I can give you a couple of arguments against paying for organs.

1) in terms of living donation (kidneys mostly, but livers, pancreata and lungs to a lesser extent), anywhere donation-for-compensation has been allowed, it has led to exploitation of the poor. India is the best example of this; the “donors” (not all are willing) receive substandard care and end up with a missing kidney and extensive health problems, and relatively little money left over after paying for unforeseen medical expenses.

2) in the case of deceased organ donation, with a finacial incentive dangling in front of them families could have an incentive to lie about their loved one’s medical/social history. As just one example, even a remote history of melanoma is an exclusion for organ donation because of the many documented cases of transmission from donor to recipient. So when I go in to talk to a family about donation and tell them that I have a check for $10K if their loved one is a suitable donor, then proceed to ask them a series of make-or-break questions about their loved one’s history, do you think they might have some incentive to lie about that history? Do you want to bet your life on it?

Organ donation after death is simply the right thing to do. Any reasonable person would stop to render aid to another (absent a sitation that would put the renderer in unreasonable danger). Indeed, at least one state requires that citizens stop to render aid if no others are present to do so. Organ donation is no different. Deceased organ donors suffer no ill effects from donation. The only reasons people say no to donation is ignorance (traumatic or otherwise) or misanthropy. Neither one is a legitimate excuse, in my mind.

In my mind, living donation is less clear as a societal obligation because the risk, while still relatively small, is still there, and it’s not an easy procedure to undergo.

Fortunately, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative approval is required.

Americans who want to donate their organs to other registered organ donors don’t have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.