Defense Date


Graduation Date

Spring 1-1-2017


One-year Embargo

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Henk ten Have

Committee Member

Joris Gielen


commodification, compensated organ donation, exploitation, organ donation, organ sales, trafficking


With over 100,000 Americans currently on organ waiting lists in the United States, the mass shortage of viable organs for transplantation is one of the most pressing healthcare issues that we face as a country today. Thousands of these individuals on organ waiting lists will ultimately die waiting on an organ transplant that will never come. Many differing proposals have been discussed with the aim of increasing organ donation rates and the raw number of organs available for transplant, including changing our default consent status for cadaveric organ donation and the option of incentivizing organ donation by compensating live donors with financial incentives. Iran is the only nation in the world that currently has a legally regulated system of compensated live organ donation (CLOD), specifically for kidneys, and it has been successful since its implementation, even eradicating its kidney waiting list, which no other nation in the world can claim. However, even with this practical success, CLOD has been a very controversial concept in the professional bioethics literature, and it has been labeled as unethical and illegal in many Western countries, including the United States.

This dissertation utilizes arguments and principles from applied ethics, political philosophy, and behavioral economics to ethically and practically analyze the need for revamping the entire United States organ donation system, including both live and cadaveric organ donation. The primary focus of this dissertation will be on justifying the ethical basis of CLOD in the United States, and a practical model of CLOD will be proposed that also includes significant changes to the cadaveric organ donation system.

The dissertation proceeds as follows. Chapter one gives a brief overview of the issues and debate surrounding CLOD. Chapter two provides the necessary background context for establishing the practical need and feasibility of a system of CLOD in the United States, including examining past, present, and future systems of organ donation and situating the medical, moral, and political bases of a potential system of CLOD in the United States. Chapters three and four examine the major ethical components and arguments for and against CLOD, including but not limited to the ethical principles of principlism and the objections from exploitation and commodification. Chapter five ethically analyzes the differing types of cadaveric organ donation and examines several other potential proposals for procuring organs. And finally, chapter six amalgamates the previous arguments and develops them into a complete proposal for a practical model to revamp the current United States organ donation system to create a more efficient and ethical system of organ donation, procurement, and transplantation.