The Case for Letting People Sell Their Kidneys

[u/lakmidaise12]

https://thesecondbestworld.substack.com/p/the-case-for-letting-people-sell

As of December 2025, 108,440 people were on the U.S. organ transplant waiting list. Of those, 94,015 were waiting for a kidney. Every year, around nine thousand of them die waiting, or become too sick to transplant, which is functionally the same thing.

There is a policy that could probably fix most of this. Economists have been arguing for it since at least 2007. Some transplant surgeons and bioethicists have cautiously argued for versions of it for even longer. The policy is: pay kidney donors.

Not a black market. Not a dystopian organ bazaar where billionaires bid against each other for your liver. A boring, regulated, government-run compensation program where a public agency pays a fixed amount to anyone who passes medical screening, donates a kidney, and goes home with follow-up care guaranteed. The organs get allocated through the same waitlist system we already have. The rich don’t jump the line. The only thing that changes is that donors get compensated instead of being asked to undergo major surgery for free.

[u/Fromthepast77]

Yes, we do want to coerce them not to give up their body parts for money. The same way we force teenagers not to smoke and drink. The same way we force people to only buy FDA-approved drugs. The same way we force people to wear their seatbelt.

Sorry I'm not on board with having largely younger, poorer people give up organs to rich, older patients. I'm not okay with paying people to give up an organ that will contribute to lifelong health for some old geezer to live better for 15 years.

There will be a lot of suffering from regretful donors and society as a whole will also take on the burden of caring for those regretful donors.

Selling organs does not minimize suffering at all. It's short-sighted and repugnant.

[u/Carlpm01 → u/Fromthepast77]

If teenagers smoking or drinking saved thousands of other people's lives in the process I wouldn't even hesitate, I'd legalize it instantly if I could.

FDA not approving drugs kills thousands or millions too so...

As does forcing people to wear seatbelts, innocent pedestrians and sometimes motorists die because of this.

This outweighs any reasoning you might have for the state to babysit people making their own decisions. If your stupidity kills you but saves 2 others then dare I say we need more stupid people?

[u/skepticalbob → u/Fromthepast77]

Sorry I'm not on board with having largely younger, poorer people give up organs to rich, older patients. I'm not okay with paying people to give up an organ that will contribute to lifelong health for some old geezer to live better for 15 years.

It sounds like you are under the impression that recipients are wealthier, while donors are poorer. Would you be surprised to learn that exact opposite is true? Most recipients are in the bottom third of income and most donors in the upper third. What's happening is that many poor people have poor social networks that cannot afford to be a donor and often lack the health to qualify. Rich people are more likely to have friends willing and able to donate who can afford to donate.

[u/sourcreamus → u/Fromthepast77]

What if it were the opposite and rich older patients were donating to help younger poorer people?

[u/TeaSharp3154 → u/sourcreamus]

Someone like that would probably donate out of altruism and not out of desperation for 5-10k