There are more than seventy-seven thousand Americans on the waiting list for kidney transplants, with thousands more waiting for other organs. The wait can be as long as eight years--if the patient can survive that long. Eleven people die each day for lack of a donated kidney. Ask Sally Satel, a practicing psychiatrist and resident scholar at AEI. In 2006, she received a kidney from a living donor, but too few people are as fortunate. Since then, she has researched how to save lives by increasing the supply of donated kidneys. In When Altruism Isn't Enough: The Case for Compensating Kidney Donors (AEI Press, December 2008), Satel assembles medical practitioners, legal scholars, economists, and ethicists to evaluate the merits of and need for an incentive-based system for increasing the supply of kidneys.

Federal law prohibits donors from receiving material gain for an organ. But since living donors are the best source of transplantable kidneys, the contributors propose a safe, transparent compensation system that could offer noncash rewards (such as a tax credit, lifelong health insurance, or a contribution to a retirement fund). The compensation would come from the federal government or states, not from the recipients. The contributors argue that kidney donation is an acceptably safe and surgically common procedure and that living donation is more cost-effective than lifetime dialysis.

What of ethical concerns? A noncash incentive structure would actually mitigate the "morally reprehensible" black market in organs, contributors say. Satel writes that "refusing to experiment with incentives is itself an unethical posture because it perpetuates needless suffering and death." Compensating donors, she and her coauthors conclude, can do what altruism has proven incapable of doing.

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