John and Ken start out by listing some dizzying statistics – in 2006, 6000 people in the US died awaiting organ transplant and only about half of those who could donate, did. They review a brief list of reasons for and against selling organs: aiding the financially-needy (who are willing to sell organs for money) and the organ-needy one the one hand, violating donor’s personhood and exploiting the poor on the other.

Debra Satz joins Ken and John, and they begin their conversation by considering why the organ market should be run by anything other than principles of efficiency. Are those considerations so strong as to suggest that there should not be a market at all? While emphasizing the moral reasons against having an organ market, Debra notes that there is not much reliable data on how organ markets actually work in the real world, since they have almost never been legalized.

Ken and John then ask Debra about some of apparent inconsistencies of outlawing an organ market. If people may donate blood, then why not organs? Given that there are many individual cases in which organ donation is noble, why does it become smarmy when the market gets involved? Debra recaps some of the best arguments for an organ market, but also draws some bottom lines: in particular, the percentage of donors who regretted selling their organs, after the fact, when there was a legalized organ market in India.

John, Ken, and Debra end by exploring what the best possible version of an organ market could be, if there was such a market. In the US, individuals must ‘opt-in’ to have their organs donated upon their death; in Europe, individuals must opt-out. Why shouldn’t we have the latter? Debra suggests an in-kind futures market, whereby individuals or their families are paid by future in-kind donations, rather than monetarily. Ken and John discuss a single-buyer and distributor system. They end by emphasizing the complexity – and intrigue – of the problem.

Roving Philosophical Report (seek to 5:50): Julie Napolin interviews David Magnus, director of Stanford Center for Biomedical Ethics, who talks to her about the dynamics of the organ donation game. He discusses the rules for solicitation, directed donation, and finding real friends.