By the way, as a separate issue; if people were allowed to bid for organs. And assuming you're right that rich people horded them, then wouldn't the supply rise up to meet that new demand? Wouldn't more people sign up to be organ donors? Wouldn't we reach equilibrium where the supply side matched the demand side? If poor people were getting fabulously wealth from committing to donate organs, and more lives were saved, wouldn't we eventually reach equilibrium? The 1% only need so many organs.... Poor people with money in their pockets and less organ shortage wouldn't be a horrible scenario. Maybe it would force the real hard work of cloning organs and improving a unsatisfactory system.

I must say, if it became an outright bidding system some people who society might say are less deserving than someone else might benefit. But that happens already! Look at Mickey Mantle who received a liver after a lifetime of alcoholism (and died soon thereafter). Or Steve Jobs who shopped around for the best region to receive a new organ (he's not FROM Tennessee after all...).

So please tell me, how would a MORE market based system be significantly worse? It seems like we have the worst of everything right now in our pursuit of the idealistic fantasy that the system treats everyone equally and that organ donation should be a purely altruistic gesture.

I agree with everything you're saying (except the part about hording) perhaps....

My expectation is that donors would be paid based on expected value, which is how (I believe), the issue is being framed in debates.

ie assume there's a 1% probability that potential donor will be a.) young enough b.) die under right circumstances.

Then we should offer that potential donor 1% of the expected value of his/her organs (ie if organs are worth $100k then we should offer $1k).

Obviously these are all made up numbers. But the idea of paying up front based on expected value makes sense to me in theory.