TRANSPLANTThree people a day die because of a shortage of vital organs for transplant, according to the Organ Donation and Transplantation division of NHS Blood and Transplant. The BMA has called for introduction of presumed consent to donation, but this is politically unfeasible and, in any case, unnecessary. Instead, the government should remove the ban on paid organ and tissue donations. This would very quickly end the shortage of vital organs and save hundreds of lives every year.

There are two kinds of organ donation: living donations and posthumous ones. Living donations occur when someone donates a surplus organ or tissue – the most common example is a kidney, but tissue donations of blood, bone marrow and skin are also in short supply. Posthumous donations can include the heart, kidneys, pancreas, lungs and liver. Both would rise rapidly if sales of organs were allowed.

In the case of posthumous organ and living tissue donations, the case is clear. A major reason for the shortage of organs is that most people lack the time necessary to go through the hoops needed to donate. Others have problems with the ‘yuk factor’ associated with thinking about their own mortality, a fear of needles (in the case of blood) or reluctance to go through with a painful operation (in the case of bone marrow).

Many of these marginal problems would be overcome if money could be paid for donations (or for signing onto the donor register for posthumous donations). People would have the incentive to spend the time finding out about how they can donate, and many people's squeamishness would diminish if they could make some money out of donations. Some might be balk at the thought of a generous act being turned into a financial transaction, but this sentimentality costs hundreds of lives every year.

Worries that living people would feel forced into donating a kidney are real and must be given serious consideration before the law is changed. But the debate over this element of paid donations should not be allowed to overcome the much broader case for paid donations – posthumous organ and living tissue donations – that would not endanger the life of any donor, but would save the lives of many people in need of a transplant. Legalizing these donations would be an immediate way to save lives at zero cost.