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According to Matas’ plan the donor would get paid by the government or insurance company; the selection of who gets a transplant could still be done by a UNOS-type system; all donors would be fully evaluated (as they are now), and a legal system would include oversight, long-term follow-up, and “treatment of the donor with dignity and appreciation for providing a lifesaving gift.” Matas says “the payment could be a fixed sum and/or include term life insurance, long-term health insurance, reimbursement for travel expenses and time out of work, or a tax deduction.”
Matas makes one other important point about cost. Because dialysis is so much more expensive than a transplant, paid donation could be cost-neutral to the health care system.
What the debate comes down to is whether or not one believes in the power of markets. Public policy experts and the public at large will also have to get over their revulsion at the thought of selling organs to the highest bidder.