THE sale of organs such as kidneys for use in transplantation should be made legal to help to meet the rising demand for donors and curb the booming international black market, doctors say.

A paper by two American doctors, published today in the journal Kidney International, suggests that the medical profession should consider setting up a regulated market in organs from live donors.

The idea of human organ sales remains one of medicine’s greatest taboos, but the researchers argue that it could be the only way to ensure that the growing queue of people in urgent need of organs such as kidneys could be addressed. They say that it would save lives and help to keep out unregulated surgeons.

There are more than 5,500 patients waiting for a new kidney, but only about a third of that number receive a transplant each year. Figures show that a total of 1,783 people had the operation last year.

While many doctors discount financial transactions for organs as wholly unethical, others have suggested that it is not such a large moral distance from selling semen or eggs.

Eli Friedman, of the State University of New York, and Amy Friedman, of Yale University, the authors of the paper, say that the case for legalising kidney purchase hinges on the key premise that individuals are entitled to control of their body parts, even to the point of inducing risk of life.

“Strategies to expand the donor pool have been mainly unsuccesful . . . ”, they say. “One approach to expanding the pool of kidney donors is to legalise payment of a fair market price.”

The doctors suggest a figure of about $40,000 (about £23,000) to the donor, with marketing and purchase regulated by a government agency.

The paper notes that last September, 65,000 people in the US were listed as waiting for a deceased-donor kidney. At least 3,000 of those who died each year might survive if a suitable donor kidney were found.

A report commissioned recently by the parliamentary assembly of the Council of Europe found that demand for kidneys was soaring in all Western countries as more patients suffered kidney failure and the organ supply continued to fall.

It suggested that 40,000 patients were waiting for a transplant in Western Europe, and 15 to 30 per cent would die on the waiting list. Desperate patients have been known to pay more than £100,000 for an illegal kidney transplant and take whatever risks were necessary. But the Council of Europe report found that the going price paid to people in Eastern Europe for a kidney was only about $2,500, with black-market traffickers taking the huge profits.

Living donors are being increasingly used for kidney transplants across the world, as the results are better for the recipients and donors can lead normal lives with one kidney if they have good medical care. Of the 1,783 kidneys donated last year, a quarter came from a friend or relative of the patient.

Such is the sensitivity over the subject of organ sales — and the implied selling of organs by the poor to the rich — that when the British Medical Association held a debate in 2003 it provoked outrage.

Drs Friedman and Friedman argue that full discussion of all aspects of organ donation is urgently needed. They suggest that eliminating black-market brokers would divert funds to kidney sellers, while the money saved by cutting the number of patients on dialysis might fund transplants.

“At the least, debating the controlled initiation and study of potential regimens that may increase donor kidney supply . . . is better than doing nothing more productive than complaining about the current system’s failure,” the authors conclude.

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