Thirty years ago this month, Congress approved and President Reagan signed one of the most well-intentioned but disastrous laws in American history. The 1984 National Organ Transplant Act (NOTA) formalized a nationwide organ transplant system and—more importantly—prohibited compensating organ donors or their estates. Lawmakers reasoned that money should not be a deciding factor in who gives or gets a vital organ. 

Under the law, hundreds of thousands of dollars are spent on each life-sustaining transplant of a kidney, lung, liver or heart,[1] but not one cent can be used as incentive to secure a healthy organ. As a result, the national transplant list has swelled from 10,000 in 1988[2] to nearly 125,000 today.[3] Some 6,500 Americans die each year awaiting transplant,[4] roughly equal to the total number of American troops killed in Afghanistan and Iraq. Yet, every year, thousands of other Americans’ bodies with transplantable organs are lowered into the earth—organs intact—to become food for worms.[5]

Some ethicists and doctors defend NOTA, saying it protects people from the temptation to sell their organs for money. That’s a strange argument in a country where conservatives favor “individual liberty” and liberals defend a person’s “right over his or her body.” But put that concern aside; enough organs could be harvested from the recently deceased to reduce—if not eliminate—the current organ donor list. In return, the donor’s estate could receive credit toward funeral expenses or a cash award; economists have estimated that awards of as little as $1,350 could resolve the need for donor kidneys.[6]

 NOTA supporters also claim that compensating donors would reduce the total number of organs available for transplant because some current donors might hold out for money or else think donation is “tainted” by the incentives. Perhaps that’s true, but that would mean transplant organs are unlike any other good.[7] Farmers are paid for their crops, yet people donate food to the needy and there’s no U.S. food shortage. Builders are paid for houses, yet Habitat for Humanity has volunteers and there are plenty of homes. Teachers are paid, yet people volunteer at schools and no one calls for pay cuts to solve a teacher shortage. For that matter, no one claims that transplant surgeons should be unpaid to ensure an adequate supply of doctors.

NOTA supporters offer one more argument: compensating donors just feels wrong. [8] Yet they struggle to justify that feeling in ethical theory. For instance, the late medical ethicist Benjamin Freedman wrote, “That which cannot be bought and sold is by definition priceless. By removing human life and health from the marketplace, we affirm this principle.” That’s a moving statement—but it’s wrong. When something can’t be bought and sold, despite the owner’s willingness to part with it, then it isn’t priceless—it’s worthless. Yet donor organs aren’t worthless to the tens of thousands of people who now suffer while on the transplant list. They certainly merit $1,350 for a kidney or the few thousand dollars it might take for a heart—amounts that are less than half a percent of the cost of transplant surgery.

To their credit, some NOTA supporters say they are willing to consider evidence that incentives might improve organ donation. But when shown that incentives encourage the supply of other goods, they say other goods are not like vital organs. They want specific evidence that incentives will increase organ donations, but they won’t consider easing NOTA—even for a pilot program—until they have such evidence. Obviously, it’s hard to provide such evidence when it’s illegal to collect that evidence.

And yet, there is such evidence—if NOTA supporters would only consider it. For instance, though NOTA prohibits incentives for organ donations, a 1968 federal law allows financial incentives—such as covering funeral expenses—for donations of whole cadavers for research purposes. There is a steady supply of research cadavers, and even an overabundance in states where incentives are more generous.[9]

Other evidence comes from overseas. In 1988, Iran adopted an incentive system for living kidney donors in an effort to reduce that country’s lengthy kidney waiting list. Today, Iran’s wait list is retired.[10] In 2006, the Saudi province of Riyadh began an incentive system for organ donations from families of the recently deceased. The supply of transplantable organs immediately tripled and has remained at that level ever since.[11]

When it comes to transplant organs, the United States unfortunately is not as progressive, liberal or free-market as Iran or Riyadh. As a result, another 6,500 Americans will die this year because they didn’t receive a transplant, and the waiting list will top 125,000 suffering souls. It’s well past time to reform one of America’s deadliest laws.

Thomas A. Firey is a senior fellow for the Maryland Public Policy Institute and a Washington County native.