Markets routinely misprice goods and services when people are in highly emotional states. In such states, people either overpay, or sell too cheaply, a situation that especially happens when people are desperate. Behavioral research clearly shows how intense emotions and the presence of scarcity (whether real or imagined) narrow individuals’ cognition and skew choices. So, in “hot” states, we can easily be manipulated into taking deals we’d reject when calm (Lerner, Li, Valdesolo, & Kassam, 2015; Loewenstein, 2005; Mani, Shah, Mullainathan, & Shafir, 2013) (Lerner et al., 2015) (Loewenstein, 2005) (Mani et al., 2013).
But, fortunately, spending too much or selling for too little, while painful, won’t kill us. Unless, for some reason, one could sell organs.
A for-profit organ market would take the dynamic of emotional manipulation to its cruel extreme. Nobody in a calm, serene state just wants to go and sell their organs. The seller is, therefore, almost by definition, in acute distress and thus primed for harmful, short-sighted bargains. And, to make this situation even more cruel, these are conditions disproportionately borne by minorities and other vulnerable groups in real organ transplant systems (HHS OMH, 2025; OPTN, 2024) (HHS OMH, 2025) (OPTN, 2024).
Now imagine there is a woman named Maria, a single mother of two working two minimum-wage jobs in El Paso, Texas, who then sees an advertisement taped to a lamppost outside a free clinic: “Healthy Individuals Needed. Save a Life. Generous Compensation Guaranteed.” The figure listed is $50,000—more than she earns in two years. It’s a sum that could erase her crushing debt, secure a deposit on a safe apartment, and help, even if not ensure, her children have a future. The commodity in question isn’t her labor, however, but one of her kidneys.
This scenario, while fictional (at least in Texas), is a logical and terrifying endpoint of the debate surrounding the legalization of a for-profit organ trade. It presents a Faustian bargain where the most vulnerable members of society are incentivized to risk their long-term health for short-term economic survival. While the global organ shortage is a profound and legitimate crisis, the legalization of a private, for-profit organ market isn’t a solution; rather, it’s a predatory mechanism that would systematically exploit poverty, transforming the human body into a commodity. Such a market would erode the very foundations of social solidarity and human dignity that underpin a just healthcare system, while also exploiting people who are already facing painful adversity.
The scale of the global organ crisis is undeniable and thus necessitates a desperate search for solutions. According to the Health Resources and Services Administration, over 100,000 people in the United States alone are on the national transplant waiting list, and official dashboards regularly report roughly 13–17 deaths per day among those waiting (link - https://www.organdonor.gov/learn/organ-donation-statistics?) (HRSA, 2024).
With this shortage, it’s understandable (not the same as acceptable) why a global black market, which international bodies have repeatedly condemned as exploitative “transplant tourism” (WHO, n.d.; Declaration of Istanbul Custodian Group, 2018) (WHO link) (Declaration of Istanbul, 2018) has spawned. The persistence of this illicit trade of organs demonstrates the grim arithmetic of scarcity when vital resources are priced in a laissez-faire market: demand outstrips supply, and the poor and vulnerable become suppliers.
Historical context indicates that there have been policy successes in this area that don’t require a for-profit organ trade to increase the number of organs available for transplant. Spain’s opt-out architecture, hospital-embedded coordinators, and culture of solidarity have delivered the world’s highest deceased-donor rates for years (approximately 49–53 donors per million population in 2023–2024). This alone shows how structural design can lift supply without paying sellers (Streit et al., 2023; The Lancet, 2024; Spain MoH/ONT, 2025) (Streit et al., 2023) (The Lancet, 2024) (Spain MoH/ONT, 2025).
By contrast, some economists argue that introducing monetary incentives would clear waiting lists efficiently (Becker & Elias, 2007) (Becker & Elias, 2007). But those models abstract away the lived reality of poverty and its cognitive load (Mani et al., 2013) (Mani et al., 2013), nor do they account for how, even if organs were sold on a “free market,” it’s extremely unlikely sellers would actually get offered fair prices. It’s much more likely they’d make short-term decisions they’d regret forever.
A for-profit organ trade is inherently predatory: it takes biological capital from the poor to serve the wealthy. Even though the problem should be rather obvious in a moral sense, to explain further: trading organs turns people into things and all relationships into contracts (Marway, Johnson, & Widdows, 2014) (Marway et al., 2014). When someone signs a sales contract, a kidney stops being part of a whole person tied to social bonds and becomes a mere object, a Lego piece, to buy and sell. That would cause society to shift from “my body, my choice,” to “my Lego piece, not my choice.” Donors would just become marketable parts (Marway et al., 2014).
Maria’s value then wouldn’t be in her humanity, motherhood, her goals, or anything about her except for her ability to provide a healthy kidney to a wealthy patient. This commodification fuels exploitation, the second key pillar of the case against such a market.
Supporters of a regulated market say fixed, government-set prices could stop bidding wars and ensure “fair” pay. This however, ignores economic coercion. Research on organ trade black markets shows most sellers are “crushed by poverty” and sell only out of desperation (Marway 2014, p. 591) (Marway et al., 2014). In India’s well-known kidney bazaars, paid “donors” often end up become even poorer and less healthy after surgery. The vast majoirty regretted the sale, and long-term relief did not follow (Goyal et al., 2002) (Goyal et al., 2002).
Where a legal market exists, such as in Iran, research shows most vendors are poor and driven by hardship, with high rates of regret and social harm (Zargooshi, 2001; Malakoutian et al., 2007; Ambagtsheer, 2022) (Zargooshi, 2001) (Malakoutian et al., 2007) (Ambagtsheer, 2022). A choice made under threat of homelessness, hunger, debt, or the inability to care for one’s children isn’t exactly real autonomy. It’s surrender to circumstance, worsened by the hot–cold empathy gap and the cognitive tax of scarcity (Loewenstein, 2005; Mani et al., 2013) (Loewenstein, 2005) (Mani et al., 2013). Regulated prices don’t remove coercion, they just institutionalize it, not to mention loopholes that might occur.
It's also impossible to ignore who would be most pressured to sell. In current U.S. organ transplantation, racial and ethnic minorities are overrepresented on waitlists and simultaneously face inequities (e.g., legacy race-based eGFR policies that delayed access for Black patients) (HHS OMH, 2025; OPTN, 2024) (HHS OMH, 2025) (OPTN, 2024). Translating that reality into a cash market would predictably push vulnerable groups already facing income volatility and debt into selling, thereby deepening health and wealth gaps (Saunders et al., 2015; Wadhwani et al., 2021) (Saunders et al., 2015) (Wadhwani et al., 2021).
Furthermore, a for-profit market would also destroy the gift relationship, the third harm highlighted by commodification theory. Today’s donation system, though imperfect, is built on altruism and solidarity. A freely given organ represents human connection and shared responsibility. A study study of blood donation showed that commercialization replaced altruism with individualism, weakening trust (Titmuss, 1970). Later evidence confirms the risk of “crowding out” intrinsic motivation (Niza, Tung, & Marteau, 2013) (Titmuss, 1970) (Niza et al., 2013). (2014, p. 594) (Marway et al., 2014). This means allowing organ trade would likely reduce donations, making things even worse, or maybe erasing donations entirely.
It's not as if regulation would fix things either. First, regulation cannot erase structural injustice: the same inequalities that fuel black markets would shape legal ones, with organs flowing from poor to rich, from the Global South to Global North (Scheper-Hughes, 2000) (Scheper-Hughes, 2000). Second, regulation cannot solve the deeper ethical loss: selling tissue for money strips dignity and corrodes solidarity (Marway et al., 2014) (Marway et al., 2014).
Then, there are the health risks to sellers. Living kidney donors, although carefully selected, have a higher relative long-term risk of end-stage kidney disease than matched non-donors (Muzaale et al., 2014; Grams et al., 2016) (Muzaale et al., 2014) (Grams et al., 2016), with debate about the magnitude but consensus that the long-term risk is not zero (Lam et al., 2015) (Lam et al., 2015). Make that risk into a paycheck, and simply put, the risk will become much more significant.
Circumstances like these are so grim that one almost almost has to reach for gallows humor as a thin coping thread, because, frankly, in Texas, or anywhere for that matter, you can’t “yee-haw” if you don’t have organs. That line aims to lighten a topic so crushing upon inspecting it many might simply never want to talk about it. Such organ markets are an ethical failure that pressures vulnerable people to sell organs, and should be discussed more openly so this situation doesn’t become a reality in more places than it already is, and so that this kind of market might be reduced or retracted where it’s happening.
Therefore, the conclusion is inescapable. Due to the inextricable links between poverty and coercion, the inherent dehumanization of commodification, and the corrosive effect on social solidarity, a for-profit organ trade should be vigorously resisted and outright banned. The solution to the organ shortage doesn’t lie in exploiting one public health crisis (poverty) to address another (organ scarcity). Instead, we must pursue ethical alternatives (and this is not simply naïve talk but something that has been proven possible) that strengthen, rather than fracture, our collective humanity.
This would first require massively improving donation systems: implement opt-out (presumed consent) with hospital coordination and family-support protocols, following evidence-based models like Spain’s (Streit et al., 2023; The Lancet, 2024) (Streit et al., 2023) (The Lancet, 2024). And, strengthen international enforcement against trafficking in alignment with WHO Guiding Principles and the Declaration of Istanbul (WHO link) (Declaration of Istanbul, 2018).
Second, being the most crucial, it is essential to address the root cause that makes organ sales seem appealing: poverty itself, while also ideally improving public health so fewer people need new organs in the first place. Living wages, universal health coverage, strong social safety nets, and humane debt relief reduce the “hot” pressures that compromise autonomy (Mani et al., 2013; Lerner et al., 2015) (Mani et al., 2013) (Lerner et al., 2015). A just society doesn’t ask its most vulnerable members to pawn their organs for survival; it builds a world where such a “choice” is unthinkable. The goal isn’t a more efficient market for human parts, but a community where no one is ever so desperate that they have to enter one.
References:
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