5. The quality of organs goes down.
It's been extensively studied for paying for blood donations, and the consensus is widely to discourage the practice.
Blood donations produce the needed amount of blood, and that system basically works. So it makes sense to not take any risks to expand the already sufficient supply.
Meanwhile the kidney transplant world is desperately tragic. About a dozen Americans die each day from lack of a kidney. Even if an added kidney supply would be lower quality on the margin, it would save a huge amount of lives.
Before donating a kidney, I went through half a dozen invasive, detailed medical exams that didn't depend on my given answers at all.
What I worry about, is in countries like the US/UK where "having a student debt" has somehow become a badge of honour, I can see "selling a kidney" to get through university becoming the same honourable demonstration that you are committed to do what it take to succeed.
... and by extension, show people who are not as committed. You can see it coming: "my son sold his kidney to succeed, why should we give even more to the people that are not even ready to take such a small step".
In general, we seem to expect people to take an ever growing amount of risk for the reward of maintaining their social standing. Being able to sell your body in piece is just raising the bar even higher.
Middle men are easy to fix. Require the kidney transplant be done in a registered location and don't accept "nameless" kidneys.
So do the same failed arguments -- how has legalization and regulation of the market gone for Germany? Or rather how has it gone for German prostitutes, because from a tax revenue perspective Germany is doing wonderfully, with the perverse incentive to keep exploiting poor and trafficked women.
Luckily, someone is offering $1,000 for a kidney and you're compatible! You can fix your car / post your bail / pay the loan shark, with $500 left over!
You're pretty much forced to sell your organ at this point. And this point is reached all the time by the economically disadvantaged.
Of course, without the last resort of selling body parts they'd be even more screwed, so I don't know the right thing to implement in this case. Just wanted to answer your question.
This is what gets brushed aside when the organ donation process is activated. Only now do we have results from long term study of donors and some of them as pointed out by the author are not good at all.
This problem is not confined to kidney donations for instance, is a growing body of evidence that points to long term complications from another medical procedure - laser surgery (lasix). Here many patients suffer degenerative vitreo-reinal changes over time (if you can, avoid it).
It is not actually the case that donors do not benefit from the current process. Outside the US in the largest market for kidney surgeries India, they are paid; as well as in the Thailand and the middle east. End stage renal disease is one of the worst conditions to die from, and everyone involved with an afflicted patient is desperate for a solution since they suffer almost as much as him/her.
So,No. Paying for organs will not solve this particular problem. But neither will doing nothing. One solution that can improve the number of donor organs is to make it mandatory that organs from qualified people who die violent or accidental deaths be immediately considered for transplant to those who need them. But you can guess this proposal would be (illogically imo) opposed in many countries.
Edit: On a related note, I have been mulling over an idea for a while for a startup to reduce the cost of dialysis for patients with renal disease. At present, it is prohibitively expensive and some patients require 2 sessions a week. If anyone is interested in joining me, reach out. My email address is in my profile.
Also there are a few big studies comparing long term quality of life. Pretty favourable for surgery. This easily trumps "we found changes in cornea".
The ethical problem there is how hard the hospital works to save a patient as opposed to letting them die so they can harvest the organs.
I suspect that if organ donation is widespread, it becomes much more normal, and this would cease to be an issue/rumor at all. And I do think the OP is correct - the bigger problem is families and religious views more than folks simply letting people die.
But a huge problem also is that many relatives will baulk at the idea of their loved ones being harvested and also some religions have injunctions against this
There are arguments on both sides of opt-out ("presumed consent"), but even the cons argue more about ethics and lawsuits -- re dead people who clearly no longer need the organs -- than that there'd be more organs available to the living who might.
pro: https://sparq.stanford.edu/solutions/opt-out-policies-increa...
con: http://www.hopkinsmedicine.org/news/media/releases/presumed_...
But, please, let's stop parting people out as the easy answer and try a little harder to solve serious medical conditions some other way.
This is so very UGH.
If you walk through the current process, everyone in the donation gets paid -- doctors, nurses, hospital, pharma -- except the donor.
There are a number of advantages of donors getting paid:
1. The supply market would increase dramatically. Thus many more people receiving organs who would have otherwise died waiting.
2. Heirs to people who have died young, with healthy organs could get paid for donating their organs.
3. Black markets would be dramatically reduced, since people in desperate need of an organ could pay in the open, rather than secretly paying a donor.
4. People without money can legally open a Kickstarter to raise funds for an organ donation.
Note Iran has partially done this, and the results have been very positive [1].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819484/