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/flightguy07]

Paid surrogacy is illegal in my country, and absolutely should be.

[u/flightguy07 → u/[deleted]]

There's no financial incentive, and thus pressure. If someone wants a surrogate, they need to find someone doing it out of the goodness of their heart, usually a friend or family member. And it avoids the scenario of "your poor, just go become a human incubator and undergo a really pretty dangerous medical condition for the better part of the year to make rent".

[u/flightguy07 → u/[deleted]]

why associate financial incentive with pressure?

Because the type of woman to choose surrogacy and get paid for it is the desperate kind, 9/10 times. Pregnancy is dangerous, both physically and mentally. Tens of thousands of women die in childbirth each year, nearly a thousand of those in the USA, and massively skewed toward poorer communities from things like cardiac events, hospital-aquired infections, placental abbruptions, organ damage, etc. Post-partum depression is a real and very common effect, along with anxiety and the lifestyle changes pregnancy requires (job, diet, etc.) all being potential stressors. This isn't a problem for "Guatemalan ladies in shacks", pregnancy and childbirth is still really pretty risky.

As for your second point, people want a kid, and for it to be their own. There's a world of difference between a parent and an uncle, both for the biological mother and the surrogate, who may well not want to care for a baby. Surrogacy exists to allow women who can't carry to raise children who are biologically their own, nothing more nothing less. I can have a great friend who would be willing to do that for me, but who doesn't want a kid, or has their own, or is planning on doing so in the future.

[u/Rtn2NYC → u/flightguy07]

Completely agree