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The demand for organ donors far outstrips the supply.

In this week's Scrubbing Up, Martin Wilkinson, a visiting professor at Keele University and former chairman of the New Zealand Bioethics Council, argues that selling organs is the way forward.

When people's organs fail, their best hope - sometimes their only hope - is a transplant.

Transplants are not only effective treatment, they are worth the money too. But there are not enough organs.

Tinkering with the rules for consent, using less-than-pristine organs, and more donations by living people have still left a big gap between supply and demand.

Should the law be changed so that people could sell their organs? I think it should.

Permitting sale would mean more people could get the organs they need. People should not be stopped from selling their organs because they have a right to do what they want with their bodies when they would not be harming others.

Increasing supply

And would allowing sale make more organs available?

The most basic economics lesson says that supply increases with price.

Organs currently have a price of £0. Give people money for their organs and you will get more of them.

Basic economics is a bit too basic though. Perhaps few people would want to sell; perhaps people who would have donated now would not because, for instance, they are offended by the idea of money changing hands. In theory, the supply of organs could even fall if sales were allowed.

However, when Iran gave generous compensation to live kidney `donors', it not only met demand but cleared the backlog on its waiting list.

Of course, people in the UK may not behave like people in Iran, so it would be sensible to do some research into people's willingness to take money for their organs. Still, if the aim is to increase the supply of organs, it would be worth giving sale a try.

Ethical questions

What about the ethical objections? Many take pride in the system of altruistic donation.

They do not want to replace altruism with commerce and they think society would find commerce repulsive. But the extent to which we have altruistic donation is greatly overrated.

Many people die without giving any serious thought to donation. It is their families who agree and, when they agree, they are not donating their organs.

In any case, if organ sales would increase supply, it would not be altruistic to say: `we like altruism so much we will not allow sale even though more people will die as a result.'

As for society finding sale repulsive, there is no serious evidence that it would. Even if it did, people do all sorts of things with their own bodies that other people do not like.

Legal battle

Punishing people for trying to sell their organs - which has happened in the UK - infringes on a right to decide what to do with one's own body.

People should be able to choose for themselves whether to sell their organs. But surely, the argument goes, it is the poor who would sell, and what choice would they have?

Well, the poor do have bad options, but it is a pretty strange policy that takes away the one option they may think the best, and punishes them for trying to use it. And that is what criminalising organ sales does.

The critics have a point, though. People who are desperate lay themselves open to exploitation and deceit, and organ sellers are exploited and deceived in black markets now.

But the answer is to regulate the market, not to drive it underground. Selling an organ should no longer be a criminal offence.