It's obvious from the responses to Dr. Satel's article that the idea of financial incentives for organ donation remains controversial. As the organ shortage continues to grow, I expect public opinion will eventually support a legal organ market and changes in public policy will follow.

In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative approval is required.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

As a lifelong organ donor, I 100% agree. I believe we should, upon developing illness, have first shot at necessary organs.

Even though I am against the idea of selling organs, if it were allowed, I would remove myself from the organ donor program. Upon my death, I would rather my family be compensated for my organs if that was an option.

This is an interesting idea... But I doubt it would be 'fair'.

In my experience, there can be many medical reasons why someone who requires an organ transplant would not be qualified to be an organ doner as well.

(example - I had a friend who had SCIDS. When in his late 20's, he was on the waiting list for a heart/lung. There's no way he could ever be considered an organ doner after death. He ended up taken off the list though, became too sick, and died in 1996. He'd contracted Hepititus-C from a badly screened batch of gamma globulin.)

Sigh.

Excellent points, Wren. I also wonder how you could ever police the system, given the numerous variables involved in selecting who is the best match. It would only seemingly work if all things were equal...but are all things ever equal? And, if not, how do you decide how much to weight it? People squawk about the unfairness of insurance having waiting periods. Can you imagine the first time somebody was denied a kidney because they hadn't signed up as a donor a week sooner?

If it's deemed unfair to offer donors money, surely it's equally as bad to basically guarantee them organs should they ever need them. But if you don't give them a significant edge, then you're back to there being no real incentive to be a donor.