Epstein in WSJ and Satel in NYT both say something needs to be done about kidneys (reversing the Ethicist’s stand). They both look to big payments to kidney sellers as a way to stop “6,500 excess deaths” due to lack of kidneys.

It is against the law to offer “valuable consideration”. Kidney buyers can take the matter into their own hands and not wait for a law change. Instead of a “valuable” consideration for a sold kidney, consider the following proposal:

• Small payments to lots of prospective sellers upon death
• A contract that pays a buyers organization a large sum of money from the estate if the organ sale is obstructed by family

It would work like life insurance in reverse. Kidney buyers would pay lots of people a consideration that doesn’t trigger the “valuable” language. In the absense of a kidney being delivered on death if one is available, the estate of the deceased would owe a payment. Some donors might sign the commitment without a consideration just to create a strong incentive for their family to honor their wishes with regard to donation.

The proposal is not sensitive to the needs of the grieving family, but I would rather have 3250 irate families than 6500 extra prematurely grieving ones due to a lack of kidneys.