Still, it’s a cause that many people advocate for. Alvin Roth, a Nobel-winning economist, has seriously considered what a kidney market would look like. “I've become interested in the fact that it’s against the law to pay for a kidney anywhere in the world,” he told NPR. “But it's not against the law to remove financial disincentives.” Roth has noted that steps could be taken so that hospitals could easily reimburse donors’ costs, and then in turn be reimbursed through Medicare or private insurance. He says that, in the big picture, this would pay for itself, given how many people it would exempt from the costs of frequent dialysis and hospitalizations. Unfortunately, though, it won’t be enough to assure donors they’ll be reimbursed—they need a stronger incentive.

As distasteful as it seems to commodify organs, the current situation is simply too catastrophic not to change something. Defenders of the status quo should put aside their belief finding “the mixing of kidneys and cash repugnant” in order to help arrive at an alternative that will not leave millions dead.

Moreover, in the current unregulated system, the world’s poor are being exploited en masse. As of 2010, one in every five kidneys transplanted each year originated in the black market. The vast majority of people currently selling their organs are poor and live in developing nations—many do so in order pay off their debts. When one of these people sells his or her kidney, the World Health Organization estimates, it will go for about $5,000. The brokers who buy them can then turn around and sell them for as much as $150,000. Though it may seem cold and dystopian to use a market to incentivize poor people to sell their body parts, the truth is that some of them are doing it anyway.

So, as unsavory as compensation for live-organ donations may seem, a highly-regulated global market with an emphasis on equitable compensation could allay these concerns, as well as ensuring that operations are performed safely. It would be important to make sure such a market doesn’t devolve into “transplant tourism,” but if orchestrated properly, it could simultaneously satisfy the needs of wealthy countries with long waiting lists and poorer countries with rampant poverty.

Such a market is not just some nebulous item on the world’s wish list—a successful regulated market currently exists in Iran, the only country in the world that allows paid donations. (Even though the words "donors" and "donations" may seem out of place in the context of transactions, these terms are commonly used when discussing compensation for organs.) In the 1990s, after years of war and economic slumps, the country decided to pay donors for kidneys rather than incur the health-care expenses of treating people with kidney disease. Within a few years, the program eliminated the national waiting list for kidney transplants and these days, the black market is virtually nonexistent.