Governed financial incentives as an alternative to altruistic organ donation.

In 1984, an offensive proposal for kidney sales by a US physician led the National Organ Transplant Act to become a law in the United States. Similar legislation passed in many other countries. An ethical consensus developed around the world that there should be no monetary compensation for transplantable organs, either from living or deceased persons. Unfortunately, the altruistic supply of organs has been much less than adequate, and thousands of patients die each year waiting for organ transplantation. As the altruistic system of organ donation has met with failure, some from the transplant community believe that altruism alone is not enough to satisfy the needs of the thousands of patients on organ transplant waiting lists, and providing some financial incentives or social benefits to organ sources is necessary to increase the number of cadaveric or living organ donations. In this article, the many controversies surrounding altruistic and compensated organ donation systems are discussed. The Iran model for renal transplantation, a compensated and well-regulated living-unrelated donor renal transplantation program that has successfully eliminated a renal transplant waiting list in Iran, is briefly reviewed.