People should be paid to donate their organs.
One of the most striking arguments for the power of the free market lies in the so-called “organ market,” where a crucial feature of a functioning market is missing: payment. We ask living donors to give up an organ without compensation and rely on people consenting to donate their organs after death. Then we confront the defining feature of the transplant waiting list: a shortage of organs, a characteristic typical of a system that lacks monetary transactions.
As of July 2026, about 109,817 people were on the U.S. organ transplant waiting list. By comparison, just over 49,000 transplants were performed in all of 2025, equivalent to roughly 45 percent of the number waiting in that July snapshot.
The shortage is especially stark for kidneys: Roughly 95,500 Americans were waiting for one as of July 2026, while only 27,574 kidney transplants were performed in 2025. Another 8,776 people were waiting for a liver, 4,039 for a heart and 961 for a lung; the previous year’s transplant totals were 12,344, 4,587 and 3,490, respectively.
Yet one potential solution is something many people instinctively recoil at: paying people to donate their organs.
The case for financial incentives is not merely theoretical. From paid plasma donations to incentives for organ donors, the evidence points to the same result: Increase the incentive to donate, and the supply increases with it.
In the U.S., you are legally permitted to sell your blood plasma for money, but it's called "donation". In recent years, the numbers of places set up for donations has skyrocketed, and the amount they're compensating donors has followed suit. Let's dig in. https://t.co/u5Hd3RRo9b
— Crémieux (@cremieuxrecueil) August 21, 2024
When organ procurement organizations were given performance incentives, they began collecting more organs. Because they were compensated more for kidneys, they focused on those more than other organs. The reform reduced dialysis costs by almost $2 billion over five years. https://t.co/Db2276rKYU
— Crémieux (@cremieuxrecueil) December 14, 2025
Interestingly enough, the country of Iran also provides a striking example. Setting aside the regime’s atrocities for a moment, in 1988 the country established a system that pays people to donate their kidneys, a model credited with largely eliminating its kidney transplant waiting list.
The argument for incentives is straightforward: Give people a greater reason to donate, and more will be willing to do so.
Yet proposals to compensate organ donors are routinely met with moral objections, that payment could exploit the poor, pressure vulnerable people into taking medical risks, or turn the human body into a commodity.
But the exploitation critics warn about already happens in the organ black market, where donors can be cheated by brokers, poorly compensated, left without proper medical care, and are often victims of trafficking. Banning payment has not eliminated the trade, it has simply pushed it beyond the safeguards a legal system could provide. This of course doesn't solve all of the ethical considerations, but it gives us a reason to consider a different approach.
Now imagine an organ market under American law, built on the principles of a free market, where compensation rises when more people need organs and falls when demand declines. A system that rewards people for donating rather than forbidding them from being paid, and one that could save tens of thousands of lives in the process.
