A regulated system of living kidney sales

Arising from: Jha V and Chugh K S (2006) Nat Clin Pract Nephrol 2: 466–467 doi: 10.1038/ncpneph0268 In a recent opinion piece Jha and Chugh1 argued against the use of a market for organs in the developing world. One of the principal rationales behind their argument was that they viewed the market as the cause of exploitation of impoverished "sellers" of organs and of poor outcomes of transplant recipients. It is unclear that a market for organs is to blame for these poor outcomes. The fact that organs are exchanged for money in a seemingly exploitative manner could be a consequence of the greater problem that the political institutions in developing countries do not effectively police the behavior of patients, doctors, and donors in transplant surgery. For example, the sale of kidneys has been illegal in India since 1994, yet an active black market for kidneys still exists.2 This is consistent with the underlying problem being the inability of the government to regulate the kidney trade in an effective manner. If these substantial underlying institutional problems are ever fixed, it is quite possible that the market for kidneys could look very different than it does today in the developing world. Without these institutional reforms it is impossible to evaluate the relative strengths and weaknesses of a market for kidneys.