The ban on the sale of organs has the effect of imposing a price of zero. And as with the case of all price controls, shortages are the natural consequence. A few other countries have taken a different course. In India, where payments for organs are legal, the going price for a kidney is $1,800, about six times the average annual wage. As a result, the supply of kidneys in India is much higher than it otherwise would be. In the United States, it is evident both that there is a shortage of organ donors and that potential donors would respond to financial incentives. Accordingly, H. Tristram Engelhardt, Jr., a bioethicist and physician at Baylor College of Medicine in Houston, thinks organ sales should be legalized, but carefully regulated to prevent abuse. A growing number of his medical colleagues are coming to the same conclusion.

A strong case can be made for allowing individuals full freedom of choice in these areas. The objection is that the choices may be irreversible and often occur under circumstances in which real patient preferences may be hard to discern and opportunities for abuse may be rife. Although that objection may justify careful procedural safeguards, the possibility of abuse cannot possibly justify a blanket, sweeping prohibition against individual choice.