Why should it be illegal to do something for money that is perfectly legal to do for free?

The title of this article is something I have asked about the repugnant profession of prostitution, but a guest column in The Philadelphia Inquirer doesn’t like the notion that a person could choose to make a live organ donation for filthy lucre:

The legalization of human organ sales would only undermine human dignity

A measure in New York state offers tax credits to living organ donors. That’s reignited one of medicine’s most contentious ethical debates: Should we legalize the sale of human organs?

by Caleb Coy Guard, For The Inquirer | Saturday, July 19, 2025 | 6:01 AM EDT

New York’s recent legislation offering hefty tax credits to living organ donors has reignited one of medicine’s most contentious ethical debates: Should we legalize the sale of human organs? While proponents argue this would alleviate transplant shortages, the reality is far murkier.

When I gave a kidney to my father in 2019, I received compensation. A couple of hundred dollars’ worth of gifts came from friends and family. The American Transplant Foundation was able to provide a small, generous check to help cover a bill while I was unable to work. But there was never any expectation that I would be reimbursed with a sum of money at a market price.

Every day in America, on average, 13 people die waiting for organ transplants. The current system, built on voluntary donation, clearly isn’t meeting demand. There are always opportunities to reinvigorate our culture of altruism and to remove unnecessary barriers to donation. The commodification of human parts should not be on the table.

The original title of the article, which can be seen by holding the cursor over the article tab, was “Human organ sales are illegal — and should stay that way.” Someone, an editor I assume, changed it to “The legalization of human organ sales would only undermine human dignity.” I have to ask: for those 13 people who die every day waiting for organ transplants, how much do they think about the dignity of not having paid for a replacement kidney or lobe of a liver?

The author, Caleb Coy Guard, very generously donated a kidney, but he donated it to his father. A afiorly young man, at least to judge from his photos on Twitter — as always, I refuse to call it 𝕏, the worst rebranding in history! — and his website, I think it fair to ask: why hadn’t he previously donated a kidney to a stranger?

That, you see, is what he wants, “to reinvigorate our culture of altruism and to remove unnecessary barriers to donation.” That’s all fine and good, and I absolutely agree, but, as he pointed out, there are 13 people dying every day awaiting a transplant.

Mr Guard then spends several paragraphs telling us about the one country in which the sale of organs is legal, and that country is Iran. It’s obvious that anything based upon a study of how things are done in the Islamic Republic is going to be bad, and the author tells us that the system there “dirties not just the reputation of compensated donations, but of donating in general,” and that “more than 60% of their donors are below the poverty line. Many report no follow-up care and deteriorating health.” Not good at all. But he also told us that there are no waiting lists for kidneys in Iran.

Apparently, the price of not “undermin(ing) human dignity” is paid in a dozen people dying early every day.

(T)he direct sale of organs, even by consent, is almost universally banned, and legal compensation is tightly regulated, as it should be. If organ sales were legalized, America’s already dire health disparities would widen as the wealthy bought from the poor at desperation rates. Even with regulation, a market for healthy organs opens the door to exploitation of the vulnerable. It’s the reason 80% of plasma centers appear in poor neighborhoods.

Full disclosure: I sold plasma when I was a poor student. And I have donated blood, but blood and plasma regenerate. I was also asked, and went in, for genetic testing in a wide-cast net for someone who needed a compatible bone marrow donor, but bone marrow recovers as well. I was never called for that patient, though I was contacted a few years later about another patient for whom I was at least a closer match. I was not the closest match, so someone else made that donation. The only cost I incurred was a bit of discomfort for a blood draw.

Mr Guard concluded:

Laissez-faire economics, however, can’t guarantee strong social cohesion or psychological well-being. You cannot replace the value of altruism with the value of currency. We’ve seen what uninhibited capitalism can do to human dignity in other areas, including healthcare costs. The organ shortage demands urgent action, but not at the cost of our humanity. Before we monetize the human body, we must exhaust every ethical alternative.

Humans are not vending machines. If the reason we don’t have enough willing organ donors is that our society is too selfish, how would legislation allowing body part sales not amplify our national selfishness? Would it give us one more excuse not to act in the interest of others?

We “monetize” the human body every day, because the vast majority of us have to pay for the food we eat every day, the shelter over our heads that keeps us safe, and the utilities which have lifted us above the level of the Neanderthal. Mr Guard suggested that the reason we haven’t sufficient willing organ donors is that we are too selfish, but I cannot see how the desire to keep both our kidneys is a selfish thing. Remember: Mr Guard donated one of his kidneys to his father, not a suffering junkie on the streets of Kensington or to a corporate executive in business-friendly Delaware.

It’s interesting that we can legally sell plasma, something that costs about 45 minutes of discomfort but is completely regenerable, but donating a kidney or the lobe of a liver or lung, something which requires surgery and recovery time, and more than a bit of discomfort for several days, is something for which the only available compensation is to time spent away from work.

There is, however, already a black market for usable organs, and the British House of Commons estimated that 10% of transplanted organs come from the black market:

Illegally trafficked organs are very expensive. According to some reports, the cost of a kidney, the most commonly trafficked organ, can range from US$50,000 to US$120,000. Thus, purchasers are normally wealthy persons from developed nations such as Canada.

Translation: Mr Guard’s fears about the poor being victimized are already being realized. Perhaps more of the money would go to poor Americans than to the black-market network and middlemen who make it possible.

Sure, I’d love to see a situation in which there were sufficient organs available for transplantation in the United States, all due to the goodness of the donors’ hearts, but I’ll bet that those 13 Americans who die every day wishing and hoping and praying that an organ will become available might be OK with the organ having been bought rather than freely donated.

Organ donation is something which is perfectly legal to do, if it’s for free. How, I have to ask, can it be illegal to do for money?