Almost every other country has prohibitions like America's. In Iran, however, selling one's kidney for profit is legal. There are no patients anguishing on the waiting list. The Iranians have solved their kidney shortage by legalizing sales.

Many will protest that an organ market will lead to exploitation and unfair advantages for the rich and powerful. But these are the characteristics of the current illicit organ trade. Moreover, as with drug prohibition today and alcohol prohibition in the 1920s, pushing a market underground is the way to make it rife with violence and criminality.

In Japan, for the right price, you can buy livers and kidneys harvested from executed Chinese prisoners. Three years ago in India, police broke up an organ ring that had taken as many as 500 kidneys from poor laborers. The World Health Organization estimates that the black market accounts for 20 percent of kidney transplants worldwide. Everywhere from Latin America to the former Soviet Republics, from the Philippines to South Africa, a huge network has emerged typified by threats, coercion, intimidation, extortion, and shoddy surgeries.

Although not every black market transaction is exploitative -- demonstrating that organ sales, in and of themselves, are not the problem -- the most unsavory parts of the trade can be attributed to the fact that it is illegal. Witnessing the horror stories, many are calling on governments to crack down even more severely. Unfortunately, prohibition drives up black-market profits, turns the market over to organized crime, and isolates those harmed in the trade from the normal routes of recourse.

Several years ago, transplant surgeon Nadley Hakim at St. Mary's Hospital in London pointed out that "this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done safely, the donor will not suffer."

Bringing the market into the open is the best way to ensure the trade's appropriate activity. Since the stakes would be very high, market forces and social pressure would ensure that people are not intimidated or defrauded. In the United States, attitudes are not so casual as to allow gross degeneracy. Enabling a process by which consenting people engage in open transactions would mitigate the exploitation of innocent citizens and underhanded dealing by those seeking to skirt the law.

The most fundamental case for legalizing organ sales -- an appeal to civil liberty -- has proven highly controversial. Liberals like to say, "my body, my choice," and conservatives claim to favor free markets, but true self-ownership would include the right to sell one's body parts, and genuine free enterprise would imply a market in human organs. In any event, studies show that this has become a matter of life and death.