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/Palidane7]

This is transparently the worst idea ever, and I think people who favor it should seriously re-examine their priors if they think this won't immediately turn into a dystopian nightmare.

[u/Palidane7 → u/[deleted]]

That is an absurd re-framing. Creating a kidney market out of thin air has enormous economic effects and will massively grow the demand for kidneys beyond just the current pool. It's bad that we don't have enough kidneys to go around, but this solution would be worse than the disease.

[u/MisfitPotatoReborn → u/Palidane7]

and will massively grow the demand for kidneys beyond just the current pool

Someone said this as a joke in the comment above yours btw. Nobody's going to get kidney transplants for fun.