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.

"Valuable consideration," as a legal matter, means any consideration at all. You can't get out from under that language just by making the payment sufficiently small.

I agree that something needs to be done to encourage organ donation (living or otherwise), but you need to get a change at the legislative level to allow for it.

Perhaps a game of skill with a low entry fee woudl work.

If the kidney is a prize, not a purchase, this just might work. Paying for the kidney might be tough, but perhaps the company could hire the kidney donors for a period of time - say, to review data.

But who would run this kind of game?

Hire for data--sounds like a space act agreement. Maybe I'll run it for NASA. Trouble is that the donor could refuse to donate and there would be no recourse. And if the donee committed to a large penalty for not donating, the data buyer could refuse to buy the data and the donee would have no recourse. Sounds like this will continue to be a foreign activity for a while.

Nah, just make having one kidney a requirement for getting the job, and make part of the compensation a health care package designed for folks who have only one kidney.

Or, once a donor is found, he is compensated as a 'test subject', researching the long-term effects of kidney donation on the donor. You can still pay folks to participate in studies, right?