A legal market for organs? It’s not as far-fetched as you think.

Today in the US, the average wait time for an organ transplant is several years. According to the Department of Health & Human Services, someone is added to the donation list every 10 minutes, while 21 people in need of a transplant die every day.

Northeastern law Professor Kara Swanson says the situation is getting increasingly worse. Because of increased health insurance access and stricter seatbelt laws, there have been fewer deaths of otherwise healthy, young people whose organs are typically used in transplants. But the logic  — or lack thereof — driving the system may be the real issue.

Swanson says it doesn't make sense “to have medicine relying on individual people waking up one morning and saying ‘well yeah, I’ll give up some of my body today.'"

So if relying on the randomness of people’s goodwill isn’t enough, what can we do to fix the issue?

Swanson, author of Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America, believes that offering some type of compensation for organs — as odd and illegal as it may sound — might actually be the solution.

Interestingly enough, according to Swanson, Iran, the only country in the world that allows a market for organs, does not have issues with supply.

Currently, the National Transplant Act of 1984 bans the sale of organs in the United States. Yet, she says the law ends up creating a situation where the wealthiest people can cut corners and get organs much easier by traveling to other countries and buying a donor or their way to the top of the list — a practice called “organ tourism.” On the other hand, the poorest people not only don’t have access to organs, but may also end up exploited for their organs and not receiving sufficient follow-up care.

If you could legally buy organs in the United States, this might not be a problem.

There’s just one catch: “We know what happens in the marketplace, the person who has the most money gets it, right? And we don’t want to allocate on the basis of financial ability, we want to allocate on the basis of medical need.”

So Swanson thinks we should avoid a completely open market.  “What I am advocating is that we need to consider compensating people who supply organs… I am not advocating for an Ebay in organs.”

One option, she says, could be setting up a central bank that allocates based on medical necessity and charges a rate in proportion to the person’s income level, averaging the prices out in order to break even. A similar system was used successfully in the U.S. in the first breast milk donation banks.

“I think we need to try some different models in order to increase the supply, in order to decrease the scarcity, in order to increase the justice in access to these things.”

This story first aired as an interview on PRI's Innovation Hub.