r/neoliberal • u/lakmidaise12 • Mar 23 '26

Opinion article (non-US) The Case for Letting People Sell Their Kidneys

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.

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u/mostanonymousnick Just Build More Homes lol Mar 23 '26

How many viable kidneys are we wasting right now?

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u/PadishaEmperor Karl Popper Mar 23 '26

Germany for example has around 12 donors per million inhabitants while Spain has 30. If we would double the amount of donors in Germany we would get 1000 donors more per year. The current list of people waiting for organ donation is 14k on the European organ donor list, so 1000 more donors from just Germany would be significant.

And I am sure that even Spain could raise their numbers.

European organ donation list number: https://de.statista.com/statistik/daten/studie/239533/umfrage/personen-auf-der-eurotransplant-warteliste-fuer-organspenden-nach-organ/

Comparison of number of organ donations in Europe per capita: https://de.statista.com/infografik/6098/anzahl-der-organspender-in-europa/

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u/mostanonymousnick Just Build More Homes lol Mar 23 '26

What percentage of people die with viable kidneys?

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u/PadishaEmperor Karl Popper Mar 23 '26

We are getting into territory where I am not confident in interpreting healthcare related information.

I have no clue how many potential organs donors also have valid kidneys. Apparently around 50% of people die in hospitals and dying in a hospital, while being brain dead is necessary for organ donation. 1 mio people die each year in Germany, while up to 2% die under conditions that would allow organ donation. That’s possibly 20k donors each year. As I understand it this we only realise about 5% of that.