Designing a Compensated–kidney Donation System

One of the barriers to ending the prohibition on compensated organ donations is that people do not have a good idea what a legal, compensated system would look like. The ban on compensation is nearly global, and has existed, de facto or de jure, almost since the development of immunosuppressive drugs made donations from unrelated individuals feasible. The resulting dearth of first-hand knowledge of a working system that involves compensated donations helps to sustain the prohibition on “valuable consideration,” despite the huge morbidity and mortality costs associated with the persistent and growing organ shortage. Resistance to compensation is further bolstered by (understandable) revulsion at what an unregulated, highly commercialized market in human organs would likely involve. Media reports of the existing “unregulated” organ market—that is, of the largely illegal black