The legalization of human organ sales would only undermine human dignity

New York’s recent legislation offering hefty tax credits to living organ donors has reignited one of medicine’s most contentious ethical debates: Should we legalize the sale of human organs? While proponents argue this would alleviate transplant shortages, the reality is far murkier.

When I gave a kidney to my father in 2019, I received compensation. A couple of hundred dollars’ worth of gifts came from friends and family. The American Transplant Foundation was able to provide a small, generous check to help cover a bill while I was unable to work. But there was never any expectation that I would be reimbursed with a sum of money at a market price.

Every day in America, on average, 13 people die waiting for organ transplants. The current system, built on voluntary donation, clearly isn’t meeting demand. There are always opportunities to reinvigorate our culture of altruism and to remove unnecessary barriers to donation. The commodification of human parts should not be on the table.

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The compensation argument is persuasive. Proponents can point to Iran, the one country where it is legal, as their example of success. Organ trade in Iran is regulated by a government-backed charity. Donors are paid by recipients and tax credits. Even with a common religious taboo on donating body parts, Iran has no waiting list for kidneys. Financial incentives seem to work there.

Below the surface, however, there is a healthcare system that does not necessarily diagnose every renal failure patient. The Ministry of Health regulates the process, but also fails to make sure every patient is properly diagnosed. A donor can receive enough to pay a month’s rent in a nice Tehran apartment. However, more than 60% of their donors are below the poverty line. Many report no follow-up care and deteriorating health.

The situation dirties not just the reputation of compensated donations, but of donating in general. A major reason Americans give for not donating organs is the belief that donation centers will recklessly harvest their parts for profit. As a donor at the University of Virginia’s hospital, I was treated the same as any patient. I have no confidence that selling my kidney would have guaranteed the same.

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Most damningly, donors in Iran frequently describe their decision as economic coercion. Too often, poor donors, in the hope of paying off debts, spend most of their compensation on treatments for the very conditions brought on by poor aftercare.

There are three good reasons to condemn financial transactions for body parts:

Thus, the direct sale of organs, even by consent, is almost universally banned, and legal compensation is tightly regulated, as it should be. If organ sales were legalized, America’s already dire health disparities would widen as the wealthy bought from the poor at desperation rates. Even with regulation, a market for healthy organs opens the door to exploitation of the vulnerable. It’s the reason 80% of plasma centers appear in poor neighborhoods.

Even with regulation, a market on healthy organs opens the door to exploitation of the vulnerable.

There are many innovations we can apply to the donation system: moderate nonprofit or tax-funded compensation packages, opt-out donation and presumed consent systems, improving exchange networks, investing in preservation research, outreach to educate low-income communities. But not an organ market.

When I donated my kidney, the compensation wasn’t financial — it was knowing I’d given someone years of life. This intangible benefit carries profound psychological and social value that money can’t replicate. Donors and recipients feel better psychologically when an organ is freely given. When generosity is celebrated over transactions, communities grow stronger.

Laissez-faire economics, however, can’t guarantee strong social cohesion or psychological well-being. You cannot replace the value of altruism with the value of currency. We’ve seen what uninhibited capitalism can do to human dignity in other areas, including healthcare costs. The organ shortage demands urgent action, but not at the cost of our humanity. Before we monetize the human body, we must exhaust every ethical alternative.

Humans are not vending machines. If the reason we don’t have enough willing organ donors is that our society is too selfish, how would legislation allowing body part sales not amplify our national selfishness? Would it give us one more excuse not to act in the interest of others?

Caleb Coy Guard is a kidney donor and donor mentor with the National Kidney Foundation.