New Internationalist

Is it ever right to buy or sell human organs?

Issue 436

A leading medical think-tank, The Nuffield Council for Bioethics in London, is currently examining this thorny issue. They are due to report their findings in 2011. In the meantime we have asked two experts to argue the case for and against.

We’d love you to take part in The Argument, a new feature in the magazine in which a different issue is debated each month. We’ll be printing a selection of your comments on the debate below next month - read the contributions from the two experts and join the conversation at the bottom of the page. We’d prefer you to use your real name, but want to hear what you have to say either way.

Sally Satel

The global organ shortage has spawned illegal and unregulated organ markets. The World Health Organization estimates that five to ten per cent of all kidneys transplanted annually – perhaps 63,000 in total – are obtained in the organ bazaars of Africa, Asia, Eastern Europe and South America. Thus, we face a dual tragedy: on one side, thousands of patients who die each year waiting for a kidney; on the other, a human rights fiasco in which corrupt brokers deceive indigent donors about the nature of surgery, cheat them out of payment and ignore their post-surgical needs.

Altruistic appeals to organ donation have not yielded enough organs for transplantation. Not all developed countries have made the most use of posthumous donation, and of course they should. Unfortunately, much of the world transplant establishment – including the World Health Organization, the Transplantation Society and the World Medical Association – focuses exclusively on obliterating organ trafficking. While at face value this may seem reasonable, in reality it is a lethally one-sided prescription, because trying to stamp out underground markets either drives corruption further underground or causes it to flourish elsewhere. Government-sponsored compensation of healthy individuals who are willing to give one of their kidneys to save the life of a dying stranger is the best short-term solution.

Jeremy Chapman

So we start on common ground: illegal and unregulated organ markets are reprehensible consequences of individuals driven to seek transplantation therapy. The tragedy has played out across the world. The drive for survival is a very strong human instinct and one that overcomes feelings and common bonds between people. It overthrows decency and humanity and it requires consequentially strong and united laws and regulations. ‘I must leave the country tonight because they are shooting my donor tomorrow,’ was said by a patient to one of my colleagues recently. Such opportunistic human cannibalism has no place in healthcare.

Organ donation after death is the only practicable solution for heart, lung, pancreas, intestine, composite tissue and most liver recipients. There can be no solution that ignores the reality of people with these needs. By focusing on kidneys alone, where the solutions must embrace both the deceased and the living donor, you seem to have discarded the broader needs for transplantation. I thus seek more from you than a throw-away line on ‘the need to make the most use of posthumous donation’.

Sally Satel

Let me say a few words about myself. In August 2004 I became one of those whose ‘drive for survival’ became very strong. That’s when I learned I had idiopathic renal failure. After a year of searching for a donor among people I knew well – and coming up empty – a casual (but now very dear) friend stepped in to spare me years of life-draining dialysis and premature death.

I am well aware of my good fortune. Many people without a donor are failing on dialysis, and some have no access to dialysis at all. And they will follow that survival instinct to foreign lands, despite the sickening knowledge that their new organ might come from an executed prisoner in China or an illiterate labourer in India. I, for one, had considered it. Your reference to ‘opportunistic human cannibalism’ took me aback. The tragedy we face is symmetric: hapless donors and wretched patients are locked in a morbid embrace. I outlined one model for disentangling them – a government-regulated programme of in-kind benefits to well-informed donors, offered by a third party and distributed to the next ill person, not the wealthiest. What innovations have you offered?

I realize that most types of organs must come from deceased donors. But let’s be realistic about the extent to which deceased donation can help. You tell of Chinese prisoners who are shot for their organs. This horrific practice is precisely the kind of extreme situation that takes place when there is no legal alternative. If anything, it is an argument in favour of safe and legal means of rewarding donors. Developed countries must enlarge the pool of transplantable organs, by rewarding living and posthumous donors, if they are to keep some of their citizens from becoming reluctant participants in organ trafficking. Voluntary and compensated live donation for kidneys and deceased donation (compensated or not) can and should exist side by side.

Jeremy Chapman

Deceased donor programmes are the central issue for organ donation. In your country [the US] deaths on the roads alone are capable of meeting the needs of your population; in China there are 79,000 deaths each year on the roads. Harnessing the existing unavoidable mortality is sufficient to meet the needs if the scientific and social requirements to retrieve those organs are resolved. The system of both blood and organ donation that provides the best protection for both the donor and the recipient is altruistic gifting. The moment that money is introduced to buy a kidney from a vendor, the nature of the exchange and the motivation changes, and with that change come dangerous consequences for both parties. The donor changes, since those driven by money are the poor and the vulnerable in the community. The altruistic, related living-donor evaporates since the recipient can simply buy a kidney and recipients would rather put someone else at risk than their own family. The deceased donors evaporate, since there is no government drive for deceased donation; and the liver, heart and lung recipients simply die. I have just described [the situation in Iran] – the only country in which there is regulated organ sale. This is not a hypothesis, but a proven fact.

Sally Satel

I agree that countries can and should make better use of deceased donation. But even in Spain, which has the world’s highest deceased donation rate, individuals continue to die waiting. Even non-renal organs, which are in lesser demand than kidneys, are not produced in adequate numbers, according to the Spanish National Transplant Organization. As for the US, you are mistaken. Of the roughly two million Americans who die annually, only 10,500-13,000 possess organs healthy enough for transplanting. Meanwhile, 85,000 Americans are waiting for kidneys.

I challenge your assertion that deceased donation evaporates when patients can obtain their organs from compensated donors. In Iran the government began compensating living kidney donors in 1988 and since then the waiting list for kidneys has dwindled. Yet Iran also established a deceased programme to increase the supply of livers, hearts, and lungs in 2000. Before passing a law allowing deceased donation, less than one per cent of kidney transplants came from deceased donors, but by 2007 this had risen to 16 per cent.1

Altruism, while a glorious virtue, is simply not enough. You have succumbed to the straw man argument that giving an organ for free is noble but doing so in exchange for material gain is a sordid affront to human dignity.

This is a false choice. Transactions on a black market are dangerous because they are illicit, not because they are transactions. There is a fertile middle ground on which to establish safe, legal programmes that protect donors who would be happy to accept enrichment for saving the life of another. Humanitarian and financial motives intertwine all the time. Are we any less grateful to the firefighters who rescue us because they are salaried?

  1. B Einollah, ‘Is the Annual Number of Deceased Donor Kidney Transplantations in Iran Lower Than the Middle Eastern Countries?’ Transplantation Proceedings, September 2009 (vol 41, issue 7, pages 2718-2719).

Jeremy Chapman

You should take a long hard look at those 85,000 people who are registered in the US organ transplant system – a large number are never deemed fit enough actually to be transplanted by the listing transplant programme. Some 2,700 kidneys were discarded in the US last year – so the first place to make changes is in the efficiency of US systems.

Many ethical and trusting individuals like you, who advocate for buying organs, resolve the undoubted reality of abuse of the poor by the rich by using the reassuring words ‘safe and legal’. It is easy to minimize the conceptual consequences using words but so much harder in reality.

Let us take the example of the Philippines – here the trade in organs flourished until 2008. The vendors were poor people living in the slums and making a living off the waste tips of Manila and Quezon City. The kidney broker lives in the only brick home in the slum from which he extorts the kidneys, for a sum of money similar to his fee. The then president of the Philippines decreed the purchase of organs illegal. This led to a drop in the number of transplant tourists.

In Australia, by getting organized nationally, we are witnessing a 30 per cent rise in deceased organ donation this year and a rise in living kidney donation. The Transplantation Society, working with the Spanish National Transplant Organization and World Health Organization has derived a programme to achieve the changes you ask for. I cannot give you the recipe in a simple email, but if you visit these shores I can show you or you could look on

Our job now is to assist the emerging economies of the world to do the same and not to rely on solutions that further entrench the disadvantages of poverty.

You’ve read the debate from the magazine - now tell us your thoughts.

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Nancy Scheper-Hughes on this month's Argument

We asked Nancy Scheper-Hughes, Chancellor’s Professor of medical anthropology at the University of California, Berkeley, and director of Organs Watch, for her thoughts on this month's Argument. Read them in her article on The Organ Donors’ Bill of Rights

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  1. #1 Sandy 22 Sep 10

    organ donation practicalities

    Nancy Scheper-Hughes’ article is excellent. She states: Green donation (deceased donors) should be the default system.

    THINGS I DIDN’T KNOW (until recently when my daughter died tragically and suddenly).
    1) In Australia having a tick on your driver’s license for organ donation is not enough. You also need to register at . It takes ABOUT A MINUTE to complete the form. I encourage you most strongly to do it right now.
    2) My daughter’s corneas were harvested a number of hours after her death (and donated to a 30 year old and 35 year old). I’d previously thought that all organ donation was only possible immediately after death.
    3) Yes, on death there is a longish questionnaire to go through when the donor register people contact you (can be done by phone) and yes, you are in a state of terrible shock and grief, but the sense of something positive for other(s) is a great comfort at such a sad time.
    4) Yes, you can ‘will’ your body to science - just contact your local Medical School.

  2. #2 smsm 23 Sep 10

    it is not right to buy or sell humans organs. This is called ’organ market’ . I hear a lot about people selling their organs with a big amount of money because they are suffering from poverty and famine. I think it also encourages organ thieves. Only in some specific situations under specific circumstances organ voluntary is allowed.

  3. #3 Sarah 28 Sep 10

    People in desperate situations take desperate action and will put themselves at risk in many ways to support a family. Ideally no one would be driven to take such risks but while people are suffering extreme poverty people will be selling organs.
    We should ensure that they are protected as much as possible. To me this has similarities with the debate on legalising prostitution - proliferation vs safety.

  4. #4 socialist 28 Sep 10

    We sell our labour

    Working people sell their labour so why not their body parts? It amounts to much the same thing for many occupations -- think asbestos poisoning, vibration whitefinger and other work-related disorders. My guess is that there is probably a similar amount of risk, foreshortening of life and effect on the quality of life.

    Just my 0.5p worth.

  5. #5 DozyDenise 29 Sep 10

    Maybe it's time for more countries to follow France, Belgium and others and have an opt-out, rather than an opt-in, for organ donors. So if you don't carry an opt-out card, it's assumed that you consent to your organs being used. It wouldn't solve the problem entirely, but surely by having more organs available, there would be less need for people to sell their own organs for money?

  6. #6 aswas 29 Sep 10

    At the lower end of the socio-economic scale, there have been numerous times I have been inclined to sell an organ... to pay rent, to buy food, to score weed... thankfully in Australia this is not an option; the crisis which drove me to this extreme solution, in the end,resolved itself in one form or another... without recourse to surgery.

  7. #7 Michelle 30 Sep 10

    What would most help the poorest?

    An underlying assumption of much of the debate above is that it is always worse for a person to sell their organ than not to. While in a country with adequate welfare provisions that might be the case, I question whether it is elsewhere. Consider the possibility of someone currently unable to afford housing or food selling a kidney in exchange for a home for their family, and enough money to support them for the rest of their life. This seems to me to be a clear case in which the seller benefits, and hence a counter-example to the claim that it is never right to sell an organ. Obviously, such exchanges are not currently the case. However, perhaps that indicates that we should be trying to change the nature of the exchanges, rather than limiting people’s options without compensating them for it. For instance, Mr Chapman talks about people living in slums in the Philippines selling their organs, and the fact that such sales have now been banned and organ tourism has declined. No mention is made of what will now happen to those people who were so desperate for money that they were willing to sell a kidney. The very fact that they were willing to sell their organs indicates that they believed that they would be better off if they did so. Therefore, rather than taking that possibility away from them, it might have been more helpful to ensure that they received a fair price, and were not swindled, thus giving them the opportunity to escape the slums. In an ideal world, there would be adequate welfare provisions to ensure that no-one would be better off selling their organs, but unfortunately that is not the world we live in.

  8. #8 Brad 30 Sep 10

    I'm with Michelle and Sally Satel.

    Yes of course getting organized nationally is a way forward, as Jeremy Chapman says is happening in Australia, but this is a rich country with the resources to do so. What happens in poor countries is a world away.

    Rich countries improving their donor programs may help reduce 'transplant tourism' but the trade in organs is not going to go away. Surely lessons learnt from the drugs trade apply here - legalization brings the trade out in the open and leads to regulation.

    Only once there is more control can poor countries and communities start to get organized like Australia.

  9. #9 propertyhasmadefiendsofmen 03 Oct 10

    is it ever right?

    Yes, but subject to control. We are concerned to regulate the source of all sorts products, so the sale and purchase of body parts can be regulated and controlled. If you think its not possibile, then concider if the fair trade goods you buy are indeed fair. If they are then its possible to regulate the sale of body parts. So money to those who sell or to the estates of those who donate on death can be a reasonable way of increasing the supply of parts for transplant.

  10. #10 carlo 06 Oct 10

    to sell or not to sell

    In USA you sell blood. In Europe is not possible: it is forbidden.
    Should be part of international law to forbid the organ trade. It should be the first move.

  11. #11 ROSJ 06 Oct 10


    Having read through the comments, a few of my own spring to mind...

    1. There is no evidence to prove that the selling of organs lifts people out of poverty either short or long term. In fact Scheper-Hughes and others have found the opposite to be true with people unable to do the physical demanding work usually only available to them. Furthermore, in some communities there is massive social stigma towards those who bear the scars of their poverty.

    2. Selling our own labour cannot be compared to selling such a finite, essential resource. Plus, is it right that we should justify it because historically people have died as a result of their industrial injuries? For example we no longer condone/endorse Victorian workhouse conditions, or those faced by people working for in sweatshops, etc.

    3. Given that many of the 'donor' countries that have been mentioned have an inadequate welfare system to begin with, how would the medical aftercare and payment of the donor be funded and administrated?

    4. The Organ Donation Taskforse in the UK recently released a report whereby they found the opt in/opt out debate to be a misnomer in that other factors were more important in increasing donor numbers: education, religion and procurement practices and efficient administration of the hospitals themselves. Even within Spain (who have an opt-out system and the highest national donation rate) experiences regional variations.

    5. Through legalising organ markets, how far do we accept national, regional and global policy failures to meet the demand for organs?

    6. Richard Titmuss exposed the risks and inefficiencies involved in selling blood by comparing UK and the UK policies and promptly reversed US policy. Furthermore, he demonstrated altruistic donation as contributing to a general sense of social responsibility which was the cornerstone of progressive welfare for all. By legalising commercial organ markets, how far do we risk compromising this at a local and global level?

  12. #12 Pamela Glotzbach 14 Oct 10

    short term and long term solutions

    First there are a few points that need to be made.
    It has been proven that live kidney donations last twice as long as deceased donations.
    Also, for clarification it isn't only kidneys that are on the black market, but half of a liver and corneas.
    Whenever you have the huge varience of supply and demand that we are experiencing now with kidneys you are automatically creating a market, black or not. By compensating donors, who are not able to do physical labor for six months after thier donation you make it easier to be willing to donate. By legalizing donor compensation you would increase the supply and be able to provide proper health care to the donor. The black market does not compensate well if they actually receive thier promised pay and leaves the poorest people in countries without decent health care. By not compensating you are not only letting those on dialysis die but you are also putting at high health risk the donors.
    No one has mentioned the cost of dialysis verses the cost of a transplant. In Scotland, the cost of a transplant is 17,000 pds plus 5,000 pds a year in drugs. Dialysis costs are 38,000 pds per year. By giving the donor a healthy financial reward along with great health coverage, you save two lives and an awful lot of money.
    WHO is against legalizing organ donor compensation because why would the rich ever need to donate? That is thier only argument. Who cares WHO? The rich are only 1% of the population, do you honestly believe that not legalizing donor compensation would actually affect the rest of the world for the better, the other 99%?
    Legalizing donor compensation is the correct short term answer and the long term answer is already in the works. Within a generation we will be able to make an organ. We will use the recipients own tissue to do this therefore the body will be making it's own medicine.
    I also have no problem with thier being a licensed broker involved. We do this for adoption, surrigate mothers et al. We also can sell our blood, eggs and seman, and for that matter women can rent thier womb for 9 months. They are paid very very well as a matter of fact, so why not allow for healthy individuals to sell thier body parts. It's thier body.

  13. #13 hola08 16 Oct 10


    It is worng for a person to give a organ to a dying person if a person health is bad and there habits are not anaylazed to ensure that all goes well with the transplant .Many drivers license office in America ask if you want to be a organ donor so that upon death you can donate your organs to science or for the use of another human being to keep them sustained .

    Regulations and a lack of money seem to be hte cause of much ruin for many people that are in poor health ,without the lubricate of life (money) what can you do put throw your hands in the air and keep your head down and await death .

    Those that agree with the system of capitialism must be aware that people are hurting daily and dying in large numbers are around hte world the world due to a lack of money ,smoking ,drug abuse ,child abuse ,many many mental illness and health problems are plauging people no other system has caused more death ,and destruction we all play our role and try to keep a happy face but behind our mask many people do not feel apart of there soceity the only time when they are helped is when the scream like a baby then a check is furnished ,food stamps provided ,for some even homes .

    Many of us have somethng to grieve about but who do we turn our grievances to for some it may be there church ,the counselors or the family but many keep there health problems and there pain to themselves people dont care they dont want to hear it people want to life and not be concerned with matters that dont involve them and one day they find themselves in matters worse laying on a bed grasping for air ,struck by depression so bad you could blow your head off and not know what you just done or did. Lose your family and be forced to work jobs so crappy and so shitty that only a Mexican would take because they dot mind living in a crowded house to just live that what low wages provide shit and with our wages comes alienation ,no housing even dating is a waste of time ,you better of looking for a $10 dollar hooker just to be done with that side of a human needs.
    Even with money it is no good if a man can not use it to quickly recover from his soon death ,waiting list are long for many possibly terminally ill folks and without more attention of this matter many people will die while awaitng surgery this is a matter governments should not just work on but see that all those that are facing death have a chance at life and that there life is not based on a buck .

    Capitialist say this system works it does but it has killed many people and has created many monsters some are politicians some are business owners have people seen the shit in our food much of it is poisen not fit for the human body but for the sake of gain the FDA allways crap on our shelves ,we are truly better of reverting to more organic food which can create more jobs ,living wages and help man to apperciate nature more we are becoming a world full of sluggish and lazy people becuase we depend on the machine to do everything and we get mad when people want to do nothing and work for nothing

  14. #14 sian julian 22 Oct 10

    A few thoughts...

    Whilst reading this article I could not help but feel a little uncomfortable, as it this is a very sensitive matter which challenges the very core of what it is to be a human being. Clearly, illegal, black market trading of organs completely subverses our natural beliefs, and frankly is an issue which most people would rather ignore, or have absolutely no awareness of. I agree that the implementation of publicly administered bodies to mobilise and organise legitimate donations is the only way of solving this issue; when money is involved it naturally makes it illicit, and creates a morally challenging scenario.

    As Jeremy Chapman pointed out, many organs are wasted which are fit to be transplanted every year, and I know there is also a huge problem with this in the UK. This is not something which can simply be tackled by setting up programmes overseas where a black market exists, this could serve as a form direct competition to the black market itself, which could see more lucrative deals being offered and the poorest still being enticed. I would argue that creating the option to 'legally buy' an organ could also open the door for corruption, and lead to illegal practices being buried in a 'legitimate system' - the reality is this is a way to run away from the real problems, and make everything okay for those who can afford to pay.

    This is clearly a problem that needs to be realised as the dynamic issue that it is; with there already being problems and waste in the bureaucratic systems of the west, then this only serves to illustrate that this is not simply another problem of the developing world, and a real evaluation must occur if any progress is to be made at either end.

  15. #18 Mitchell.Sexner 11 Sep 13

    There would always be people who will be taking advantage of the system – those who are aware of the current demand and those who knew where that demand is. At the early stages of the firm’s plastic surgery malpractice, we encountered so many cases of malpractice in human organ transplant – non-functioning organs given to patients who paid dearly for it. Doctors spotted the issue and decided not to push thru but they ended up getting sued for it.

  16. #19 lisa ann collins 03 Feb 14

    i would like to learn more about selling human organ. why do people do this stuff and get into trouble.

  17. #20 Crystal 04 Mar 14

    Black market. People are selling and buying organs illegally.
    It is happening anyway, the government should allow them to sell.

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This article was originally published in issue 436

New Internationalist Magazine issue 436
Issue 436

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New Internationalist Magazine Issue 436

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