Paid Organ Donations: Oxymoron or Valid Solution?

Authored by: Neanth Suresh

Art by: Caitlin Sweeney

Just today, 13 people have died waiting for an organ transplant. In the time it takes to read this article, another person will be added to the transplant list [1]. With the need for organs surpassing the number donated, the United States is currently facing a massive shortage of organs [2, 3]. One proposed solution for this is offering financial compensation to the organ donor and their family. This could be a simple check written out to the donor before they die, a subsidy to the family to cover funeral costs, or an insurance plan contingent upon organ donation [2]. Proponents of this system argue that it will increase the availability of organs and reward donor families for a morally virtuous behavior [4]. However, opponents say the practice is inherently exploitative and difficult to regulate [5]. Given that our current system is not effective, it is clear that some change is necessary. Could paid organ donation be the change this country needs to help patients in need?

The most significant reason in favor of paying organ donors for their body parts is that it will incentivize people to donate their organs. To reiterate, the United States is in a very apparent organ drought, and paid organ donation could be an oasis. Offering compensation for organ donations after death could encourage more people to register as donors, ideally increasing organ availability [2, 4]. However, critics of this idea claim it “will cause a loss of ‘altruistic’ donation” [6]. Essentially, the concern is that those who would have wanted to donate without any reward may choose not to do so anymore if they oppose the idea of receiving payment. This could potentially lead to a decline in organ donations. In this case, it would be more effective to raise awareness about the current system of purely altruistic donation. Unfortunately, there does not seem to be polling data to support either side of this argument. Regardless, supporters of paid organ donation argue that those who donate their organs have a moral right to ask for compensation. This is because “the donor and the family are the only participants not directly benefiting from the process [of organ donation] and therefore, some form of compensation is the right thing to do” [2]. Thus, even if the idea of receiving compensation does not have a practical effect, it would be more righteous to reimburse the donor and their family than not.

However, none of these questions regarding the efficacy or morality of incentivizing organ donors even matter if there is no clear plan to implement the system. This is one of the biggest critiques of paid organ donation: the lack of details, such as how much money will be awarded, when it will be awarded, and who will administer the system. [2]. These are all extremely logical questions that need answering, as it is critical that the system is not exploitative or coercive in any way, especially of poorer potential donors. The Working Group on Incentives for Living Donation has proposed a plan to organize the compensation of both deceased and living donors (e.g. kidney donors, partial liver donors, etc.) [7]. Their plan emphasizes removing hurdles to donating, such as financial costs to the family traveling to sign the consent papers. It also prioritizes the regulation of this practice, saying the process should be transparent and subject to criminal legislation to prevent wrongdoing. One important facet of their plan is that all payments must be carried out by “the state or state-recognized third party,” and not via “direct payment from the recipient to the donor” [7]. This is significant because it lowers the possibility of exploitation since wealthy patients cannot try to directly buy organs from poorer patients. 

Still, the largest obstacle for paid organ donation to get off the ground in the United States is its illegal status. Currently, it is not legal to buy or sell organs in this country, as per the National Organ Transplant Act [8]. Whether this legislation will be overturned is hard to tell at this point in time. According to a survey conducted by Mario Macis at Johns Hopkins Carey Business School, about 46% of individuals said they would be in support of paid organ donations, and another 18% said they would be in support of it provided there was evidence that it increased organ availability [9]. That means that a majority of Americans would be in favor of financial compensation for organs if this system yields a noticeable difference in organ accessibility, providing some evidence that public opinion on the subject is more favorable than not. With more visible and stronger support, organ compensation could be legalized in the future.

In short, paid organ donation is an intriguing answer to the problem of the United States’  organ shortage. Although it is currently hard to tell for certain if it will be accepted morally and legally by the government and citizens, recent data seem to point in the affirmative. However, more research should be conducted on the efficacy of this process before it is officially adopted. Until then, there are still efforts to be made that could increase the availability of organs, specifically educating people about the current donation system and encouraging people to donate altruistically.

References:

1. Organ, eye and tissue donation statistics. Donate Life America. (2025, February 25). https://donatelife.net/donation/statistics/

2. Ethics - financial incentives for organ donation - OPTN. Organ Procurement and Transplantation Network. (n.d.). https://optn.transplant.hrsa.gov/professionals/by-topic/ethical-considerations/financial-incentives-for-organ-donation

3. Lewis, J., & Gardiner, D. (2023). Ethical and legal issues associated with organ donation and transplantation. Surgery (Oxford), 41(9), 552–558. https://doi.org/10.1016/j.mpsur.2023.06.010 

4. Dalal, A. R. (2015). Philosophy of Organ Donation: Review of Ethical Facets. World Journal of Transplantation, 5(2), 44. https://doi.org/10.5500/wjt.v5.i2.44

5. Adair, A., & Wigmore, S. J. (2011). Paid organ donation: The case against. The Annals of The Royal College of Surgeons of England, 93(3), 191–192. https://doi.org/10.1308/rcsann.2011.93.3.191

6. Chkhotua, A. (2012). Incentives for Organ Donation: Pros and cons. Transplantation Proceedings, 44(6), 1793–1794. https://doi.org/10.1016/j.transproceed.2012.05.038

7. Matas, A. J. (2012). Incentives for organ donation: Proposed standards for an internationally acceptable system. American Journal of Transplantation, 12(2), 306–312. https://doi.org/10.1111/j.1600-6143.2011.03881.x

8. Middleton, J. (2025, January 18). Can you sell organs in the United States?. Donor Alliance. https://www.donoralliance.org/newsroom/donation-essentials/can-you-sell-organs/

9. Ercolano, P. (2019, July 11). Most Americans favor compensation for kidney donors if it leads to more saved lives. The Hub. https://hub.jhu.edu/2019/07/11/kindney-donation-transplant-compensation-study/