Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
It is often pointed out that altruistic procurement systems accept donations from people in circumstances that would presumably undermine the validity of their consent to a similar extent (e.g., a father choosing to donate his kidney because his daughter is sick or people pressured by their families to donate) (see Anonymous 1974; Denise 1985; Hartman 1979; Kishore 2005; Liberto 2013; Manga 1987; Robinson 1999). Such claims rely on the empirical assumption that the two kinds of circumstances affecting the validity of consent are equally hard to detect in a screening process. Furthermore, as Malmqvist highlights, it is a reasonable fear that this new kind of pressure may supplement existing pressure to part with an organ (Malmqvist 2014b).
Donation can of course in itself be harmful. A large Norwegian study found that kidney donors have an increased long-term risk of end-stage renal disease and higher mortality compared to a control group of non-donors who would have been eligible for donation (Mjøen et al. 2014).
Admittedly, other interpretations of exploitation may have a similar feature. See for example versions of exploitation discussed in Koplin (2017).
Adair, A., and S.J. Wigmore. 2011. Paid organ donation. Annals of The Royal College of Surgeons of England 93(3): 188–192.
Altshuler, J.S., and M.J. Evanisko. 1992. Financial incentives for organ donation: The perspectives of health care professionals. JAMA 267(15): 2037–2038.
Andrews, L.B. 1986. My body, my property. Hastings Center Report 16(5): 28–38.
Anonymous. 1974. The sale of human body parts. Michigan Law Review 72(6): 1182–1264.
Aramesh, K. 2014. A closer look at the Iranian model of kidney transplantation. The American Journal of Bioethics 14(10): 35–37.
Arnold, R., S. Bartlett, and J. Bernat. 2002. Financial incentives for cadaver organ donation: An ethical reappraisal. Transplantation 73(8): 1361–1367.
Barnett, A.H., R.D. Blair, and D.L. Kaserman. 1992. Improving organ donation: Compensation versus markets. Inquiry 29(3): 372–378.
Beard, T.R., D.L. Kaserman, and R. Osterkamp. 2013. The global organ shortage: Economic causes, human consequences, policy responses. Stanford, California Stanford Economics and Finance.
Becker, G.S., and J.J. Elías. 2007. Introducing incentives in the market for live and cadaveric organ donations. Journal of Economic Perspectives 21(3): 3–24.
Björkman, B. 2006. Why we are not allowed to sell that which we are encouraged to donate. Cambridge Quarterly of Healthcare Ethics 15(01): 66–70.
Bowles, S. 2016. The moral economy: Why good incentives are no substitute for good citizens. New Haven: Yale University Press.
Brecher, B. 1994. Organs for transplant: Donation or payment. In Principles of health care ethics, edited by R. Gillon and A. Lloyd, 993. Chichester: John Wiley & Sons.
Chadwick, R.F. 1989. The market for bodily parts: Kant and duties to oneself. Journal of Applied Philosophy 6(2): 129–140.
Chapman, D.E. 1983. Retailing human organs under the uniform commercial code. The John Marshall Law Review 16(2): 393–417.
Cherry, M.J. 2005. Kidney for sale by owner: Human organs, transplantation, and the market. Washington, D.C.: Georgetown University Press.
Cohen, I.G. 2013. Transplant tourism: The ethics and regulation of international markets for organs. The Journal of Law, Medicine and Ethics 41(1): 269–285.
------. 2014a. Regulating the organ market: Normative foundations for market regulation. Law and Contemporary Problems 77(3): 71–101.
------. 2014b. A fuller picture of organ markets. The American Journal of Bioethics 14(10): 19–21.
------. 2015. Patients with passports: Medical tourism, law and ethics. New York, NY: Oxford University Press.
Cohen, L. 1991. The ethical virtues of a futures market in cadaveric organs. In Organ replacement therapy: Ethics, justice commerce, edited by W. Land and J.B. Dossetor, 302–310. USA: Springer.
Cook, P.J., and K.D. Krawiec. 2014. A primer on kidney transplantation: Anatomy of the shortage. Law and Contemporary Problems 77(3): 1.
------. 2018. If we allow football players and boxers to be paid for entertaining the public, why don’t we allow kidney donors to be paid for saving lives. Law and Contemporary Problems 81(9): 9–35.
Council of Europe and Organización Nacional de, and Trasplantes. 2016. Newsletter transplant: International figures on donation and transplantation 2015. http://www.ont.es/publicaciones/Documents/NEWSLETTER%202016%20NIPO.pdf. Accessed 18 Jan 2017.
Crespi, G.S. 1994. Overcoming the legal obstacles to the creation of a futures market in bodily organs. Ohio State Law Journal 55(1): 1–77.
Danovitch, G.M., and A.B. Leichtman. 2006. Kidney vending: The “Trojan horse” of organ transplantation. Clinical Journal of the American Society of Nephrology 1(6): 1133–1135.
DeJong, W., J. Drachman, S.L. Gortmaker, C. Beasley, and M.J. Evanisko. 1995. Options for increasing organ donation: The potential role of financial incentives, standardized hospital procedures, and public education to promote family discussion. The Milbank Quarterly 73(3): 463–479.
Denise, S.H. 1985. Regulating the sale of human organs. Virginia Law Review 71(6) 1015–1038.
Dworkin, G. 1994. Market and morals: The case for organ sales. In Morality, harm, and the law, edited by G. Dworkin, 155–161. Boulder: Westview Press.
Epstein, R.A. 2014. How to create markets in contestable commodities. In The global body market: Altruism’s limits, edited by M. Goodwin, 44–66. New York, NY: Cambridge University Press.
Erin, C.A., and J. Harris. 1994. A monopsonistic market: Or how to buy and sell human organs, tissues and cells ethically. In Life and death under high technology medicine, edited by I. Robinson, 134–153. Manchester, UK: Manchester University Press.
------. 2003. An ethical market in human organs. Journal of Medical Ethics 29(3): 137–138.
Flescher, A.M. 2018. The organ shortage crisis in America: Incentives, civic duty, and closing the gap. Washington, DC: Georgetown University Press.
Friedlaender, M.M. 2002. The right to sell or buy a kidney: Are we failing our patients? The Lancet 359(9310): 971–973.
Ghods, A.J., and S. Savaj. 2006. Iranian model of paid and regulated living-unrelated kidney donation. Clinical Journal of the American Society of Nephrology 1(6): 1136–1145.
Ghods, A.J. 2004. Governed financial incentives as an alternative to altruistic organ donation. Experimental and Clinical Transplantation 2(2): 221–228.
Glasson, J., C.W. Plows, O.W. Clarke, et al. 1995. Financial incentives for organ procurement: Ethical aspects of future contracts for cadaveric donors. Archives of Internal Medicine 155(6): 581–589.
Goodwin, M. 2006. Black markets: The supply and demand of body parts. New York, NY. Cambridge University Press.
Goyal, M. 2002. Economic and health consequences of selling a kidney in India. JAMA 288(13): 1589.
Guttmann, R.D. 1991. The meaning of “The economics and ethics of alternative cadaveric organ procurement policies.” Yale Journal on Regulation 8(2): 453–462.
Hansmann, H. 1989. The economics and ethics of markets for human organs. Journal of Health Politics, Policy and Law 14(1): 57–85.
Harris, C.E., and S.P Alcorn. 2001. To solve a deadly shortage: Economic incentives for human organ donation. Issues in Law and Medicine 16(3): 213–233.
Hartman, T.M. 1979. The buying and selling of human organs from the living: Why not? Akron Law Review 13(1): 152–174.
Harvey, J. 1990. Paying organ donors. Journal of Medical Ethics 16(3): 117–119.
Hippen, B., and A. Matas. 2009. Incentives for organ donation in the United States: Feasible alternative or forthcoming apocalypse? Current Opinion in Organ Transplantation 14(2): 140–146.
Hughes, P.M. 2009. Constraint, consent, and well-being in human kidney sales. Journal of Medicine and Philosophy 34(6): 606–631.
Investopedia. 2003. Futures Market. http://www.investopedia.com/terms/f/futuresmarket.asp. Accessed 5 Apr 2017.
Kaserman, D. 2001. Markets for organs: Myths and misconceptions. Journal of Contemporary Health Law & Policy 18: 567–581.
Kerstein, S.J. 2009. Autonomy, moral constraints, and markets in kidneys. Journal of Medicine and Philosophy 34(6): 573–585.
Kishore, R.R. 2005. Human organs, scarcities, and sale: Morality revisited. Journal of Medical Ethics 31(6): 362–365.
Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. The American Journal of Bioethics 14(10): 7–18.
------. 2015. From blood donation to kidney sales: The gift relationship and transplant commercialism. Monash Bioethics Review 33(2): 102–122.
------. 2017. Beyond fair benefits: Reconsidering exploitation arguments against organ markets. Health Care Analysis 26(1): 33–47.
Larijani, B., F. Zahedi, and E. Taheri. 2004. Ethical and legal aspects of organ transplantation in Iran. Transplantation Proceedings 36(5): 1241–1244.
Liberto, H. 2013. Noxious markets versus noxious gift relationships. Social Theory and Practice 39(2): 265–287.
Lysaght, M.J., and J. Mason. 2000. The case for financial incentives to encourage organ donation. ASAIO Journal 46(3): 253–256.
Mahoney, J. D. 2009. Altruism, markets, and organ procurement. Law and Contemporary Problems 72: 17–36.
Malmqvist, E. 2014a. Are bans on kidney sales unjustifiably paternalistic? Bioethics 28(3): 110–118.
------. 2014b. A further lesson from existing kidney markets. The American Journal of Bioethics 14(10): 27–29.
------. 2015. Kidney sales and the analogy with dangerous employment. Health Care Analysis 23(2): 107–121.
Manga, P. 1987. A commercial market for organs? Why not? Bioethics 1(4): 321–338.
Matas, A.J., B. Hippen, and S. Satel. 2008. In defense of a regulated system of compensation for living donation. Current Opinion in Organ Transplantation 13(4): 379–385.
Mjøen, G., S. Hallan, A. Hartmann, et al. 2014. Long-term risks for kidney donors. Kidney International 86(1): 162–167.
Murray, T.H. 1987. Gifts of the body and the needs of strangers. Hastings Center Report 17(2): 30–38.
Muyskens, J.L. 1978. An alternative policy for obtaining cadaver organs for transplantation. Philosophy and Public Affairs 8(1): 88–99.
Novelli, G., M. Rossi, L. Poli, et al. 2007. Is legalizing the organ market possible? Transplantation Proceedings 39(6): 1743–1745.
Nuffield Council on Bioethics. 2011. Human bodies: Donation for medicine and research. London: Nuffield Council on Bioethics.
Ockenfels, A., and J. Weimann. 2001. The supply side of organ allocation. Analyse & Kritik, 23(2): 280–285.
Pajouhi, A., F. Zahedi, Z. Pajouhi, and B. Larijani. 2014. Paid living kidney transplantation in Iran: Rethinking the challenges. The American Journal of Bioethics 14(10): 40–42.
Radcliffe-Richards, J., A.S. Daar, R.D. Guttmann, et al. 1998. The case for allowing kidney sales. The Lancet 351(9120): 1950–1952.
Radin, M.J. 1996. Contested commodities. Cambridge, Mass: Harvard University Press.
Richards, J.R. 1996. Nephrarious goings on: Kidney sales and moral arguments. Journal of Medicine and Philosophy 21(4): 375–416.
------. 2012. The ethics of transplants: Why careless thought costs lives. New York: Oxford University Press.
Rid, A., L.M. Bachmann, V. Wettstein, and N. Biller-Andorno. 2009. Would you sell a kidney in a regulated kidney market? Results of an exploratory study. Journal of Medical Ethics 35(9): 558–564.
Rippon, S. 2014a. Organ markets and harms: A reply to Dworkin, Radcliffe Richards and Walsh. Journal of Medical Ethics 40(3): 155–156.
------. 2014b. Imposing options on people in poverty: The harm of a live donor organ market. Journal of Medical Ethics 40(3): 145–150.
Rizvi, A.H.S., A.S.A. Naqvi, N.M. Zafar, and E. Ahmed. 2009. Regulated compensated donation in Pakistan and Iran. Current Opinion in Organ Transplantation 14(2): 124–128.
Robinson, S.E. 1999. Organs for sale-an analysis of proposed systems for compensating organ providers. University of Colorado Law Review 70: 1019.
Rothman, D.J., E. Rose, T. Awaya, et al. 1997. The Bellagio Task Force Report on transplantation, bodily integrity, and the international traffic in organs. Transplantation Proceedings 29(6): 2739–2745.
Rothman, S.M., and D.J. Rothman. 2006. The hidden cost of organ sale. American Journal of Transplantation: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons 6(7): 1524–1528.
Sandel, M.J. 2012. What money can’t buy: The moral limits of markets. London: Penguin Books.
Satz, D. 2010. Why some things should not be for sale: The moral limits of markets. New York: Oxford University Press.
Schwindt, R., and A.R. Vining. 1986. Proposal for a future delivery market for transplant organs. Journal of Health Politics, Policy and Law 11(3): 483–500.
Scott Andrew, V., and W. Block. 2011. Organ transplant: Using the free market solves the problem. Journal of Clinical Research and Bioethics 2(111): 2.
Semrau, L. 2017. Misplaced paternalism and other mistakes in the debate over kidney sales. Bioethics 31(3): 190–198.
------. 2019. When the patina of empirical respectability wears off: Motivational crowding and kidney sales. Ethical Theory and Moral Practice 22: 1055–1071.
Tadd, G.V. 1991. The market for bodily parts: A response to Ruth Chadwick. Journal of Applied Philosophy 8(1): 95–102.
Taylor, J.S. 2005. Stakes and kidneys: Why markets in human body parts are morally imperative. Burlington, VT: Ashgate Publishing.
------. 2014. Avoiding harms to kidney vendors through legal, regulated markets. The American Journal of Bioethics 14(10): 21–22.
------. 2015. Moral repugnance, moral distress, and organ sales. Journal of Medicine and Philosophy 40(3): 312–327.
Titmuss, R.M. 1997. The gift relationship: From human blood to social policy. Edited by A. Oakley and J. Ashton. New York: The New Press.
Turner, L. 2009. Commercial organ transplantation in the Philippines. Cambridge Quarterly of Healthcare Ethics 18(02): 192–196.
Veatch, R.M. 2000. Transplantation ethics. Washington, D.C.: Georgetown University Press.
Waldby, C., and R. Mitchell. 2006. Tissue economies: Blood, organs, and cell lines in late capitalism. Durham: Duke University Press.
Wertheimer, A. 1989. Coercion. Princeton, NJ: Princeton University Press.
------. 1999. Exploitation. Princeton, NJ: Princeton University Press.
Wilkinson, S. 2000. Commodification arguments for the legal prohibition of organ sale. Health Care Analysis: HCA: Journal of Health Philosophy and Policy 8(2): 189–201.
------. 2003. Bodies for sale: Ethics and exploitation in the human body trade. London. Routledge.
Wilkinson, T.M. 2011. Ethics and the acquisition of organs. Issues in biomedical ethics. New York. Oxford University Press.
Williams, C. 1994. Combatting the problems of human rights abuses and inadequate organ supply through presumed donative consent. Case Western Reserve Journal of International Law 26(2): 315–364.
Zargooshi, J. 2001. Iranian kidney donors: Motivations and relations with recipients. The Journal of Urology 165(2): 386–392.
Zutlevics, T.L. 2001. Markets and the needy: Organ sales or aid? Journal of Applied Philosophy 18(3): 297–302.
This paper has benefitted significantly from comments received on a number of occasions. It was presented at ECPR General Conference in Montreal, August 2015; Nordic Network for Political Theory in Copenhagen, October 2016; Higher Seminar, Department of Philosophy Stockholm University, April 2016; Higher Seminar Linköping University, April 2016; Center for Medical Ethics, Karolinska Institute Stockholm, April 2017; and Political Theory Section, Department of Political Science Aarhus University, September 2017. I am very grateful for comments provided by Didde Boisen Andersen, Gustaf Arrhenius, Isra Black, Helene Bodegård, Greg Bognar, Krister Bykvist, Hege Cathrine Finholt, Markus Furendal, Barbro Fröding, Madhuri Gogineni, Erik Gustavsson, Gert Helgesson Fredrik Dybfest Hjorthen, Mats Ingelström, Niklas Juth, Eszter Kollar, Kasper Lippert-Rasmussen, Sune Lægaard, Erik Malmqvist, Søren Flinch Midtgaard, Lasse Nielsen, Daniel Weinstock, Åsa Wikforss, Anna Slettmyr, Manne Sjöstrand, András Szigeti, Daniel Ramöller, Jens Damgaard Thaysen, Frej Klem Thomsen, Rasmus Uhrenfeldt, Gustav Østeraa, and two reviewers.
The work on this article was part of a project funded by the Carlsberg Foundation (Grant number: CF14-0896)
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Albertsen, A. If the Price is Right: The Ethics and Efficiency of Market Solutions to the Organ Shortage. Bioethical Inquiry 17, 357–367 (2020). https://doi.org/10.1007/s11673-020-09981-y
- Organ markets
- Future markets
- Organ trade