Yesterday’s New York Times carried an Opinion by the Editorial Board which suggested ways in which the current and chronic shortage of kidneys available for transplantation could be alleviated without “resorting” to (certain types of) payment.

Unlike the earlier NYT post by Katrina Bramstedt on this issue, which I criticized earlier, the views expressed in the Opinion are reasonable. Except that the math just doesn’t add up.

The Board suggests that steps should be taken to reduce the current wastage of viable organs, that more people should be encouraged to donate, and that some of the costs associated with the live donation of a kidney (such as those incurred in travel to transplant centres for evaluation) should be covered. These are all sensible suggestions.

However, they won’t be enough to secure the numbers of organs that are needed.

The Board notes that the waiting list for kidneys in the US is over 100,000, and that 4,000 people die each year waiting for a transplant. The measures that they propose will come nowhere close to securing enough kidneys to meet this demand. We know that encouraging people to donate doesn’t secure enough–we’ve been trying that for years. Even if we secure the 1,000 kidneys that are wasted each year there’s still a huge shortfall. And covering the costs associated with donation will no doubt encourage a few more people to donate who would otherwise be deterred by the costs associated with this, it is unlikely to motivate enough additional people to meet the shortage.

Interestingly, the Board also notes–and appears to endorse–that in addition to these proposals some “experts” have argued that people should be encouraged to donate by allowing their relatives to jump to the top of the list for transplants if they need to receive one. This is clearly a straightforward incentive. But if this type of incentive is considered acceptable, why shouldn’t we allow other incentives-such as the tax credits, college tuition programmes, or early access to Medicare that the Board notes have also been proposed? After all, there’s no real difference between providing a donor early access to Medicare and providing a donor’s relative with early access to a transplant. And kidney exchanges are already legal. So, if I can swap my kidney for a kidney for my partner, why couldn’t I simply sell it to buy her one?

It’s time that we stopped trying to draw illusory distinctions between different types of incentives and simply recognize that there’s nothing unethical about markets in human transplant kidneys.