Recently, the Internet auction company eBay had an unusual item up for bid, a healthy kidney. Though selling human organs on eBay violates both federal law and eBay's own rules, the bidding reached $5.7 million before the folks at eBay found out about it and pulled the plug on the bidding. A week later, a woman donated one of her kidneys to a stranger. Physicians and policy makers have been calling for a new system to determine who gets which organs. All the while, people are on long waiting lists for organ transplants, many dying before getting matched up with a donor organ. As a society, we are faced with severe organ shortages and must come to grips with the problem.

With improvements in immune suppression and experience of transplant surgical teams, success rates have markedly improved since Joseph E. Murray and his colleagues at Harvard Medical School first transplanted a human kidney in 1954. So many more people are willing to have organ transplants, while the number of matching organ donors has not kept up, even though we have record numbers of possible donors because of accidents and violence. How can we increase the number of organ donors?

In his book, Machinery of Freedom, David Friedman argued rather convincingly that there are only three basic ways to get people to cooperate with one another. First, we could force them, use coercion. Second, we could use love, that is, get people to see that our goal and their goal are the same, appealing to the charitable side of human beings. Finally, we can use bribery or voluntary exchange, giving up something that others value to obtain something you value, appealing to the more selfish side of people.

Friedman argued that a free society should avoid the use of force or coercion when it can and should concentrate on getting people to cooperate through charitable giving and voluntary exchange. While lauding the charity approach, Friedman noted an overwhelming problem with relying upon charity, love for one's fellow beings--there just isn't enough of it. Most of us do not rely upon the "kindness of strangers," because strangers (and acquaintances) aren't as kind as we would like them to be, they don't provide for all of our wishes. The shortage of transplantable organs is a result of trying to rely completely upon the kindness of strangers.

There are many ethical questions that arise with any system of allocating scarce organs to people who could use them. Whether the allocation system relies upon a panel of doctors setting up and monitoring an organ allocation protocol or a system that provides for payments to be made to donors or their families, the unfairness of who gets an organ and who doesn't remains. Not long ago people questioned the fairness of singer David Crosby receiving a liver transplant, in spite of his liver problems being largely self-inflicted liver damage from years of drug and alcohol abuse. The lack of fairness in allocating organs lies with not having enough. A system that relies upon the kindness of strangers only exacerbates our lack of transplantable organs.

Some may complain that if we set up a market for organs that only the rich would be able to afford $5.7 million for a kidney. What is ignored is that the reason that the bidding on the eBay kidney went so high is that it is illegal to sell human organs. The number of organs would drastically increase with a market of some type. Black market prices that we see from the eBay kidney case are the direct result of making the market illegal.

Making it illegal for people to receive money for their organs does not keep costs down to recipients. It is still very expensive to get an organ transplant. Now, however, the only ones to be paid for the transplant are the doctors, other health professionals and the hospitals. We know that if they were not paid, they would not provide their services. We also see that when organ donors are not paid, they do not provide enough organs.

The organ shortage problem is so acute in Britain that some are suggesting that instead of signing donor cards or getting a family's permission to take a person's organs, that people would have to sign cards saying that they do not wish to have their organs available for transplantation. Essentially, making a person's organs the government's by default. The ethical problems with such a system seem to far outweigh any type of voluntary exchange in organs.

Scarcity, in whatever resource it occurs, forces people to compete for that resource. If the competition is not through voluntary exchange using money, it will occur some other way. We do not allow people to buy babies, yet would-be adoptive parents spend great sums on attorneys and various agents to adopt babies. A market for adoptive babies arises, but it is one that is quite convoluted.

To end this serious discussion, I offer the words of wisdom and charitable thoughts from John Prine's song, "Please don't bury me."