Every year, thousands of Europeans die not because kidneys are unavailable, but because the law forbids the only transaction that would produce them. According to the Council of Europe 2026 report, which covers all organs, 6,626 people died while being on a waiting list in 2025, an average of 18 people a day. At the same time, Iran, which is the only country with a legal market for living donors, has eliminated its waiting list. People on the waiting list with kidney failure can spend years receiving dialysis; a treatment that can keep them alive for some years yet not fully replace a healthy kidney. The prohibition on compensating kidney donors relies on dignity and solidarity. But if compensation could encourage more people to donate a kidney, should government prohibit it in the name of protecting human dignity? A carefully regulated system of donor compensation can respect autonomy, prevent exploitation and save lives.
The European Parliament and Council Directive states that organ donation must be voluntary and unpaid. Living donors may receive reimbursement for expenses and lost income related to donation, but any other financial benefit related to organ donation is prohibited by law. An individual can voluntarily donate a kidney to a stranger without receiving payment, but if the same individual wants to receive a financial gain from the donated organ, it is outright prohibited. The government justifies this restriction by pointing to low-income individuals taking health risks out of financial desperation. However, adults are generally trusted to make decisions over their bodies, even if these decisions carry risks. Why should the introduction of compensation automatically invalidate their consent?
Since 1997, Iran has operated a system allowing compensation for kidneys donated by living, unrelated individuals. A 2006 study by Ghods and Savaj reported that the program increased kidney transplantation and claimed that Iran eliminated its kidney transplant waiting list by 1999. The Iranian example also shows why regulation matters. A 2025 review of the Iranian system showed that living kidney donors receive two forms of compensation: one from the government ($1,400) and the other from the recipient. Iranian model suggests that financial compensation can become part of a functioning transplantation system.
One objection to paying kidney donors concerns economic inequality. But the government allows people to take dangerous jobs, such as logging, mining and construction, out of economic necessity. The government cannot ban employment because some workers are desperate. The government denies low-income individuals a legal option to improve their lives while doing nothing to address the poverty itself. Coercion is mitigated not by banning financial compensation, but via designing safeguards: minimum age, psychological evaluation, independent donor advocacy, etc. Payment does not automatically prove exploitation, just like the absence of payment does not automatically guarantee that a donation is free from pressure, manipulation, and other means of influence. Indeed, the current system simply hides coercion behind the word “gift,” while leaving donors to absorb travel costs, lost wages and recovery expenses out of their own pocket.
Another objection comes from the principle of bodily autonomy: individuals should have significant control over decisions that concern their bodies. If an adult is ready to donate a kidney, the moral status of that decision should not change because of the financial compensation being involved. But this dignity argument is slippery: whose dignity is being protected? The donor who wants compensation, or the person who dies waiting for his kidney? The kidney donated through altruism is beautiful; the kidney donated for money is useful. The kidney that does not exist because the government criminalised the transaction is neither. Individuals have authority over their own bodies, and that authority should not simply disappear because a decision involves money.
The donor owns the kidney and the right to sell it, and the regulation exists to protect their right. If two consenting individuals agree on compensation for a kidney donation, the state should not automatically prohibit their agreement because money is involved. Medical screening, consent and protection against force are necessary, but they do not require the government to become the sole buyer of human organs. The purpose of these regulations should be to protect the individual right, not to replace personal choice with bureaucratic decisions.
A complete prohibition may be motivated by legitimate concerns, but these concerns must be weighed against the consequences of maintaining a system in which demand for kidneys exceeds supply, and people continue to die waiting for transplantation. The current prohibition is an active policy choice that makes people practice dialysis, which is a treatment that cannot fully replace a healthy kidney. The prohibition is a market, not one measured by price, but by death. A regulated system of financial compensation is not the absence of ethics. It is ethics applied to the world we live in. The question is not about putting a price on a kidney. The question is about our willingness to keep paying for the kidneys with our lives.
