I'll Trade You Two Spleens and a Pancreas…

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One of the first pieces I wrote for Reason was about the group LifeSharers, whose members pledge to donate organs upon death, but request that priority be given to any other compatible members on the waiting list. The medical establishment, as I noted there, seems mostly opposed to this approach. Today, there's a New York Times story on the apparently kosher practice of explicit quid pro quo organ trades, wherein the family members of people requiring organs undergo simultaneous operations, swapping to achieve a match. Can anyone construct a coherent bioethical theory according to which this is OK, but LifeSharers is objectionable?