Too many desperate patients worldwide are defying existing laws. Is it time to reconsider the ban on kidney sales?

In mid-July 2008, 90,000 Americans were listed by the Organ Procurement and Transplant Network (OPTN) as waiting for a deceased donor kidney.

An undefined but definite cohort—estimated to be at least 3,000—of those on the wait list will die this year but might survive if suitable donor kidneys were available. Indeed, of 1,732 adults on a transplant list in Scotland, the relative risk of mortality at one year was 68% lower for deceased donor kidney transplant recipients compared with those who remained on hemodialysis (J Am Soc Nephrol. 2005;16:1859-1865).

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The grim reality was noted in a 2006 speech by Kenneth P. Moritsugu, MD, MPH, then Acting Surgeon General of the United States: “Every day, 18-20 people die, waiting for a solid organ transplant (, accessed August 27, 2008).”

Despite intensive public relations efforts, including celebrity endorsements, National Kidney Foundation efforts, and state driver’s license advance permission, the number of deceased donor kidney transplants performed in the United States has been relatively static over the past decade.

The United Network for Organ Sharing (UNOS) notes that while the number of kidney transplants performed between 1988 (8,870) and 2007 (16,625) increased 87.4%, deceased organ transplants in the same interval increased only 33.3% (from 7,061 to 10,587).