A sale would be cleaner

In this week's Ethicist column of the New York Times, a woman whose husband benefited from a stranger's donated kidney asks whether she has a moral obligation to help the stranger, now that the stranger is in financial trouble and has written to ask for help. The writer says, "I wish it were legal to sell organs; it would be much cleaner in many ways."

So true. If selling organs were legal, then the stranger could have asked a substantial price for her kidney, and both parties would have benefited -- the stranger, by earning money she could then use to keep her home, and the donee and his wife, by purchasing an extension of his life.

Instead, the stranger could only choose to give up one of her kidneys out of altruism. For the benefit of a person she had never met -- who could have been a creep for all she knew! -- she gave up an enormous value, part of her own body! This is the kind of transaction altruism demands of people -- sacrificing a great value for the sake of a lesser one.

If the woman had been allowed to sell her kidney, the patient could have purchased it and continued his life with no further obligation to her. Instead, he accepted a gift far beyond what anyone can possibly earn from a stranger, and now has to decide whether he owes her, and how much.

I do think, were I in the donee's situation, that I would want to offer the donor at least some money, in recognition of the great value she provided. On the other hand, we don't know how much the donor has asked for, whether it's an amount the couple can afford to pay, and whether it's more than they would have paid for a kidney if there were a free market. Not only that, but if they give her money, will the donor then feel emboldened to ask for more any time she is in need?

The writer of the letter is correct: Allowing organ sales would make such transactions far cleaner, because there would be no moral blank check, real or implied, held by a donor. And such lifesaving transactions would be more frequent, as well, because people who (correctly!) aren't motivated by brother-love alone to make so enormous a gift as an organ might give one up if they receive commensurate value in return.