[mort96]

> selling kidneys doesn't preclude us having the same thorough screening process we have now, although it means there may be people who try harder to game the screening process.

Nothing I have said really even touches on the topic that that safety could be impacted by people trying to game the screening process, though it is of course a legitimate concern.

> i just don't see kidney donation as being a significant enough harm to outweigh the harm of the recipient not getting the kidney.

I don't disagree that kidney donation is a net good. The question is what you do with that opinion. You could defend the idea of a "kidney draft", where some random selection of the population gets forced by the state to "donate" one of their kidneys; though I suspect a lot of the proponents of a free organ market would be uncomfortable with that idea, as would I. The difference is that I view financial coercion as just as much of a problem as state coercion.

> if we're worried about people being financially desperate, we should allow organs to be sold and build a stronger social safety net

I agree! If there was a social safety net which reliably kept people out of desperate poverty, I would be less worried about financial incentives.

The safety net needs to come first, however.

[algas]

I agree, and would extend your point even further. Drafting people into the army against their will is a grave harm, for obvious reasons. But the existence of a "volunteer" army that nevertheless gets paid for their participation represents no less financial coercion. People on a financial precipice, given the option to join the army, might take it -- and thus increase their risk of being shot or blown up abroad. Removing those payments removes that coercion.

I was originally going to post this as a facile gotcha, until I thought about it slightly harder and realized that effectively disbanding the military would actually be a pretty good idea, all considered. However, I would still argue that we should accept monetary rewards for altruistic yet dangerous acts, like fighting fires and rescuing cats from trees (and donating kidneys).

[Suzuran]

The screening isn't just for safety, it's for biological compatibility with the recipient - a mismatched organ will not function and will be destroyed by the recipient's (even suppressed) immune system. It's worse than just failing, you damaged the recipient and you wasted an organ that could have gone to a proper match. When I received my kidney transplant I had to acknowledge a risk of contracting an undetected bloodborne illness from the (deceased) donor's history of drug usage. If the primary concern driving screening was simply safety the organ would not have been considered available. The primary concern is compatibility. Other resulting conditions can be managed afterward. The risk of me dying as a result of the aforementioned undetected bloodborne illness was some tiny fraction of a percent - The risk of me dying on extended dialysis is one hundred percent.