Paid organ procurement: pragmatic and ethical viewpoints.

None of the familiar arguments against paid organ procurement really works. Most arguments spring from revulsion that arises from the abuses of the practice rather than the act itself. This has not stopped official condemnation. However, the evidence we have at present is that such condemnation, aimed at correcting a perceived moral wrong rather than at abuses of a practice (the correction of which might actually bring some moral good), has utterly failed, and many more countries including the United States now harbor paid organ procurement. We can try to develop and articulate a truly compelling moral argument against paid organ procurement or we can try to minimize the harm that comes out of this practice. Since it is unlikely that all countries will agree on a standardized approach in such a muddled field, the best way may be to let every country decide on what is best for itself. Some may want to ban the practice using legislation. Others may want to try regulating the practice, knowing full well that they cannot stop it and that turning a blind eye to the practice, or simply condemning it, does no good whatsoever and actually increases the harm because everything is done underground, with middlemen and mafia-like organizations making a lot of money out of a lot of misery. Some countries may choose to find other, more innovative solutions. We call attention to an important resolution dealing with this subject at the December 2002 ethics and transplantation congress in Munich.