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Paid organ donation is an emotive subject in the transplant community. Part of the reason for this is that in many countries, including the UK, the notion of organ donation as a ‘gift’ is highly valued. The difference between a gift and a commodity is clearly understood and applies equally to living as well as deceased organ donation. In the UK, legislation prohibits commercial dealings in human material for transplantation (Human Tissue act 2004 (England and Northern Ireland)1 and 2006 (Scotland)2).
In other countries such legal protection does not exist and in 2004 the World Health organization (WHo) urged members ‘to take measures to protect the poorest and vulnerable groups from transplant tourism and the sale of tissues and organs'.3 Paid donation and transplant tourism are inseparably intertwined. Further debate at a summit in 2008 by the Transplantation Society and the International Society of Nephrology led to the Declaration of Istanbul on Organ Trafficking and Transplant Tourism stating: ‘Organ trafficking and transplant tourism violate the principles of equity, justice and respect for human dignity and should be prohibited. Transplant commercialism targets impoverished and otherwise vulnerable donors leading to inequity and injustice'.4
To understand the issue of paid donation it is necessary to understand the drivers for it. There is a global shortage of organs available for transplantation. This gap between demand and supply has prompted many people in the west with organ failure to seek transplants overseas, often in developing countries.5,6 Frequently these individuals do not ask questions about how that organ was obtained.7 The process is further fuelled by unscrupulous health professionals and brokers seeing the potential for financial gain and taking advantage of both the desperate recipient and the vulnerable seller. It is a sad indictment of the human condition that wherever there is a market, people will strive to find a profit margin even when...