Authored By: Ayah Ghaith
Middlesex University
Introduction
In the past decade, more than 12,000 people died in the United Kingdom waiting for an organ transplant, which is approximately 3 people a day.[1] Moreover, worldwide, merely 10% of demand is met, making this an international problem.[2] Despite advances in medicine and the possibility of living kidney and liver donations, there is a significant organ shortage. The UK relies on altruistic donors.[3] Many adults are prospective donors; however, only half the people on the waiting list are getting a transplant. [4]The country is relying on the willingness of donors, while more people die waiting, therefore, altruism alone is insufficient to meet demand. This raises the question as to whether the UK’s prohibition on monetary compensation remains justified. This legal article argues that in the UK, while prohibition of commercial transaction in human tissue protects dignity and prevents exploitation, each person has autonomy to make decisions over their own body, so the UK should consider a regulated model for living organ donation that could increase the rates of donation, thereby saving lives and balancing the interests of society. This article advances as follows: the current legal framework of the UK, arguments for and against monetary compensation, as well as a comparative analysis of other jurisdictions and concludes by evaluating whether the current framework is justified.
The Existing Legal Framework
Human Tissue Act 2004
The Human Tissue Act 2004 (HTA) governs activities involving the removal, storage and use of human tissue, ensuring proper consent, protecting individuals and prohibiting commercial transactions.[5] Sections 2 and 3 of the HTA involve the consent of children and adults in different circumstances.[6] This aims to protect individuals and seeks to prevent the use of their human tissue against their will.
Section 32 of the HTA provides that a person commits an offence if they seek to give or accept a reward in exchange for any controlled material, which is defined in the Act as parts of the human body, excluding gametes and embryos.[7] Commercial transactions for transplantation are considered illegal.
The Act established the Human Tissue Authority to regulate the use, removal and storage of tissue for research and medical treatments. They aim to use human tissue safely and with proper consent.[8] Parliament intended the Act to preserve dignity, avoid distress of future scandals and to improve public confidence regarding donations.[9]
Human Rights Considerations
Article 8 of the European Convention on Human Rights (ECHR) is the right to respect for private and family life.[10] The prohibition of commercial transactions may interfere with an individual’s right to private life, as preventing monetary compensation can interfere with bodily autonomy. Nevertheless, the prohibition stops ordinary citizens from becoming involved in unlawful conduct. Article 8 is a qualified right, so it can be interfered with in accordance with law to protect health, morals and vulnerable people from manipulation.
Living Organ Donation in Practice
The NHS ensures that those who donate their kidney or liver do not struggle financially due to the donation.[11] Donors may submit a reimbursement claim that may cover costs like transportation, loss of earnings and any expenses incurred as a result of the donation process. Reimbursement compensates donors for financial loss rather than awarding them with a profit.
III. Arguments Supporting Monetary Compensation
Two academic researchers, D. Roger and B. Venter, previously suggested a monopsony system where the NHS provides monetary compensation for living donors.[12] In 2024/25, the number of living donors was 994, which decreased to 953 in 2025/26, as previously mentioned, those donors are altruistic, so this decrease may indicate that the current system is inadequate.[13] Therefore, instead of waiting for the willingness of potential donors, providing some compensation might reduce the organ shortage in the UK.
To add, the case of Airedale NHS Trust v Bland [1993] AC 789 considered the principle of autonomy and the right of an individual to determine whether they wish to accept or reject a treatment.[14] As the law recognises that competent adults are free to determine what to do with their own body, it can be argued that this should extend to the choice of receiving monetary compensation for a living organ donation.
A system regulated by the NHS can reduce the risk of ordinary citizens involving themselves with organ traffickers, but it could provide them with the financial compensation they may seek when donating. Many people may resort to illegal markets due to their desperate need for a transplant.[15] With monetary compensation, more people may donate their kidney or parts of the liver, causing fewer people to turn to illegal organ markets.
It is known that humans can live with one kidney given that it is healthy, but any deterioration might lead to the need for dialysis – a treatment for people whose kidneys are not working.[16] This results in ongoing expenses to pay for dialysis, which in 2024 was around £30,800 annually, which is more costly than transplantation in the long run, which is £17,000 along with £5,000 for immuno-suppression medications annually.[17] Thus, reimbursement may still leave a donor financially disadvantaged.
Hence, an increase in living donors may reduce the need for dialysis, which decreases the costs of the NHS. Therefore, according to Roger and Venter, financial compensation for living donors is likely to lead to more donations, causing more transplants. This would shorten the waiting lists and transplants would happen sooner, resulting in a reduction in deaths and an increase in the survival rate of patients.[18]
Arguments Against Monetary Compensation
Exploitation and Genuine Consent
Victims of organ trafficking are usually poor and vulnerable individuals who are coerced into giving up their kidney without their consent.[19] In the case of R v Obeta and others [2023], a young, poor Nigerian man, C, was brought by a Nigerian senator who planned to procure his kidney for a transplant for his daughter.[20] C was unaware of the transplant nor had he given genuine consent. The senator alleged that C was the recipient’s cousin and was donating altruistically. Those individuals exploited C and deceived him into believing that they would provide him with a better life in the UK, however they were planning to operate on him and leave him with no aftercare, increasing the chances of his death. The risks of exploitation and using a person as a commodity are reasons why commercial transactions of organs are prohibited.
If the sale of organs is permitted, it may cause a difficulty in identifying genuine consent to donate from the desperate need for money. This may lead to individuals acting against their will and involuntarily donating for the purpose of gaining money, due to the financial pressure people feel. Such actions go against the principle of bodily autonomy, as people may not be choosing but rather forced to do it.
As Roger and Venter’s monopsony suggestion, where the NHS is the only ‘buyer’, ideally it should be a regulated system, but in practice it is uncertain whether the NHS can manage a new system ensuring the prevention of exploitation.[21]
B. Inequality and Human Dignity
The people who donate are often reported to be in debt. They sell their organs for the sole purpose of paying it off, but after that they do not have enough money to start a new life, resulting in debt again.[22] However, due to lack of aftercare or discontinuing treatment, their health worsens and they may be unable to work. Hence, they lose their money, possibly their job, and a part of their body, which suggests the serious problems that arise from commercial transactions.
Selling one’s organs may cause a significant inequality between individuals,[23] which arguably already exists, as the UK has a high income inequality.[24] Consequently, it can be viewed that the economically disadvantaged people are commodified. This is inconsistent with human dignity which Parliament values.[25]
Comparative Perspectives
Singapore
Similar to the UK, Part 4 of the Human Organ Transplant Act (HOTA) states that the buying or selling of organs is prohibited.[26] This is to ensure “equity and fairness” between individuals and protect them from exploitation. In 2009, there was an amendment to the HOTA to allow reimbursement payments for living donors. A reimbursement model was established for short- and long-term medical care, as well as compensation for expenses and loss of earnings incurred as a result of the donation.[27]
Compared to the UK, the reimbursement model in Singapore is broader and incorporates future medical expenses, rather than just the short-term costs as a consequence of donation. Singapore demonstrates that instead of permitting the commercial sale of organs, a legal system that provides financial support to living donors may increase the donation rates.
Iran
Iran is the only country that recognises financial compensation for living kidney donations.[28] “The “rewarding gifting” act” was approved in Iran. Individuals aged between 18 and 40 may sell their kidney in exchange for payment.[29] The state provides a certain reward, while the main ‘gift’ comes from the private agreements between donor and patient.
As a result of the compensation scheme, the waiting list for transplant patients has been significantly reduced to nearly zero.[30] This reduces deaths due to waiting for a transplant. Hence, the organ shortage has decreased, which may lower the need for illegal organ markets.
However, many donors come from poor backgrounds, people struggling to support themselves, rent a house or meet their essential needs.[31] Poverty is widespread in Iran, leading to younger individuals, including a 16-year-old boy, posting advertisements on the walls of streets to sell their kidney.[32] The target donors are usually vulnerable and uneducated people. They are often younger, less educated and poorer than the recipients.[33] This demonstrates the unfairness in the system. Consequently, in the long-term their health is likely to deteriorate because of inadequate medical aftercare.
To add, the case of Ghaffar illustrates a man who wanted to become a teacher but had renal disease. He came from a poor background, but he and his family were in desperate need for a kidney.[34] They sold land, and were left with nearly nothing. They paid the donor that was supposed to be suitable and underwent the transplant. A week later Ghaffar’s body rejected the kidney and died. Thus, such commercialism and commodification of people is likely to have negative outcomes.
In contrast, the UK only provides reimbursement and continues to have a long waiting list in need of altruistic donors. Meanwhile, Iran highlights that a monetary compensation scheme could reduce organ shortage and shorten the waiting list. However exploitation and inequity remain a problem.
Conclusion
The ongoing organ shortage experienced by the UK and its continued reliance on altruistic donors should raise the question as to whether the current legal framework remains justified.
The Human Tissue Act 2004 prohibits any form of commercialism of the body, with the aim to protect human dignity and prevent abuse and inequality.[35] Meanwhile, the NHS provides reimbursement, so that individuals do not suffer financially as a result of the donation.[36] Monetary compensation could increase living donations, which may reduce the waiting lists and hence avoid the deaths of patients awaiting a transplantation. Nonetheless, a financial compensation scheme still has its disadvantages, as vulnerable people remain a target for commodification and are at a high risk of exploitation.
Iran illustrates that a regulated system of receiving payment for kidney donations is possible. It leads to a country with practically no waiting list and fewer deaths, but remains a target of criticism due to the economically disadvantaged individuals. Meanwhile, Singapore demonstrates a broader financial scheme to support altruistic donors throughout the long-term consequences of donation without the need to commodify the people.
Accordingly, the laws of the UK prohibiting commercial transactions of living organ donation remain justified as it maintains the aims of Parliament to conserve dignity and prevent exploitation. However, the UK should incorporate a reimbursement scheme similar to that of Singapore, as it could assist donors for any continuing medical treatment and to prevent a decline in their health. This ensures that donors are treated adequately without undermining the objectives of Parliament.
VII. References
Primary Sources:
Airedale NHS Trust v Bland [1993] AC 789
Human Tissue Act 2004
R v Obeta and others [2023] Sentencing Remarks of Mr Justice Johnson Central Criminal Court, 5 May 2023
Secondary Sources:
Adair A and Wigmore S, ‘Paid Organ Donation: The Case Against’ (NIH, April 2011) < https://pmc.ncbi.nlm.nih.gov/articles/PMC3291132/ > accessed 21 July 2026
Alesi F and Muzi L, ‘Kidneys for Sale: Iran’s Trade in Organs’ (The Guardian, 10 May 2015) < www.theguardian.com/society/2015/may/10/kidneys-for-sale-organ-donation-iran > accessed 21 July 2026
B J Inq, ‘An Even Fairer Exchange: Further Reasons Why Living Kidney Donors in England Should Be Financially Compensated’ (NIH, 22 Decemeber 2025) < https://pubmed.ncbi.nlm.nih.gov/40459825/#full-view-affiliation-1 > accessed 21 July 2026
‘Children As Young As 16 In Iran Sell Kidneys Amid Poverty’ (Iran International Newsroom, 28 March 2024) < www.iranintl.com/en/202403289088 > accessed 21 July 2026
Currie S, ‘Paying Kidney Donors Won’t Solve the Problem’ (The Guardian, 30 January 2026) < www.theguardian.com/society/2026/jan/30/paying-kidney-donors-wont-solve-the-problem > accessed 21 July 2026
‘Dialysis’ (Cleveland Clinic, 28 March 2025) < https://my.clevelandclinic.org/health/treatments/14618-dialysis > accessed 21 July 2026
European Convention on Human Rights 1950
Explainer: Understanding Human Trafficking for Organ Removal’ (United Nations) < www.unodc.org/unodc/en/frontpage/2024/June/explainer_-understanding-human-trafficking-for-organ-removal.html > accessed 21 July 2026
Explanatory Memorandum to the Human Tissue Act 2004 (ETHICAL APPROVAL, EXCEPTIONS FROM LICENSING AND SUPPLY OF INFORMATION ABOUT TRANSPLANTS) Regulations 2006 SI 2006/1260
GMDP Academy Editorial Board, ‘Global Organ Shortage and Ethical Solutions’ (GMDP academy, 27 November 2024) < https://gmdpacademy.org/news/global-organ-shortage-and-ethical-solutions/ > accessed 21 July 2026
Human Organ Transplant Act (Singapore)
Loud F, ‘Transplantation and Organ Donation for People Living with Kidney Disease’ (25in25, 21 September 2024) < www.bsecho.org/25in25collab/25in25collab/Articles/202409-EXE008-Fiona-transplant.aspx > accessed 21 July 2026
Matas A, ‘Should We Pay Donors to Increase the Supply of Organs for Transplantation? Yes’ (BMJ, 14 June 2008) < https://pmc.ncbi.nlm.nih.gov/articles/PMC2427086/ > accessed 21 July 2026
Moeindarbari T and Feizi M, ‘Kidneys for Sale: Empirical Evidence from Iran’ (24 June 2022) < www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10178/full > accessed 21 July 2026
‘More than 12,000 people lost their lives waiting for a transplant in the past decade’ (NHS, 22 September 2025) < www.organdonation.nhs.uk/news/more-than-12-000-people-lost-their-lives-waiting-for-a-transplant-in-the-past-decade/ > accessed 21 July 2026
NHS, Organ Donation and Transplantation Activity Data: UNITED KINGDOM (13 April 2026)
‘Organ Donation and Transplantation’ (NHS) < www.nhsbt.nhs.uk/what-we-do/transplantation-services/organ-donation-and-transplantation/ > accessed 21 July 2026
‘Organ Tree Ltd, offering payment for deceased organ donation’ (NHS, 8 August 2017) < www.organdonation.nhs.uk/news/organ-tree-ltd-offering-payment-for-deceased-organ-donation/ > accessed 21 July 2026
‘The Human Organ Transplant (Amendment) Bill Second Reading Speech’ < www.moh.gov.sg/newsroom/the-human-organ-transplant-(amendment)-bill-second-reading-speech/ > accessed 21 July 2026
‘The Scale of Economic Inequality in the UK’ (Equality Trust, 2022) < https://equalitytrust.org.uk/scale-economic-inequality-uk/#contents > accessed 21 July 2026
‘Who are the HTA’ (Human Tissue Authority) < www.hta.gov.uk/about-the-HTA/who-are-hta > accessed 21 July 2026
[1] ‘More than 12,000 people lost their lives waiting for a transplant in the past decade’ (NHS, 22 September 2025) < www.organdonation.nhs.uk/news/more-than-12-000-people-lost-their-lives-waiting-for-a-transplant-in-the-past-decade/ > accessed 21 July 2026.
[2] GMDP Academy Editorial Board, ‘Global Organ Shortage and Ethical Solutions’ (GMDP academy, 27 November 2024) < https://gmdpacademy.org/news/global-organ-shortage-and-ethical-solutions/ > accessed 21 July 2026.
[3] ‘Organ Tree Ltd, offering payment for deceased organ donation’ (NHS, 8 August 2017) < www.organdonation.nhs.uk/news/organ-tree-ltd-offering-payment-for-deceased-organ-donation/ > accessed 21 July 2026.
[4] ‘Organ donation and Transplantation’ (NHS) < www.nhsbt.nhs.uk/what-we-do/transplantation-services/organ-donation-and-transplantation/ > accessed 21 July 2026.
[5] Human Tissue Act 2004 (HTA 2004).
[6] HTA 2004, s 2 and 3.
[7] HTA 2004, s 32.
[8] ‘Who are the HTA’ (Human Tissue Authority) < www.hta.gov.uk/about-the-HTA/who-are-hta > accessed 21 July 2026.
[9] Explanatory Memorandum to the Human Tissue Act 2004 (ETHICAL APPROVAL, EXCEPTIONS FROM LICENSING AND SUPPLY OF INFORMATION ABOUT TRANSPLANTS) Regulations 2006 SI 2006/1260.
[10] European Convention on Human Rights 1950, art 8.
[11] See n 3.
[12] J Bioeth Inq, ‘An Even Fairer Exchange: Further Reasons Why Living Kidney Donors in England Should Be Financially Compensated’ (NIH, 22 Decemeber 2025) < https://pubmed.ncbi.nlm.nih.gov/40459825/#full-view-affiliation-1 > accessed 21 July 2026.
[13] NHS, Organ Donation and Transplantation Activity Data: UNITED KINGDOM (13 April 2026).
[14] Airedale NHS Trust v Bland [1993] AC 789, 816.
[15] ‘Explainer: Understanding Human Trafficking for Organ Removal’ (United Nations) < www.unodc.org/unodc/en/frontpage/2024/June/explainer_-understanding-human-trafficking-for-organ-removal.html > para 3 accessed 21 July 2026.
[16] ‘Dialysis’ (Cleveland Clinic, 28 March 2025) < https://my.clevelandclinic.org/health/treatments/14618-dialysis > accessed 21 July 2026.
[17] Fiona Loud, ‘Transplantation and Organ Donation for People Living with Kidney Disease’ (25in25, 21 September 2024) < www.bsecho.org/25in25collab/25in25collab/Articles/202409-EXE008-Fiona-transplant.aspx > accessed 21 July 2026.
[18] Arthur J Matas, ‘Should We Pay Donors to Increase the Supply of Organs for Transplantation? Yes’ (BMJ, 14 June 2008) < https://pmc.ncbi.nlm.nih.gov/articles/PMC2427086/ > accessed 21 July 2026.
[19] See n 15 para 6.
[20] R v Obeta and others [2023] Sentencing Remarks of Mr Justice Johnson Central Criminal Court, 5 May 2023.
[21] See n 12.
[22] Anya Adair and Stephen J Wigmore, ‘Paid Organ Donation: The Case Against’ (NIH, April 2011) < https://pmc.ncbi.nlm.nih.gov/articles/PMC3291132/ > accessed 21 July 2026.
[23] Sandra Currie, ‘Paying Kidney Donors Won’t Solve the Problem’ (The Guardian, 30 January 2026) < www.theguardian.com/society/2026/jan/30/paying-kidney-donors-wont-solve-the-problem > accessed 21 July 2026.
[24] ‘The Scale of Economic Inequality in the UK’ (Equality Trust, 2022) < https://equalitytrust.org.uk/scale-economic-inequality-uk/#contents > accessed 21 July 2026.
[25] See n 9.
[26] Human Organ Transplant Act, Part 4 (Singapore).
[27] ‘The Human Organ Transplant (Amendment) Bill Second Reading Speech’ < www.moh.gov.sg/newsroom/the-human-organ-transplant-(amendment)-bill-second-reading-speech/ > accessed 21 July 2026.
[28] Tannaz Moeindarbari and Mehdi Feizi, ‘Kidneys for Sale: Empirical Evidence from Iran’ (24 June 2022) < www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10178/full > accessed 21 July 2026.
[29] Francesco Alesi and Luca Muzi, ‘Kidneys for Sale: Iran’s Trade in Organs’ (The Guardian, 10 May 2015) < www.theguardian.com/society/2015/may/10/kidneys-for-sale-organ-donation-iran > accessed 21 July 2026.
[30] See n 29.
[31] ‘Children As Young As 16 In Iran Sell Kidneys Amid Poverty’ (Iran International Newsroom, 28 March 2024) < www.iranintl.com/en/202403289088 > accessed 21 July 2026.
[32] See n 31.
[33] See n 28.
[34] See n 29.
[35] See n 5.
[36] See n 11.
