Prehistoric medicine derived from herbalism- harvesting plants and herbs to heal and treat disease. This practice was typically performed by priests and shermans of societies who believed that both natural and supernatural powers heal. Early mesopotamian medicine introduced the concept of diagnosis with the Diagnostics Handbook, as well as examinations, and prescriptions. Indian practices contributed to the evolution of medicine with the eight branches of medicine. These eight branches include internal medicine, surgery, ear/nose/throat disease, pediatrics, spirit medicine, toxicology, rejuvenation, and aphrodisiacs. Greek medicine, the first to open medical schools in 700 BCE, began the practice of observing patients. As medicine began to evolve and expand, many humans made advances in the field of science: cures for the plague and smallpox and bionic limbs and and transplants and corpus callosums and radiation and chemo and an unstoppable growth in the medical field. 

As these ameliorations surfaced, ethical controversies emerged with them. As people’s lives were put on the line, as people’s health was at risk, as people’s families put their trust into doctor’s judgement, questions of ethics and standards came, too. Precautions were set in stone to eliminate chances of breaching ethics. Doctors were forced to take oaths that claim, “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug” (Amatruda 1). This oath that includes a well rounded foundation of ethics and principles, ensures that the basis of medicine- to help and not harm- is upheld. With extremely controversial issues, such as organ donation, the lines of right and wrong are not always drawn so straight. In 1954 the first successful kidney transplant occurred, opening the gate to a flood of controversy. With issues such as offering incentives for organ donation, ethicality is widely called into question. Where does the line draw? Offering incentives for organ donation is ethical, if properly regulated. 

The simple truth is, incentives will increase the number of organs donated and save lives. Critics call into question the morality behind offering incentives, but supporters call to question the ethicality of letting people die who could potentially be saved. With the waiting list of patients continuously growing, the line is incessant. Much like the lines at Disney World, “Nearly 100,000 people are on waiting lists for organ transplants in the United States” (Caplan 1). Caplan’s proposal for reducing this number lies in presumed consent- which all people are organ donors unless stated otherwise- however, polls predict that this would not increase the number of organs donated. Offering incentives, on the other hand, could eliminate the waiting list all together, and save a greater amount of lives. The excerpt “Governed Financial Incentives as an Alternative to Altruistic Organ Donation”, from the book Experimental and Clinical Transplantation, hypothesizes how successful an incentivized system could be by using Iran as an example. “Iran- by providing financial incentives to volunteer living donors, has eliminated the renal transplant waiting list” (Ghods 154). 

In this polarized controversy, critics continue to refute the policy for incentives. Compensation, however, is not clearly defined. In the article “Ethical Incentives- not payment- for Organ Donation”, The new England Journal of Medicine proposes that “New federal legislation should embrace ethically acceptable ways to encourage such charitable donation of organs, some of which are outlined here” (2). Their claim that compensation goes beyond monetary payments is elaborated on by the proposition to offer incentives such as tax deductions, funeral reimbursements, a medal of honor, etc. Their solution eliminates the controversy over monetary compensation by offering less controversial compensations. Funeral reimbursements, for example, are likely to persuade a family seeking proper burial and minimal expenses to donate a kidney to a family in need. In the article “Shifting ethics: Debating the Incentive Question In Organ Donation” the complications of bridging the monetary and medical worlds are clearly defined. Joralemon elaborates that, “ money and vital organs occupy distinct moral universes for substantial numbers of health professionals and members of the public at large. I am among those who believe that the profession will suffer a serious setback if it attempts to bridge these domains” (34). The majority of opposing claims source from complications of monetary concern. As the New England Journal of Medicine spotlights in these two articles, however, these concerns vanish when we broaden our definition of compensation to a term encompassing more than monetary transactions. 

Altruism is a widely glorified trait that societies- especially the American society- value. Altruism, although commendable, is not required for donation. Supporters of incentives claim “Altruism is not the only route for donation because sometimes people need to be given a little push” (Castro 1). Altruism- an individual moral- should not be a deciding factor in saving lives. The supposed altruistic system “has been unsuccessful so far and left hundreds of thousands in danger who could be saved” (Erin 2). By claiming altruism is the priority, they are relegating saving lives to second place. The critics of the incentives proposal argue that altruism is an undebatable must, however, they find no ethical issues with providing doctors with monetary compensation for their services. These critics disregard the opposing view noted by Wilkinson in “The Sale of Human Organs” that questions, “ why couldn't paid and unpaid donation systems peacefully coexist, with people who want to give freely continuing to do so?” (Wilkinson 2). This hypocritical claim that altruism is the goal and it would vanish when incentives appear, disregards the basic foundation of medicine- to save lives- and leaves hundreds of thousands of patients in line knocking on death’s door. 

The current system for organ supply and donation already contains a black market. Offering incentives to donors could put a stop to the current exploitations in progress. Offering incentives could persuade donors to stray away from the market that is currently “underground, the market is not subjected to institutional regulation that could ensure proper pretransplant and posttransplant care for the donors” (Castro 2). Donors would be more inclined to legally donate where they would receive compensations, providing recipients with legal and screened organs. This would offer a safer, legal option for people that currently resort to buying organs off the black market, especially if there are incentives beyond monetary payment. The article “Arguments in favor of Compensation” lays out the current loopholes that have left holes for illegal buying and selling of organs. “we ought to be more alarmed by the exploitation that is already going on where organ purchases are illegal but are flourishing anyway” (Castro 3). As stated in the article, the illegal market will continue to exist without legal incentives, but could possibly diminish with incentives. This black market demonstrates the invalidity of the argument that there is no source of the proposed incentives. As the incentives are already occurring illegally, under our noses, there are evidence of incentives- mostly stemming from the receiving patients or patient’s family. 

The critics of the incentive proposal have one major claim: the altruistic system has not failed as much as it has not been promoted. The invalidity of the argument stems from the irony itself- incentives are a method of promotion. Altruism is not lost within the incentive system, rather given a little caffeine and steroids to act as a catalase. The argument- that offering incentives and maintaining ethicality will increase donations- still holds strong. The claimed failed attempt to promote altruistic donation is resolved with the incentive proposal. 

Samuel Hahnemann once remarked, “The physician's highest calling, his only calling, is 
to make sick people healthy - to heal, as it is termed.” To fail to do everything in our power to save lives is a greater breach of ethicality than any proposed controversial topic. Offering incentives for organ donation is ethical, if regulated. Do not let the fear of possible complications hinder the opportunity to save hundreds of thousands of lives. Do not let the doctor’s oath that promises, “To dedicate all my knowledge and strength to the preservation and improvement of the health of mankind and to the treatment and prevention of disease, and to work in good conscience wherever it is required by society” (Supreme Soviet) fade like extinc treatments.
