There is another answer rather than this which I don't think can ethically be called a voluntary act. There is no way we can ever guarantee that the transaction is purely uncoerced- yes, giving money in my mind is coercion no matter how you want to frame it.

There are many European countries who have more donations made than here, like in France. It's basicaly because as an adult you opt OUT of the donation system if you don't want to be a donor rather than here where it is a bloody nightmare to opt in. I have my willingness to be a donor down on my licence (but my family can object and overrule this if they so desire) and when I put my name on the national register I have to then sign and post back paperwork with quite a bit of information needed on it. I'm donating organs when I die (if suitable)not asking for a mortgage. Why can't my licence preference tick be enough?

Knowing the apathy of the average Aussie and the unwillingness to really accept death, chronic illness and dying in our culture, no wonder the rigmarole I have been through is avoided by the average person. There are a heck of a lot of people running around without a will so why would they go through this to have their name on a donation database.

There is also a complete lack of education and real non emotive publicity about on the matter, how many people are really aware of the register and what goes on when you donate an organ? How many are afraid that they will be "let go" in case of an accident because of a preference on their licence?. Education rather than dollars is the key here.

The show was a monumental succes by the way. Especially because of the publicity it received from disapproving MPs. There was quite a bit of glee about them ending up with the proverbial egg on their faces.

As to selling kidneys. I object to this. Not because of some imaginary slippery slope, but because when organ donation becomes commercialised it will be exploited by the more financially able. It will not end up with the 'most in need'.

As to bone marrow, anybody can go on a register to donate bone marrow.

Organ donation is not as simple as just waiting in line. The organ needs to be compatible with the recipient. Unfortunately, some of us have been blessed with more common blood types than others.

As to being a living kidney donor, this is already possible. Blood relatives are good possible matches. Friends can also donate. It all depends on compatibility.

Also, bear in mind that there is a pretty good reason why we have two kidneys and not just one. One is better than none, two is better is one.

I wouldn't do it for money for a stranger, $50 000 is not enough, though I'm financially struggling, but I would do it for my children, spouse, siblings. And that is already possible.

Organ donation should be discussed by everybody with their family. Just as funeral arrangements. Having worked in Intensive Care Units I can tell you only a small minority of people have ever discussed these things.

I support the idea that people should be able to sell their kidneys, but in my mind the argument rests as much on the individual’s right to make choices about their own life and body as maximising utility. I worry about the purely utilitarian rationale for permitting it advanced by Mirko, in particular:

“When we are confronted with difficult ethical choices, in my view the morally correct decision is the one that will maximise net human flourishing, where each person’s interests count equally. In the donor situation, this means preferring the potential recipient who needs it most (i.e., is closest to death) and who, on the basis of age and talent, is likely to contribute most to the community.”

This argument could equally be used to support compulsory organ harvesting – if someone else needs my second kidney more than me, then net human flourishing will be enhanced by taking one off me and giving it to them. Indeed, if someone better than I will die without my remaining kidney, they should have that one too.

Utilitarianism is to my mind an incomplete basis for ethical decision making. The dignity and autonomy of the individual are also important.

If I remember correctly, Spain has a much higher donor rate and this is because donor organs are removed from bodies. The wishes of relatives do not count.

If Australia really wanted to increase the organ donor rate, it could easily adopt the same practises as that of Spain.

However I feel once we cross the line on allowing organs to be sold, there will no turning back. There already exists a black market on donor organs in some countries around the world. It is after a highly profitable business.

There are cases where australians are purchasing organs like kidneys, they then travel to one of these countries for the transplant. Unfortunately they do not come with a quality guarantee and a much higher risk of acquiring a blood borne virus.

Even in the best of medical circumstances, transplantation is not without its risks.

At the moment there are only 3-4 people agitating for Australia to change it's laws to allow for organs to be sold. I suspect the numbers will grow, especially when some people realise that there is profit in it for them.

Thank you Mirko, stimulating, provocative and entertaining as usual. But let us push your philosophy back to even greater depths. The greatest good for the greatest number. For people who have a dud pair of kidneys - let them go. Caluculate the real costs of transplantation, hospitals, surgeons, rehab etc etc, subtract the gains in knowledge and expertise and advancements of science, and put the savings into the most propitious ways of increasing human welfare.
I am not expert, but I suspect very much that a buck spent on prolonging the life of a kidney sufferer would improve the wellbeing of many others by a large multiplier.

Good article, Mirko.
I agree that the Dutch Big Donor Show should be praised for being so successful in attracting worldwide attention to the shortage of organs.

I disagree that selling kidneys would be a good thing though- obviously, the rich will be on the receiving end and the poor will end up as the donors.
Many Australians can’t even afford to go to the dentist – let alone pay for a kidney when they need one.

The best solution is for the government to bring in an opt-out system; everyone is a postmortem donor unless they opt out.
Of course, it's a problem that kidneys from live donors will last an average of 23 years, while kidneys from diseased people last up to five years.

I would only ever donate my kidney to my children, husband or siblings, not to strangers.

Another kidney story which I happened to watch on Australian Story recently was about this Christian cult, the "Jesus Christians" whose members are strongly encouraged to donate their kidney to strangers to show their faith.

The mother of this young Australian donor (who was about to donate his kidney to a patient at a Canadian hospital), tried to stop her son from donating because she she found that he was brainwashed by this "Kidney Cult" and might regret it later.
Cleverly, she finally managed to stop the transplant by saying that if they ignored the fact that her son was brainwashed, he might decide to sue them later (if he ever snaps out of the cult’s influence, I suppose).

http://www.religionnewsblog.com/18418/jesus-christians-2 Canadian hospital refuses kidney donation from religious cult member.

A cult can put a lot of pressure on their members who are vulnerable or gullible so I thought it was a good thing that this kidney transplant was stopped.

I believe that money can also put a lot of pressure on poor people- being poor is also a form of being more vulnerable and being under greater pressure