1

Pro Index
Donation Rates Not Significant 2
Altruistic System Inadequate 2
Altruism Not Sufficient 2
Required Request Laws Not Sufficient 2
Moral Rewards Don’t Solve Supply Problem 2
Supply of living donors for kidneys and liver lobes limitless 3
Donation rates could triple 3
Financial Incentives are not Coercion 3
Attractive Options are not Coercion 3
Ethical Arguments Against Compensation are Disingenuous 4
Living Donors Reduce Wait Time, Save Money 4
Incentives Help Cost Effectiveness 4
Vendor-Donors Generate Savings for Recipients 4
Doubling Amount of Living Donors Plausible Economically 4
Transplantation can remain cost effective 5
Distributive Justice Rationale Flawed 5
Wealth Already Affects Health Care Quality 5
Regulations Could Help Combat Exploitation of Poor 5
Lack of Informed Consent Arguments are Paternalistic 5
Commodification Argument Not Rational 6
Incentives to Family Members Do Affect Donation Rates 6
Objections Do Not Stand Up to Scrutiny 6
Kantian Degradation Argument Does Not Apply 6
Recipients of Organs Use Fewer Resources 6
Payment Does Not Render Act Uncharitable 7
Increased Costs Arguments Do Not Hold 7
Benefits to the Rich Non-Unique 7
Keeping Poor From Organ Sales Immoral 7
Sales are still a Humanitarian Act 7
Incentives Do Not Promote Slavery 8
Incentives Extend Autonomy 8
Current Law Allows For Everyone But Donor To Profit 8
Tax Incentives Don’t Put Pressure on the Poor 8
Futures Market Doesn’t Pressure Poor 9
Incentives Should Be Offered To Increase Supply 9
Incentives Benefit Poor 9
Altruistic Donors Subject to Same Risks 9
Assumptions That Rich Will Always Get Organs Flawed 9
Egalitarian Theories Unwise 10
 2

Donation Rates Not Significant

“Donation is empowered by the consent of a family member to donate the organs of a deceased
relative, or less commonly by the specified intent of the deceased. Over the past decade, only a
15% increase in cadaver organ recovery has been realized by this approach, clearly inadequate
to meet the demand of those needing organs.” Ethics Committee of the American Society of
Transplant Surgeons, “Financial Incentives for Cadaver Organ Donation: An Ethical
Reappraisal”, 04/27/02, Transplantation, 03/05/11

Altruistic System Inadequate

“A system of organ donation based on the ethical standard of altruism is ideal, but it has been
inadequate in achieving a high rate of consent for donation. The ethical imperative of saving
further lives necessitates an attempt to reconcile the good that might be achieved by a more
effective system (pilot use of the funeral reimbursement incentive) with the ideal of the purely
altruistic system.” Ethics Committee of the American Society of Transplant Surgeons, “Financial
Incentives for Cadaver Organ Donation: An Ethical Reappraisal”, 04/27/02, Transplantation,
03/05/11

Altruism Not Sufficient

“Although altruism is an admirable characteristic to encourage in society, concern over the
possibility that voluntary donations will cease if paid organ donation is tried does not justify
outlawing organ sales, especially when it is more apparent than ever that reliance on altruism
alone 'condemns the sick'.” William Potts, Increasing the Supply of Transplant Organs by way
of Financial Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Required Request Laws Not Sufficient

“Nonetheless, in the years since these regulations were enacted, organ donation rates have
remained steady at about 4,000 per year, and by all measurements hospital staffs remain largely
unaffected by required-request laws.” LM Sanders, P Devney, E Young, and TA Raffin, An
ethically responsible approach to increasing the organ donation rate, 1992, Chest, 03/06/11,
<http://chestjournal.chestpubs.org/content/102/5/1572.full.pdf>

Moral Rewards Don’t Solve Supply Problem

“Would more public recognition of cadaver or living donation of organs provide enough of an
incentive to make much difference? It seems unlikely. Although there is no obvious moral objection
to nonfinancial incentives, there is real doubt that they will be sufficient to produce the number of
organs needed. This does not mean that such moral rewards should be opposed; merely that they
probably will not work to solve the critical supply problem.” Robert M.Veatch "Why Liberals
Should Accept Financial Incentives for Organ Procurement." Kennedy Institute of Ethics Journal
13.1 (2003): 19-36. Web. 3 Mar 2011.
 3

Supply of living donors for kidneys and liver lobes limitless

“Living donors of kidneys and possibly liver lobes are another matter: the supply is limitless, and the
yield is likely to increase in proportion to the generosity of the incentive. It is an economic dictum
that no shortage can persist in a market where truly free pricing prevails.” Michael J. Lysaght, and
Jaclyn Mason. "The Case for Financial Incentives to Encourage Organ Donation." ASAIO Journal
46.3 (2000): 253-256. Web. 3 Mar 2011.

Donation rates could triple

“Estimates of the number of “lost” cadaveric donors vary, but most experts believe that existing
donation rates could certainly be tripled, from about 20 per million population to 60 per million
population.” Michael J. Lysaght, and Jaclyn Mason. "The Case for Financial Incentives to Encourage
Organ Donation." ASAIO Journal 46.3 (2000): 253-256. Web. 3 Mar 2011.

Financial Incentives are not Coercion

“Coercion is defined more appropriately as the use of force or the threat of force to compel someone
to engage in an action against his or her will. Holding a gun to someone's head to force him to sign a
"donor" card would be coercion. So would drugging the individual and removing her kidney while
she was unconscious (assuming that were done against her will). Merely offering an inducement to
motivate someone to choose to engage in a behavior is not, by this definition, coercion. It adds an
additional option to the array of options previously available. In some cases, the additional option
may so fit with the goals of the person that that option is preferred above all those previously
available.” Robert M.Veatch "Why Liberals Should Accept Financial Incentives for Organ
Procurement." Kennedy Institute of Ethics Journal 13.1 (2003): 19-36. Web. 3 Mar 2011.

Attractive Options are not Coercion

“An offer to hire a skilled worker away from his present employer, especially if it is at a much higher
wage for similar working conditions, may be an offer that is very attractive, even irresistibly attractive,
but one would not normally say that the person was "coerced" into taking the new job. Unless "coerced"
means merely "presented with an option that is so much more attractive than any other that it is
irresistible," such offers are not coercion. One could call such offers "irresistibly attractive" but not
"coercive." Attractive offers may be perceived as offers that exert pressure or inducement, but they are
neither coercive nor unethical offers simply because they are very attractive. In fact, offers are not
necessarily unethical even if they are perceived as irresistibly attractive” Robert M.Veatch "Why Liberals
Should Accept Financial Incentives for Organ Procurement." Kennedy Institute of Ethics Journal 13.1
(2003): 19-36. Web. 3 Mar 2011.
 4

Ethical Arguments Against Compensation are Disingenuous

“Some consider the ethical arguments against financial compensation for organ donation to be
disingenuous. They note that everyone in the organ transplant process (other than the live organ
donor or next-of-kin who gives consent for cadaver donation) is compensated in some tangible
way. A salary is provided to the OPO coordinator who obtains family consent, the OPO then
charges an acquisition fee for the recovery of organs, the transplant surgeons and physicians
who care for the patient are paid for their service, and finally the transplant center charges for
the hospitalization.” Ethics Committee of the American Society of Transplant Surgeons,
“Financial Incentives for Cadaver Organ Donation: An Ethical Reappraisal”, 04/27/02,
Transplantation, 03/05/11

Living Donors Reduce Wait Time, Save Money

“However, if vendor kidneys became a reality and a large number of vendors came forward, the waiting time
(for a cadaver kidney) would be markedly reduced and, consequently, potential savings to the health care
system would be increased.” Arthur J. Matas and Mark Schnitzler,
Payment for Living Donor (Vendor) Kidneys: A Cost-Effectiveness Analysis, 08/25/03, American
Journal of Transplantation, 03/05/11 <http://onlinelibrary.wiley.com/doi/10.1046/j.1600-
6143.2003.00290.x/full>

Incentives Help Cost Effectiveness

“From an accounting perspective, society would ‘break even’ if a kidney vendor were paid the amount
saved by using a LURD [living unrelated] kidney. From a cost-effectiveness perspective, society would
‘break even’ if a kidney vendor were paid an amount so that the cost of care and vendor payments per
QALY [quality-adjusted life year] were equivalent to a lifetime of dialysis.” Arthur J. Matas and Mark
Schnitzler, Payment for Living Donor (Vendor) Kidneys: A Cost-Effectiveness Analysis, 08/25/03,
American Journal of Transplantation, 03/05/11 <http://onlinelibrary.wiley.com/doi/10.1046/j.1600-
6143.2003.00290.x/full>

Vendor-Donors Generate Savings for Recipients

“The estimated present value of medical care expenses through 20 years post-transplant was $277 600 for the
recipient of a LURD [living unrelated] kidney transplant. This is contrasted by the expected present value of
medical care expenses for a dialysis patient at $372 179. The difference of $94 579, the expected average
savings in medical care generated by a vendor-donor, would be the payment that could be made to vendor-
donors without increasing the cost of ESRD [end stage renal disease] care, or the financial breakeven
payment.” Arthur J. Matas and Mark Schnitzler, Payment for Living Donor (Vendor) Kidneys: A Cost-
Effectiveness Analysis,
08/25/03, American Journal of Transplantation, 03/05/11
<http://onlinelibrary.wiley.com/doi/10.1046/j.1600-6143.2003.00290.x/full>

Doubling Amount of Living Donors Plausible Economically

“Doubling the number of living donors would allow break-even and cost-effective payments of $47
290 and $134 659, respectively, while paying all living donors.” Arthur J. Matas and Mark Schnitzler,
Payment for Living Donor (Vendor) Kidneys: A Cost-Effectiveness Analysis,
08/25/03, American Journal of Transplantation, 03/05/11
<http://onlinelibrary.wiley.com/doi/10.1046/j.1600-6143.2003.00290.x/full>
 5

Transplantation can remain cost effective

“Our analysis suggests that even with a significant payment, transplantation could remain cost-effective.
Importantly, although our model incorporated a 20-year period, the calculated potential payment
represents the value of the savings as an investment decision. The observed savings over time would be a
larger figure, but a decision maker (the government or a payor) is concerned with the value to the stream
of returns today.” Arthur J. Matas and Mark Schnitzler,
Payment for Living Donor (Vendor) Kidneys: A Cost-Effectiveness Analysis, 08/25/03, American
Journal of Transplantation, 03/05/11 <http://onlinelibrary.wiley.com/doi/10.1046/j.1600-
6143.2003.00290.x/full>

Distributive Justice Rationale Flawed

“Economists Pindyck and Rubinfeld detail the flaws in the distributive justice rationale, noting that
physicians, hospitals, and other transplant service providers are able to adjust prices upwards to take
advantage of potential recipients’ willingness to pay for life-saving transplants.” Steve P. Calandrillo
"Cash for Kidneys: Utilizing Incentives to End America's Organ Shortage." 2005, American Law
and Ethics Association Annual Meetings 4 Mar 2011. <http://law.bepress.com/cg i/viewcontent.cgi?
article=1506&context=alea>.

Wealth Already Affects Health Care Quality

“Furthermore, to the extent that we worry about distributive injustice, we must be cognizant of
the reality that individuals’ wealth levels influence all kinds of health care decisions and
outcomes that occur in the U.S. already. It is no secret that wealthy people tend to live longer and
healthier lives than their poorer counterparts” Steve P. Calandrillo "Cash for Kidneys: Utilizing
Incentives to End America's Organ Shortage." 2005, American Law and Ethics Association
Annual Meetings 4 Mar 2011. <http://law.bepress.com/cgi/viewcontent.cgi?article=1506&conte
xt=alea>.

Regulations Could Help Combat Exploitation of Poor

“In the U.S., organs are still rationed to a significant extent based on one’s ability to pay, giving
the wealthy a decided advantage even under current law. A move to any market system could be
accompanied by government assistance to enable the poor to purchase organs on an equal
footing, but any system faces the problem that poor individuals would overwhelmingly be placed
in the unenviable position of being organ sellers.” Steve P. Calandrillo "Cash for Kidneys:
Utilizing Incentives to End America's Organ Shortage." 2005, American Law and Ethics
Association Annual Meetings 4 Mar 2011. <http://law.bepress.com/cgi/viewcontent.cgi?article=
1506&context=alea>.

Lack of Informed Consent Arguments are Paternalistic

“Many of these sellers are living in horrific poverty; the chance to receive a few thousand dollars to
escape the slums in exchange for taking on an added risk to their health is rational and well worth it. It is
overtly paternalistic to assume that those who make the decision to sell an organ do not know what they
are doing.” Steve P. Calandrillo "Cash for Kidneys: Utilizing Incentives to End America's Organ
Shortage." 2005, American Law and Ethics Association Annual Meetings 4 Mar 2011.
<http://law.bepress.com/cgi/viewcontent.cgi?article=1506&context=alea>.
 6

Commodification Argument Not Rational

“Indeed, for some, any financial inducement to increase the supply of organs constitutes a
'commodification' of something that is essential to saving lives, and this is intrinsically
objectionable. This position is typically an emotionally charged assertion and not a reasoned
argument. We have commodified many goods and services (for example, the services of
transplantation surgeons) essential to saving lives.” Pranlal Manga, A Commercial Market for
Organs? Why Not, 1987, Bioethics, 03/05/11
<http://www.cas.buffalo.edu/classes/dms/berna/dms434/readings/manga.pdf>

Incentives to Family Members Do Affect Donation Rates

“The promise of a reward paid to surviving family members affects the registration decision of all
potential donors who care about the welfare of their relatives. A donation reward will therefore distort
the signal content of registration in just the same way that a registration reward has been shown to do.”
Margaret M. Byrne and Peter Thompson, A positive analysis of financial incentives for organ donation,
2001, Journal of Health Economics, 03/05/11

Objections Do Not Stand Up to Scrutiny

“Radcliffe-Richards et al have demonstrated that almost all the familiar arguments against the sale
of organs, for example, exploitation, lack of informed consent, level of risk assumed by the
vendors/donors, difficulty of control/regulation of the sale of organs, lack of fairness for the rich to
have privileges that the poor do not have, absence and erosion of altruism as the basis for donation
of organs, undermining of confidence in the medical profession, etc, are all deficient and cannot
stand up to robust scrutiny.” A. S. Daar, Paid Organ Donation – The Grey Basket Concept, 1998,
Journal of Medical Ethics, 03/05/11
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC479132/pdf/jmedeth00001-0003.pdf>

Kantian Degradation Argument Does Not Apply

“The Kantian argument that selling a body part is degrading does not always apply, as degradation very
much depends on one's own perception of what is degrading.” A. S. Daar, Paid Organ Donation – The
Grey Basket Concept, 1998, Journal of Medical Ethics, 03/05/11
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC479132/pdf/jmedeth00001-0003.pdf>

Recipients of Organs Use Fewer Resources

“The major benefit that would come from increasing the organ supply is that there would be a
significant reduction in the number of people suffering and dying in hospitals. Moreover, not only
would the recipients of transplant organs be living normal and healthy lives, they would also be
expending fewer hospital resources.” William Potts, Increasing the Supply of Transplant Organs by
way of Financial Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>
 7

Payment Does Not Render Act Uncharitable

“Moreover, payment can be understood as simply providing an incentive to those who have altruistic
motives to donate, but refrain from doing so, there been no additional incentive. The decision to
become a paid organ donor can still be construed as a charitable act. The fact that a person is paid
does not mean that his or her act is not, also, a charitable one. Furthermore, even if laws legitimising
organ commerce were passed, citizens would still be free to donate their organs without receiving
any remuneration.” William Potts, Increasing the Supply of Transplant Organs by way of Financial
Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Increased Costs Arguments Do Not Hold

“They reflect the mistaken belief that organ transfers are unaffected by the laws of supply and
demand. Were organ commerce to succeed in bringing more organs to the market, this would allow
for more research, which would inevitably lead to lower costs. As the supply of organs increases, the
market price for organs will fall accordingly.” William Potts, Increasing the Supply of Transplant
Organs by way of Financial Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Benefits to the Rich Non-Unique

“The view that it is unfair for the rich to have privileges not available to the poor cannot be sustained as a
valid objection to a market in body parts. If organ selling is wrong for this reason, 'so are all the benefits
available to the rich, including all private medicine.’ Most financial transactions would seem to have effects
that differentiate based on income level.” William Potts,
Increasing the Supply of Transplant Organs by way of Financial Incentives, 2005,
Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Keeping Poor From Organ Sales Immoral

“If it is immoral to buy organs from someone who is desperate, it is arguably even more immoral
to continue under these circumstances to withhold the right of the desperate to market the one
valuable commodity they possess.” William Potts, Increasing the Supply of Transplant Organs
by way of Financial Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Sales are still a Humanitarian Act

“What apologists of the current laws fail to grasp is that the primary reason for allowing sales in
organs is 'to alleviate man's suffering by ensuring an increased supply of organs for transplantation'
and therein lies a fundamental contradiction in arguments that are purportedly based on
humanitarian grounds.” William Potts, Increasing the Supply of Transplant Organs by way of
Financial Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>
 8

Incentives Do Not Promote Slavery

“The view that a market in organs would lead to the legitimising of slavery cannot be sustained as a valid
objection to financial incentives for organ donors. While there may be an aversion to the notion of
alienating the living body as a whole, participation in profits arising out of products derived from one's
own body is not akin to slavery.” William Potts, Increasing the Supply of Transplant Organs by way of
Financial Incentives, 2005, Monash University Law Review,
03/06/11 <http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Incentives Extend Autonomy

“Allowing an individual to sell his or her body parts establishes the property right of the
individual in his or her own body; it does not give rights in the body of another. A decision to
sell one's organs is not the same as depriving oneself of autonomy altogether. On the contrary, it
'extends the range of individual choice and opportunity', which is synonymous with enhancing
autonomy, not limiting it. To put it another way, self-ownership allows scope for autonomous
decision-making about one's own body, whereas ownership by another person does not.”
William Potts, Increasing the Supply of Transplant Organs by way of Financial Incentives,
2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Current Law Allows For Everyone But Donor To Profit

“The moral and ethical reasons that have been offered as justifications for the current ban on
financial incentives for organ donation are somewhat undermined when the laws that allow
people to give their body parts away are the same laws that allow removed body parts to be
used for commercial gain by almost anyone except the donor, possibly even without the donor's
consent.” William Potts, Increasing the Supply of Transplant Organs by way of Financial
Incentives, 2005, Monash University Law Review, 03/06/11
<http://www.austlii.edu.au/au/journals/MonashULawRw/2005/9.pdf>

Tax Incentives Don’t Put Pressure on the Poor

“Another benefit, however, is that tax incentives inducing the rich to become organ donors have the benefit
of not putting undue market pressure on the poor to sell their organs, a common critique of proposed organ
procurement systems involving financial incentives for donation.” J. Andrew Hughes, You Get What You
Pay For? Rethinking U.S. Organ Procurement Policy in Light of Foreign Models, January 2009, Vanderbilt
Journal of Transnational Law, 03/06/11
<https://www.uchastings.edu/faculty-administration/faculty/weinberg/class-website/docs/YouGet
WhatYouPayFor-Rethinking-US-OrganProcurementPolicy-in-Light-of-ForeignModels.pdf>
 9

Futures Market Doesn’t Pressure Poor

“In a straightforward version of the futures market proposed by scholars Lloyd Cohen and Gregory
Crespi, individuals could sell the right to harvest their organs upon death--a futures contract. In return, if
their organs were subsequently taken, a beneficiary designated by the donor at the time he executed the
contract would receive the contractual payment. In theory, poor organ sellers would not be exploited
because living donor transactions would still be prohibited--their consent would not be motivated by
economics, and they would not risk their health by entering such a contract. Moreover, equal access to the
organ supply for poor organ recipients, despite income differences, could be maintained using the futures
market as a supply mechanism but not an allocation mechanism.” J. Andrew Hughes, You Get What You
Pay For? Rethinking U.S. Organ Procurement Policy in Light of Foreign Models, January 2009,
Vanderbilt Journal of Transnational Law, 03/06/11 <https://www.uchastings.edu/faculty-
administration/faculty/weinbe rg/class-website/docs/YouGetWhatYouPayFor-Rethinking-US-
OrganProcurementPolicy-in-Light-of-ForeignModels.pdf>

Incentives Should Be Offered To Increase Supply

“Organs are currently limited by supply, and in the hope of expanding the available organs, it seems
prudent to provide incentives not only to encourage donation, but also in order to express
appreciation.” N. Ghahramani, Living Organ Donation: An Ethical Evolution or An Evolution of
Ethics?, 2010, International Journal of Organ Transplantation Medicine, 03/06/11
<http://home.sums.ac.ir/~habibzaf/ojs/index.php/IJOTM/article/viewFile/24/38>

Incentives Benefit Poor

“Given the general diminishing marginal utility of wealth, on balance we would expect that the largest
gain from increased income would go to those who are the poorest off financially, not those who are
well endowed.” Richard A. Epstein, The Human and Economic Dimensions of Altruism: The Case of
Organ Transplantation, January 2008, The Chicago Working Paper Series, 03/06/11, <
http://www.law.uchicago.edu/files/files/385.pdf>

Altruistic Donors Subject to Same Risks

“In addition, there is some concern about whether potential cash donees are aware of the risks
they face and the possible psychological harms. But those risks face altruistic donors as well, and
various counseling and testing devices are used to see if a donor is fit. The same practices can be
carried over to paid transferors as well, subject to the same protocols.” Richard A. Epstein, The
Human and Economic Dimensions of Altruism: The Case of Organ Transplantation, January
2008, The Chicago Working Paper Series, 03/06/11, <http://www.law.uchicago.edu/files/files/
385.pdf

Assumptions That Rich Will Always Get Organs Flawed

“It should never be assumed that rich people will always get the organs because of their greater
wealth. They too will not bid a fortune to acquire an organ that will extend their lives only by a
single day. A poorer person with better health prospects could easily bid more, relying on savings or
loans if he could pay for the organ out of the increased earnings that come from better health.”
Richard A. Epstein, The Human and Economic Dimensions of Altruism: The Case of Organ
Transplantation, January 2008, The Chicago Working Paper Series, 03/06/11,
<http://www.law.uchicago.edu/files/files/385.pdf >
 10

Egalitarian Theories Unwise

“But everyone should be hard pressed to endorse any moral theory that prefers larger shortages to
smaller ones, which is what happens when all cash or other incentives are ruled out of bounds. All
egalitarian theories unwisely reject important classes of Pareto improvements, by taking the position
that—but only with respect to markets—unless all can receive, none should receive.” Richard A.
Epstein, The Human and Economic Dimensions of Altruism: The Case of Organ Transplantation,
January 2008, The Chicago Working Paper Series, 03/06/11,
<http://www.law.uchicago.edu/files/files/385.pdf >

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