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The Consequences of Public Policy to Buy and Sell Organs for Transplantation

There is an increasing interest in addressing the shortage of transplantable organs by using monetary payments to obtain them. Recent commentaries in the New York Times (1) and from the Kennedy Institute of Ethics Journal (2) share a recurring message: ‘it may be time to turn to a market approach’. The source of these commentaries has been from those who do not have a direct care responsibility for transplant patients or organ donors. Their primary focus has been to propose financial incentives for deceased donation; they have not recommended buying organs from live kidney donors. Legislators, aware of these editorials, have sought direction from the transplant community (3). As a result, economic analyses have been prepared that display a cost savings of successful transplantation and underscore more dramatically the need for organs (4,5). As these analyses emerge, a consideration of financial incentives has become evident, no longer restricted to deceased donation. Furthermore, the authorship of these economic analyses is no longer limited to the public sector (4). The consideration of payments for live vendors by physicians is placing the transplant community at an ethical and professional crossroad that is a departure from the standard of the past 50 years (6), and necessitates a reply. In this continuing debate (with some purporting to show the economic value of payments) there are consequences to be measured by society, independent of increasing the supply of organs. Does an economic analysis of cost-effectiveness make the buying and selling of organs by society ethically acceptable? Would such a market be acceptable health policy for government planners? We believe the answer to each of these questions is ‘no’. Neither scientific justifications nor cost-effectiveness analyses overcome ethical concerns