1. ¹Division of Renal Diseases, Department of Medicine, Downstate Medical Center, State University of New York, Brooklyn, New York, USA
2. ²Yale University, School of Medicine, New Haven, Connecticut, USA

Correspondence: EA Friedman, Division of Renal Diseases, Department of Medicine, Downstate Medical Center, State University of New York, 450 Clarkson Avenue, Brooklyn, NY 11203, USA. E-mail: elifriedmn@aol.com

Received 29 November 2005; Revised 5 January 2006; Accepted 10 January 2006; Published online 15 February 2006.

Abstract

Continuous growth of the end stage renal disease population treated by dialysis, outpaces deceased donor kidneys available, lengthens the waiting time for a deceased donor transplant. As estimated by the United States Department of Health & Human Services: '17 people die each day waiting for transplants that can't take place because of the shortage of donated organs.' Strategies to expand the donor pool – public relations campaigns and Drivers' license designation – have been mainly unsuccessful. Although illegal in most nations, and viewed as unethical by professional medical organizations, the voluntary sale of purchased donor kidneys now accounts for thousands of black market transplants. The case for legalizing kidney purchase hinges on the key premise that individuals are entitled to control of their body parts even to the point of inducing risk of life. One approach to expanding the pool of kidney donors is to legalize payment of a fair market price of about $40 000 to donors. Establishing a federal agency to manage marketing and purchase of donor kidneys in collaboration with the United Network for Organ Sharing might be financially self-sustaining as reduction in costs of dialysis balances the expense of payment to donors.