in Donor Compensation. Bookmark the permalink. 8 Comments.

  1. Hey there, You have done an incredible job. I’ll definitely digg it and individually suggest to my friends. I am sure they’ll be benefited from this site.


  2. Just a reminder….selling or buying human organs is illegal. Any effort to do either on this site will be immediately deleted.


  3. I totally agree with this article. Why condemned an organ donor/ seller? If one person is healthy and willing to help in exchange of money, this is his/her call.
    Like me, am a very healthy individual and am wiling to sell my kidney, coz I know at the end of the day I was able to help someone and in return help me out as well. LIFE IS A TWO WAY STREET.


  4. Great article, thanks for the information.


  5. There are so many flaws in Ms. Satel’s argument, it’s difficult to know where to begin.

    Living donation is not without risk. However, Ms. Satel’s and public/media perception is that relinquishing a major organ is akin to donating a pint of blood. First off, the medical/transplant community has never bothered to track LDs so they have virtually NO idea of the long-term consequences of donation. Secondly, a quick review of the medical literature reveals a variety of possible complications including bleeding, blood clots, hernias, reduced adrenal gland function, hypertension, depression, anxiety and PTSD-like symptoms (just to name a few).

    Regardless of the ‘theoretical’ savings to insurance companies by compensating donors instead of paying for dialysis, they are for-profit entities and will not do such a thing unless persuaded by federal mandate. Remember, these are the same corporations that had to be FORCED to allow a woman to stay in the hospital for 48 hours after giving birth. Some recipients receive their transplant before going on dialysis – where is the savings to the insurance company then?

    TRANSPLANTS ARE NOT CURES. Most recipients will require re-transplantation within their lifetime. Some transplants fail within days or weeks. This ‘compensation’ will not be a one-time expense.

    At one time, the U.S. believed that compensating blood donors would reduce the blood shortage, yet the experiment failed miserably (see Eastlund T. Transfusion 1998 38:874). There is no reason to believe the outcome would be any different for the controlled sale of organs. In fact, recent studies indicate many detrimental consequences to LDs who receive compensation.

    Diabetes is the major kidney killer in the U.S. and many forms of diabetes are preventable or treatable. Why are we, as a nation, not emphasizing the prevention of end-stage renal failure? Is it so much more politically correct to create a whole new class of patients by inducing otherwise healthy people to undergo major surgery and lose a vital organ?

    Many communities in the U.S. are protected by volunteer fire departments. Not only are we not experiencing a shortage of volunteers, most of the VFDs have extensive waiting lists. If Ms. Satel would actually take the time to have a conversation with a living donor or firefighter, she might discover that money is not the be-all, end-all motivator. She might actually learn some real ways to combat this issue.


  6. Awesome stuff. Keep up the great work.


  7. Nice post! Keep it real.I have looked over your blog a few times and I love it.


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