Should the Sale of Kidneys Be Legalized?
The most rigorously built ethics topic in the Year 1 rotation. It opens with arithmetic — eleven Americans died waiting for a kidney yesterday, and eleven more will die today — and then refuses to let that arithmetic settle anything. Instead of two sides it offers four perspectives, none of which fully answers the others, and closes with nine discussion questions engineered to break whatever position a student arrived with. If you want students to discover that a real moral problem can resist resolution, this is the week.
Open the student page for this topicOne-Week Instructional Plan
The Year 1 rhythm, with an unusual Monday. The deck's opening is a designed emotional sequence — a running count of deaths — and it works precisely because it comes before any argument. Let it land before you complicate it.
Eleven a Day
Free write (5 min): should a person be allowed to sell a kidney? Take it before the numbers — students' pre-data instincts are the thing the rest of the week works against.
The problem, in the deck's own escalating sequence:
- About 11 Americans died yesterday waiting for a kidney. Eleven more today. Eleven tomorrow. Roughly 4,000 a year.
- 90,000 Americans are waiting and only about 27% will receive a kidney this year. The rest stay on dialysis — hours at a time, painful and expensive, making normal work, travel, and life difficult.
- How donations actually happen: a direct match with a compatible relative; a swap, where two incompatible pairs trade so each recipient gets a compatible organ; or a chain, where one altruistic donor sets off a sequence of linked donations. Only 2% of donations come from non-directed altruistic donors — the ones that start chains.
- The ceiling on the current system: if every American registered as an organ donor and every possible deceased donation occurred, it would still take 80 years to clear the backlog. Most deceased donors' kidneys are unusable due to trauma or disease. This is the slide that ends the "just get more people to sign the donor card" answer.
- The system that already exists: about 20% of kidney donations globally come from the unregulated black market. The choice is not between a market and no market.
- What the law allows now: donors' costs can be covered — travel, hotels, medical bills — but nothing above them. You may give a kidney; you may not sell one.
Assign the readings, two arguing each way, due before Tuesday:
- Why Selling Kidneys Should Be Legal — New York Times
- Paid Organ Donation: The Case Against — National Library of Medicine
- In Afghanistan, a Booming Kidney Trade Preys on the Poor — New York Times
- Why Legalizing Organ Sales Would Help to Save Lives, End Violence — The Atlantic
Not Two Sides — Four Lenses
Mindful moment (5 min), then the structure that makes this topic work. The deck offers four perspectives and says explicitly that they are neither exhaustive nor mutually exclusive, and that no student has to adopt any of them. They are tools for weighing, not teams to join.
- Freedom (supports a market). People have the right to make choices about their own bodies, and markets are efficient at sourcing and allocating scarce resources.
- Sanctity (opposes). Selling kidneys debases and objectifies the human body — on religious or secular grounds — and corrupts the integrity and moral worth of persons by making the body property, no different from goods in a shop.
- Life Value (supports). Saving a life outweighs the other concerns. Consider what society loses when someone dies waiting.
- Class (opposes). A market would be exploitative and coercive, entrenching class differences. One defender of this view imagines moneylenders demanding organs as collateral. Even with regulation preventing the worst cases, kidneys would still flow from poorer bodies to richer ones.
The supporting data to work through alongside them:
- Kidney disease causes 2.7% of American deaths — a small but significant share, and far more than its share of news coverage and public attention.
- The waiting list has grown faster than the donor pool for years.
- Death rates from kidney disease are highest in Southern and Midwestern states. Ask why — access to care is the usual answer, and it's worth interrogating.
- Millennials are significantly more likely than older generations to think selling organs should be allowed.
- Economists support an organ market far more than the general public does. Ask what economists see that others don't — and what they might be missing.
The Questions That Break Every Position
Mindful moment (5 min), then work the deck's discussion questions. These are the best set in the Year 1 rotation — each one is a counterexample aimed at a specific position:
- Aimed at opponents: swaps are already common. Is a swap a form of paying for a kidney with another kidney? If trading is acceptable, what exactly is wrong with paying?
- Aimed at opponents: women can already be paid for donating ova, which are also finite. Is there a real difference?
- Aimed at opponents: poor people already take on more bodily risk than the rich — mining, soldiering, construction. If we permit that inequality, does the coercion argument survive?
- Aimed at supporters: should different kidneys carry different prices? What if the government bought every kidney at a single fixed price — does that answer the class objection, or dodge it?
- Aimed at both: how does a surgeon's oath to "do no harm" apply? Does permitting payment allow harm — or does preventing payment cause it?
Before students leave: themes, lingering questions, and one new resource for Thursday.
Push to the Edges
Mindful moment (5 min), resources shared, then the deck's three hardest questions — each designed to find where a student's principle actually stops:
- The single case. One donor, one recipient. The recipient will certainly die tomorrow without the kidney, and the donor will only give it for money. Does that change the morality of the payment? If the answer is yes, what was the objection really about?
- Xenotransplantation. If the choice is between a consenting adult who is paid and a pig that cannot consent, does the moral calculation shift?
- Where's the line? If you can sell a kidney, can you sell an arm? A heart? Almost every student says no somewhere — and articulating why there is the real work of the week.
Score Your Participation
The four reflective questions, then the participation matrix. Students also use the participation rubric to score the week and explain the score.
Notes for the Guide
This is the topic most likely to end without consensus, and that is the design rather than a failure. The deck says so directly: the perspectives are a starting point for weighing a thorny issue, not a menu of correct answers.
The Opening Sequence Is Deliberate
- The escalating count — 11, then 11+11, then a wall of them — is emotional by design, and it earns that because the number is real. Don't rush it and don't apologise for it.
- Then immediately give students the tools to resist being moved purely by it. "This is terrible" does not by itself establish "therefore a market." The gap between those two is the week.
- The 80-year figure is the single most important slide. Almost every student's first solution is "make everyone an organ donor," and this ends that path with arithmetic rather than argument.
The Black Market Reframes Everything
- 20% of kidney donations globally already come from an unregulated market. The real question is not market versus no market — it is regulated market versus the one that already exists.
- The Afghanistan reading is the corrective to that framing, and it should be assigned to supporters particularly. It shows what an unregulated trade does to poor people in practice, not in theory.
- Pair those two deliberately: the strongest argument for legalisation is that prohibition hasn't stopped sales, and the strongest argument against is what those sales look like where they happen.
Where Discussion Tends to Go
- The swap question is the sharpest tool in the deck. Swaps are legal, routine, and are a trade of kidney for kidney. Opponents have to explain what money adds that makes it wrong — and the answers are interesting.
- The ova comparison lands hard, because paid egg donation is legal, common, and involves a finite resource and real medical risk. Students who oppose kidney sales rarely know it.
- "Where's the line?" is the closing question for a reason. Kidney, then arm, then heart. Everyone stops somewhere, and finding out whether they can justify their stopping point is the actual assessment.
- Personal connections are possible. Some students will know someone on dialysis or a transplant list. Let it come voluntarily and keep the discussion anchored in evidence.
Adapting This Topic
- Optional extensions: For Sale, By Owner: The Psychology of Repugnant Transactions (NPR) — excellent on why some trades feel wrong — and The Sale of Human Organs (Stanford Encyclopedia of Philosophy) for students who want rigour. Arthur Matas's The Case for Living Kidney Sales is the deck's third optional piece. Link coming soon
- Independent reading suggested by the deck: Never Let Me Go by Kazuo Ishiguro, and What Money Can't Buy: The Moral Limits of Markets by Michael Sandel.
- Short week: merge Wednesday and Thursday but keep at least one question from each set — the counterexamples are the topic.
- Pairs well with: the trigger warnings topic, which is the other Year 1 week where the evidence refuses to hand anyone a clean win.