Larry Niven made his mark as a science fiction writer in the 1970s and 1980s. Among his earlier writings are a series of stories about organlegging, an illegal and legal trade in human organs. In Niven's books organ rejection has been solved and transplants promise a form of immortality. Jaywalking becomes a capital crime; executed prisoners are the primary source of legal organ donation.
We haven't solved the rejection problem, but Niven gets full marks anyway. Recently China's executed prisoners have been donating their organs to Japan. In 2004 the NYT profiled the sales of a Brazilian live donor kidney to an American recipient. A NYT ethics columnist was asked about another kidney sale to a US donor. Some years ago I read an extraordinary NYT article examining the sale of Chinese and Pakistani organs throughout asia, including sale to US recipients who traveled for their transplants (I cannot find the reference!).
This is a true growth industry, there's big money to be made for those who've developed their moral fiber in the tobacco industry. And what about those ethics?
From an ethical point of view, the prisoner trade is more clearly wrong. It incents the state to execute, and the prisoner gets nothing from the deal. The "voluntary" donations from the impoverished are in practice also terribly wrong, but the reasoning is more complex.
If my family was mired in dire poverty, I would probably donate a kidney for the right price. Alas, in practice the social consequences of this sort of transaction are likely to be so severe that they outweigh any theoretical utilitarian benefit to donor and recipient. In any case, in our world, such trade would take advantage of hundreds of millions of people with limited judgement and cognitive abilities -- taking their organs for a song.
This is wrong, wrong, wrong, wrong. Any physician partaking in this trade in any way should have their diploma revoked.
PS. I would be remiss if I did not mention my solution to a part of the organ shortage. In the US there are many, many adults who want to ride a motorbike with a helmet. We should simply require that than any brain-dead motorcyclist recovered without a helmet is a mandatory organ donor ...