Science Photo Library

IF THEY were just another product, the market would work its usual magic: supply would respond to high prices and rise to meet surging demand. But human kidneys are no ordinary commodity. Trading them is banned in most countries. So supply depends largely on the charity of individuals: some are willing to donate one of their healthy kidneys while they are still alive (at very little risk to their health); others agree to let their kidneys be used when they die. Unsurprisingly, with altruism the only incentive, not enough people offer.

Kidneys are the subject of a quietly growing global drama. As people in the rich world live longer and grow fatter, queues for kidneys are lengthening fast: at a rate of 7% a year in America, for example, where last year 4,039 people died waiting. Doctors are allowing older and more sluggish kidneys to be transplanted. Ailing, rich patients are buying kidneys from the poor and desperate in burgeoning black markets. One bigwig broker may soon stand trial in South Africa (see article). Clandestine kidney-sellers get little medical follow-up, buyers often catch hepatitis or HIV, and both endure the consequences of slap-dash surgery.

The Iranian model

In the face of all this, most countries are sticking with the worst of all policy options. Governments place the onus on their citizens to volunteer organs. A few European countries, including Spain, manage to push up supply a bit by presuming citizens' consent to having their organs transplanted when they die unless they specify otherwise. Whether or not such presumed consent is morally right, it does not solve the supply problem, in Spain or elsewhere. On the other hand, if just 0.06% of healthy Americans aged between 19 and 65 parted with one kidney, the country would have no waiting list.

The way to encourage this is to legalise the sale of kidneys. That's what Iran has done. An officially approved patients' organisation oversees the transactions. Donors get $2,000-4,000. The waiting list has been eliminated.

Many people will find the very idea of individuals selling their organs repugnant. Yet an organ market, in body parts of deceased people, already exists. Companies make millions out of it. It seems perverse, then, to exclude individuals. What's more, having a kidney removed is as safe as common elective surgeries and even beauty treatments (it is no more dangerous than liposuction, for example), which sets it apart from other types of living-organ donation. America already lets people buy babies from surrogate mothers, and the risk of dying from renting out your womb is six times higher than from selling your kidney.

With proper regulation, a kidney market would be a big improvement on the current, sorry state of affairs. Sellers could be checked for disease and drug use, and cared for after operations. They could, for instance, receive health insurance as part of their payment—which would be cheap because properly screened donors appear to live longer than the average Joe with two kidneys. Buyers would get better kidneys, faster. Both sellers and buyers would do better than in the illegal market, where much of the money goes to the middleman.

Instinct often trumps logic. Sometimes that's right. But in this case, the instinct that selling bits of oneself is wrong leads to many premature deaths and much suffering. The logical answer, in this case, is the humane one.