Is Legalizing the Organ Market Possible? G. Novelli, M. Rossi, L. Poli, V. Morabito, S. Ferretti, A. Bussotti, F. Nudo, G. Mennini, F. Antonellis, and P.B. Berloco ABSTRACT Introduction. Two opposing views of the human body have existed since time began. Can it be traded or does its value go beyond a monetary one? Today it is illegal to sell organs but the success of organ transplantation has give rise to an enormous controversy. The continued increase in the need for organs has lead to a major use of live donors. Consequently, clandestine selling of organs is becoming more widespread for two main reasons: scientific progress and market demand. Our aim was to consider the protection of ethical principles through legislation. Materials and methods. Based on the principle that it is morally unacceptable for people to die on a waiting list, we analysed various ways in which the National Health Service could give incentives to live donors, including reimbursement of health expenses, tax relief, pension or early retirement benefits, or education grants for the children. Possible incentives for cadaveric organ donation included reimbursal of health and funeral costs, or increase in widow/er’s pension. Conclusion. The tendency may be toward reimbursement of costs rather than actual payments. A legal, ethical organ market could save thousands of human lives, but it must be correctly regulated. O RGAN TRANSPLANTATION has been a major breakthrough in modern medicine, which goes well beyond the field of medicine itself, causing discussion on concepts such as the importance of life and death and our relationship to our own bodies to help others. 1 The various aspects concerning organ transplantation have raised moral, philosophical, psychological, and economic issues. 2 The prob- lem is the insufficient number of organs available compared to the number of patients on waiting lists. Urgent patient requests, the National Health Service of certain countries, inadequate laws, social conditions, and indigent poverty to- gether with a limited health culture have induced many persons to the buying and selling of organs, which only serves to mortify the donor’s condition and often compromises the donor’s quality of life due to inadequate clinical evaluation both pre- and posttransplantation. A pessimistic reality fore- sees difficulty in meeting the demand for organs even with an excellent National Health Service, increased numbers of donors, and better legislation. This complex situation has led to a more or less tolerated, if not always legal, organ market, where the rich can buy from the poor. 3 There has always been a correlation between gross national product and life expectancy, especially in poorer countries. Hence the need for clarification from a moral, ethical, legal, and political standing. Scientific progress and effective needs, not to mention society itself, have changed how we relate to our bodies. Our bodies can undergo sex changes, sterilization, and all manner of plastic surgery to improve both physical and psychological well-being. 4 We have obtained a large amount of freedom in what we do with and to our bodies. This situation has changed medical ethics. Demand could change moral principles, which is a real threat, as we live in times of “weakened ethics.” Faced with this reality, we cannot continue to hide behind words such as “altruism” and “free giving.” 5 The choice cannot be left to ethics alone. A legal stand must be taken, which of course can always be From the Dipartimento di Chirurgia Generale specialità chiru- rgiche e trapianti d’organo “P. Stefanini,” Universita’ Degli Studi di Roma “La Sapienza,” Viale del Policlinico N 188, 00144 Roma, Italia. Address reprint requests to Prof Novelli Gilnardo, Viale del Policlinico 188, 00144 Roma, Italia. E-mail: novelligilnardo@ virgilio.it © 2007 by Elsevier Inc. All rights reserved. 0041-1345/07/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2007.05.075 Transplantation Proceedings, 39, 1743–1745 (2007) 1743