I would sit down with Fred and Lucy and talk with them about Betty. Betty is a single mother of 5 young children whose father was tragically killed in a work accident and is also a perfect match with Fred and Lucy. She too is going to die quite soon without a transplant and leave 5 young orphans with no one to care for them as all of her relatives live in Dafur and are peniless.How will Betty feel if lucy gives her kidney to Fred simply because he has maoney and Betty Does not? How will Fred live with the knowledge that there are 5 orphans whose mother could be alive to care for them if he had not bought the kidney and Lucy had given it to Betty?

Oh, it gets worse.
Suppose that Fred, while he certainly needs a kidney, doesn't actually need one *right now*. He'll be OK on dialysis for, say, five years or so, but after five years of that kind of strain, his other kidney will give out, and he'll be done for. So instead of paying Lucy for her kidney, he tracks her down and introduces himself. He makes sure her housing situation improves, hires a cleaner and cook for those weeks when her job simply keeps her from taking care of such things, and comes by and talks to her every week, listening carefully to her problems and providing any support she can. He takes an active interest in her children, and actually pays a substantial part of their private school education.
There's no quid-pro-quo going on here, but of course, after five years of this, Lucy feels pretty grateful. She happily agrees to donate a kidney to her good friend Fred.
As it turns out, the time, money, and effort Fred spent on Lucy and her children is worth exactly $200,000. Should Lucy be prevented from giving her kidney to Fred? If not, is there any serious way in which this differs from Fred just giving her the $200,000 in exchange for the kidney? In some sense, isn't this sort of thing just as coercive? After all, Fred did take advantage of Lucy's situation; his actions might not have been nearly as effective in gaining her loyalty had she not been a poor single mother.
And len--not just anyone can donate a kidney to just anyone, you know. There are organ compatibility issues to worry about. What if no such Betty can be found, if, in fact, Fred is the *only person* out there who needs a kidney whose body wouldn't almost certainly reject Lucy's?

Properly supervised, there is nothing ethically incorrect about either the sale or donation of any body part. It is only when coercion and duress arise that we have any serious issues that threaten essential human rights. There is a black market in body parts that we choose to ignore because it is such an uncomfortable issue. If we managed the process openly, there would be a greater chance to regulate the exchange, thereby protecting everyone. Right now, we all have our heads well and truly buried like the proverbial emu.

Life is tough. Betty has no money and no friends and no kidney? Well, that's survival of the fittest. Nobody said life would be fair and balanced. You either stay 100% healthy and self-sufficient, or develop a support network, or use your other skills to put away enough money to cover any concerns that pop up. Even then, you could get a rare face-eating bacteria, you never know. But the POINT is: purely on principle, should it not be our right to decide what happens to our bodies? I can decide if I get a piercing, or implants, or surgery... if I want to sell a part for profit, I think the government is overstepping it's bounds by insisting it be donated and go to waiting list of strangers. And hey, I have some rather socialist viewpoints generally, but it's MY body and I want the deciding vote in what I do with any and all parts of it.

It looks like stem cell technology, etc., will soon render this discusion moot.

If the ethics of selling of organs is not inherent in the action but rather determined by how the practice will affect markets in aggregate, then is it reasonable to conclude that it would be an ethical institution in some societies but not others? For example, if we are not to be overly concerned with the case of a woman knowingly selling her kidney, without duress, for a large sum of money commensurate with her loss, then does that mean that it is more morally acceptable to allow the sale of organs in an affluent, educated society where that is more the norm than it would be to allow it someplace like India, where you have a billion desperate people, ignorant of the health risks, but willing to sell their kidneys for next to nothing?
If so, then I wonder where exactly the moral fulcrum lies that would determines whether or not the practice is moral within a given society? If only one person stands to be so exploited by opening the market to human organs, then does that nullify the morality of the practice for everyone else? Or, for that matter, if slightly more than half the donors would be adequately compensated and informed, would that then make it okay?