[cornell532]

What do they do now? You make it sound like there's a better alternative currently available!

The reason they would consider selling a FUTURE interest in their organs is because it would be the best option on the table. Since it's not currently available as an option, they must be choosing considerably worse option now (which is the best currently available option).

How is your alternative more just, more fair, better?

---------------- EDIT ----------------

Imagine YOUR loved one received a liver/heart/kidney in this manner, thereby saving his/her life. And in so doing it DID improve the welfare of someone loved by the donor allowing him/her to get a better education, get better housing, or something else worthwhile.

What is so horrible about that? Your insurance company would cover it and it would make the world a BETTER PLACE for everyone. By the way, the surgeon gets paid a lot of money for a complex procedure like organ transplant; what's wrong with a donor getting a tiny fraction of that for his/her contribution providing the amazing, wonderful gift of life?

[whateverer]

Well, without regulation it won't necessarily be the _FUTURE_ interest in selling an organ. As I said, desperation can make a person do crazy things, and there's more to consent whether there's a contract involved and no guns pointed to anyone's head.

And while it creates an incentive to donate organs, it also allows wealthier people to hoard them. Remember that the circumstances which allow the organs of a person to be successfully extracted for transplant are pretty rare[1], they essentially have to die in a hospital of brain death with their organs intact, so even if more people are willing and legally bound, offer may still fail to satisfy demand, only this time it will be mostly a matter of who has more money. And that's not exactly fair.

1. http://www.organtransplants.org/understanding/death/

[cornell532]

By the way, as a separate issue; if people were allowed to bid for organs. And assuming you're right that rich people horded them, then wouldn't the supply rise up to meet that new demand? Wouldn't more people sign up to be organ donors? Wouldn't we reach equilibrium where the supply side matched the demand side? If poor people were getting fabulously wealth from committing to donate organs, and more lives were saved, wouldn't we eventually reach equilibrium? The 1% only need so many organs.... Poor people with money in their pockets and less organ shortage wouldn't be a horrible scenario. Maybe it would force the real hard work of cloning organs and improving a unsatisfactory system.

I must say, if it became an outright bidding system some people who society might say are less deserving than someone else might benefit. But that happens already! Look at Mickey Mantle who received a liver after a lifetime of alcoholism (and died soon thereafter). Or Steve Jobs who shopped around for the best region to receive a new organ (he's not FROM Tennessee after all...).

So please tell me, how would a MORE market based system be significantly worse? It seems like we have the worst of everything right now in our pursuit of the idealistic fantasy that the system treats everyone equally and that organ donation should be a purely altruistic gesture.

[cornell532]

I agree with everything you're saying (except the part about hording) perhaps....

My expectation is that donors would be paid based on expected value, which is how (I believe), the issue is being framed in debates.

ie assume there's a 1% probability that potential donor will be a.) young enough b.) die under right circumstances.

Then we should offer that potential donor 1% of the expected value of his/her organs (ie if organs are worth $100k then we should offer $1k).

Obviously these are all made up numbers. But the idea of paying up front based on expected value makes sense to me in theory.