It's an urban legend we've all read - you meet some nice girl in Thailand and you black out and wake up in a bathtub without a kidney.

Kidneys, and other replaceable organs, have value because the wait list is long and someone has to die to donate them.

Arthur Matas, Professor of Surgery at the University of Minnesota, writing in this week's BMJ says a regulated system of compensation for living donors may be the solution to the growing shortage of kidneys for transplantation.

But Jeremy Chapman, from the Centre for Transplant and Renal Research in Sydney, argues that this could reduce the supply of all organs. He believes that the idea of the regulated market is a myth, which could have devastating consequences on the less easily regulated environments of Asia and Africa.

For it
Matas says in many areas of the United States the average wait for a transplant from a deceased donor is five years, but in some parts it is as long 10 years. Because of this the annual death rate for suitable transplant candidates has risen from 6.3% in 2001 to 8.1% in 2005.

We already compensate people for sperm, ova, surrogate motherhood, and loss of body parts in court cases without any loss of dignity or humanity, he says. Similarly, we should allow a trial of compensation for living donation to learn if we can increase the number of kidneys while protecting the dignity and humanity of the donors.

Current unregulated systems in developing countries only benefit the rich, and provide no long term donor follow-up, or protection for either buyer or seller, he says.

In contrast, a regulated compensation system in the Western world would increase the number of available organs. Such a system would provide strict control and limit harm by allowing every candidate an opportunity for transplant, full donor evaluation, informed consent, long term health follow-up, with payment managed by the government or insurance companies, and the banning of any other commercialisation.

Against it

According to Chapman, selling organs does not help lift people out of poverty. In India and Pakistan people sell their kidneys to pay off debts, but they continue to live below the poverty line, and recent data show that 86% report deteriorating health after organ removal.

He then asks which family member would donate if the government is willing to pay for a kidney? Many would prefer a stranger rather than a family member to take the risk. What's more, if a kidney is worth money before death, then rather than donating, families may demand money for all sorts of organs after death.

The reality of regulated organ purchase will be a reduction in organ donation, and the destruction of kidney, heart, lung, liver, and pancreas transplantation, he concludes.

So what do you think of a regulated market for organ transplants? Anything is better than waking up in a bathtub without a kidney, though if you told us you met a nice girl on the streets in Thailand, we are likely to be more surprised if it actually turned out to be a girl.