A large part of the foundation of the field of medicine was formed from the concept of herbalism: the harvesting of plants and herbs to heal and treat disease. This practice was typically performed by priests and shamans 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. Many humans made advances in the field of science, including cures for the plague, smallpox, bionic limbs, transplants and radiation. Throughout history, the field of medicine has been contributed to by countries all over the world working to expand our knowledge and improve the quality of life through growth in the medical field. As this growth continued to happen, the ethical controversies that came to light resulted in an oath that all doctors were forced to take. This oath, as stated in C. A. Erin’s “An Ethical Market in Human Organs”, claims that “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”, which forces doctors to uphold the ethics and standards of the medical practice (Erin 4). 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. One of the greatest breakthroughs in the field of medicine occurred in 1954 when the first successful kidney transplant occurred. This breakthrough opened a gate to a flood of controversy concerning the ethics behind organ donation and transplant. The largest debated issue in this area of medicine is the regulation of organ donation. There continues to be a large demand rate of vital organs while there is still a significant shortage in supply. Different solutions have been proposed in order to increase this supply rate. The most popularly debated solution proposes to offer incentives in order to make donating organs more desirable to society and motivate more people to donate, and in turn create a more sufficient supply of viable organs that can, in the end, save more lives. This proposal continues to take a lot of heat from a variety of people who support the current United States law that makes it illegal to offer incentives for organ donation on the grounds that donation should be an altruistic act not an act done to receive something in return. The bottom line, however, is that offering non-monetary incentives for organ donation is ethical- if properly regulated- because incentives will increase the supply rate by providing an otherwise absent motivation for people to donate organs, and in the end, save more lives.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              

There are a variety of proposals offering solutions to this problem, one of the most abundant being offering incentives for organ donation. These proposals, although they have the same base solution, are slightly modified in order to provide different perspectives and support. Arthur Caplan, the author of many different works on the controversy of organ donation, provides an argument in one of his pieces “Organ Transplantation” that elaborates on the problem of the organ shortage itself, as well as his proposed solution. He claims that incentives provide an otherwise absent motivation to donate organs; this newly provided catalyst will then motivate individuals to donate organs for the exchange of incentive. As a result, there will be an increased number of organs donated by people and in the end, save a greater number of lives. With the waiting list of patients continuously growing, the line is incessant. In the article “Organ Transplantation” published on the Hastings Center, Arthur Caplan emphasizes the dire need for more organs by stating that “Nearly 100,000 people are on waiting lists for organ transplants in the United States” (Caplan 1). Caplan’s proposal contains two main parts in which he argues will both solve the problem of organ shortage in their own way. The first part of his article proposes presumed consent- the concept which all people are organ donors unless stated otherwise- as a solution. This proposed solution will not increase the supply rate immediately; however, will create a large influx of organs after the next generation is deceased. This solution also solves a major problem that many other countries face, an uneducated society. Many people are unaware of the problem altogether and therefore, cannot be working to solve it. With presumed consent, people will automatically become organ donors after death, unless stated otherwise that they wish not to. The second part of his proposal contains a plan to implement offering incentives in exchange for organ donation. His main support is that offering incentives could eliminate the waiting list all together, and save a greater amount of lives because offering incentives motivates individuals to donate organs in order to receive the incentive. The excerpt “Governed Financial Incentives as an Alternative to Altruistic Organ Donation”, from the book Experimental and Clinical Transplantation, written by Ahad Ghods, hypothesizes how successful an incentivized system, such as Arthur Caplan’s, could potentially be. He uses Iran as an example- a country who has implemented a similar incentivized system for individuals who donate organs- to demonstrate how much of an impact such a system could potentially have. Ghods states in his piece that “Iran- by providing financial incentives to volunteer living donors, has eliminated the renal transplant waiting list” (Ghods 154). Iran, after facing a similar shortage of supply rate due to the high war fatality rate, implemented a system of incentivized donation in order to make donating organs more attractive to individuals. Their system includes offering government-funded financial incentives to individuals who donate organs. As a result, Iran’s donor waiting list has significantly decreased and has almost been eliminated altogether as explained in Ghods book Experimental and Clinical Transplantation.

The problem of organ shortage in the United States is an extremely polarized controversy that is split down the middle with half the population supporting and proposing modified versions of the incentivized system and the other half criticizing the incentivized system and continuing to refute the policy for incentives. One of the biggest arguments against the incentivized system is that offering monetary compensation for organ donation is not ethical because donation should be altruistic. In recent modified proposals, advocates have altered the meaning of the word incentives to mean more than just monetary compensation. In other words, proposed incentives that are arguably more ethical include covering funeral costs, provided healthcare and discounted education. 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 the ethicality of monetary compensation by offering less controversial compensation options. 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”, written by D. Joralemon, 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). In this article Joralemon summarizes the major issue with an incentivized system, being that the majority of opposing claims are based on the argument that monetary compensation is unethical. 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. As polled by Leonieke Kranenburg in the “Public Survey of Financial Incentives for Kidney Donation”, a large number of people who disapprove of the monetary compensation for organ donation do not disapprove of the incentivized system when it encompasses a broader range of compensation. 

Altruism is a widely glorified trait that societies as a whole, value. Altruism- although commendable- should not be a requirement for donation. Leonard Castro, a major supporter for the incentivized system, claims that “Altruism is not the only route for donation because sometimes people need to be given a little push” (Castro 1). In other words, altruism- an individual moral- should not be a deciding factor in saving lives. Charles Erin argues a similar point in his “An Ethical Market in Human Organs”, which contains a variety of proposed ideas to make the incentivized system both profitable and ethical. He argues that the supposed altruistic system that has been in place since transplantation was invented “has been unsuccessful so far and left hundreds of thousands in danger who could be saved” (Erin 2). The critics of the incentives proposal argue that altruism is an undebatable must; however, these same critics find no ethical issues with providing doctors with monetary compensation for their services. Those who claim altruism as the priority are, in turn, relegating saving lives to second place. 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 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. 

In addition to the argument that incentives are unethical, another large argument against the incentivized system is that it will create a black market in which illegal buying and selling of organs will occur. The reality of this argument, thought, is that the current system for organ donation has resulted in such a shortage of organs that there already exists a black market of illegal buying and selling of organs. Offering incentives to donors could put a stop to the current exploitations in the existing black market by providing a reason to stray away from the market that is currently attracting people to supply their organs to a middle man for a large amount of money, who in turn sells these organs to people in desperate need for a large profit. Author L. Castro explains the dangers of this black market in his article published by the Journal of Medical Ethics, “Commodification and Exploitation: Arguments in Favor of Compensated Organ Donation”, that “underground, the market is not subjected to institutional regulation that could ensure proper pre-transplant and post-transplant care for the donors” (Castro 2). This creates a significant issue for the safety of the patients transplant. This problem could easily be solved with an incentivized system because 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. The same article written by Castro lays out the current loopholes that have left holes for illegal buying and selling of organs. Castro explains that “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 because people will be more inclined to going through legal pathways of donation when they are provided with an incentive or motivation to do so. The patients receiving the organ, then, will be in better safety because they will be receiving a properly screened organ by qualified doctors and in a fully equipped hospital, instead of a foreign country or underground- where most black-market purchases take place. 

The third major claim of the critics against the incentive proposal is that the altruistic system has not failed as much as it has not been promoted. Although there is some truth to this argument- that as a society we should do more to draw attention to the problem of organ shortage at hand- the argument is invalid because offering incentives (monetary or non-monetary) is a means to promoting the problem of organ shortage. In addition, altruism is not lost within the incentive system, but rather acts as a catalase in order to motivate people to donate and help people who desperately need new organs. Offering incentives and maintaining ethicality will increase donations by promoting altruistic donation through the incentivized system.  

Samuel Hahnemann, a German physician who is famous for creating the system of homeopathy (otherwise known as herbalism) 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 solution to the problem. Offering non-monetary compensation for organ donation is ethical because it provides an otherwise absent motivation to individuals to donate organs. This newly present motivation will increase the supply of viable organs and, in turn, increase the number of lives that can be saved.  This solution is ethical, viable, and has the potential to save the hundreds of thousands of people who remain on the transplant waiting list every year. As a society, we should not let the fear of possible complications hinder the opportunity to save lives. As doctors, they should not let the 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” fade like outdated practices (Caplan 3). This incentivized system, once implemented, will offer non-monetary compensation to individuals who donate organs. This compensation will make donating organs more desirable and therefore, increase the number of organs donated. With an increased number of donated organs, we will have the ability to save a greater number of lives, sustain the altruism in donating organs, and eliminate the black market. 
