Al Roth, the Stanford economist who won the 2012 Nobel Prize in Economics, has spent the last two decades arguing that the National Organ Transplant Act kills people. The law makes it a federal felony to give or receive “valuable consideration” for a human kidney intended for transplant. A living donor in Cleveland cannot accept $10,000 from the stranger whose life she saves. The grieving family of a brain-dead twenty-year-old in Houston cannot be paid a cent for the heart, liver, lungs, pancreas, and corneas surgeons will harvest within hours of withdrawing the ventilator.
Drive ninety minutes from that same Houston hospital, though, and you will find a warehouse where whole human bodies, donated rather than sold by the deceased but freely commercialised once they arrive, are dismembered with band saws, packed in dry ice, and shipped to surgical training labs, crash-test facilities, and military blast-injury programmes.
That second business is entirely legal.
The 1984 law that drew the line
Congress passed the National Organ Transplant Act in 1984, in the wake of a Virginia physician who had publicly proposed brokering kidneys to wealthy American patients. The bill that emerged criminalised the sale of any “human organ” for use in transplantation in interstate commerce.
The statute defined “human organ” narrowly, focusing on transplantable organs and tissue. The intent was to stop a market in living donors selling pieces of themselves, and to stop families from auctioning the recently dead to the highest bidder.
What the statute did not cover was the rest of the body. A whole cadaver, donated to science under the older common-law tradition of anatomical bequest, fell outside the transplant framework entirely. It still does.
Two parallel pipelines, two different rules
An American who dies tonight in a car accident in Phoenix and whose family agrees to organ donation will have her transplantable organs procured by a federally regulated Organ Procurement Organization. That OPO operates under contract with the Health Resources and Services Administration. Every step is audited: consent, allocation, recipient matching, transport. No money changes hands for the organs themselves. The family pays nothing. They also receive nothing.
If that same family instead checks a different box and donates the whole body to a non-transplant anatomical donation company, the body becomes, in legal terms, something closer to commercial inventory. The company can recover its costs. It can also sell access to body parts to medical device firms, dental schools, automotive engineers, and the Department of Defense. Pricing information that has emerged shows significant sums changing hands for various body parts and intact bodies.
The donating family is told the gift is non-commercial. The downstream invoice tells a different story.
Why Congress never closed the gap
The 1984 drafters were focused on a problem that did not yet exist at scale: a global market in transplantable organs. They borrowed the list of body parts directly from the transplant literature of the day. Cadavers donated for research, education, and product testing were governed by the older Uniform Anatomical Gift Act, adopted in some form by every state. That older law allowed anatomical gifts but said almost nothing about what could happen to a body once a gift was made.
The result is a regulatory split that maps onto biology in a way Congress did not intend. If a piece of you might save a living patient, selling it is a felony. If a piece of you will be cut up for a hip-replacement training course, selling it is a service fee.
The FBI has investigated the body-broker industry multiple times in recent years. Most prosecutions have hinged on fraud. Families were told the body would be used for cancer research when it was actually sold to a ballistics lab, rather than charged over the sales themselves. The sales themselves are not illegal.
The waiting list that grows by the day
Tens of thousands of Americans are on the national transplant waiting list, the majority of them waiting for a kidney. Many people die on that list. The wait for a deceased-donor kidney in most regions spans years. Transplantation offers significant cost savings compared to ongoing dialysis.
This is the calculation that drives economists like Roth and the team behind a 2026 proposal to compensate the families of deceased organ donors. The economists argue that a modest payment to the family of every eligible deceased donor would close most of the kidney waiting list within a decade and save the federal government billions on dialysis.
The proposal is, today, a federal crime to implement.
What the behavioural research actually finds
One of the standard objections to paying donors is that it would “crowd out” altruistic donation. A 2024 study from the Max Planck Institute for Human Development in Berlin tested a related question. It asked whether opt-out consent systems increase donation rates, and found that the policy lever long assumed to work in fact does very little. People’s willingness to donate is driven by trust in the system, not by the default setting on a driver’s licence form.
That finding cuts both ways in the compensation debate. If altruism is not as fragile as the 1984 drafters feared, then a modest payment to a donor family may not poison the well. It may simply remove the financial penalty currently imposed on grieving relatives, who lose work hours, travel to hospitals, and absorb other costs that the federal procurement system reimburses only partially.
The cadaver economy in numbers
There is no federal registry of non-transplant anatomical donation companies. The industry operates with limited oversight, and state licensing varies wildly. In documented cases, single brokers have received thousands of bodies and shipped parts to clients in multiple states and countries.
Medical schools, which have used donated cadavers for centuries under a tradition of strict non-commercial handling, sit awkwardly inside this same legal space. Many programmes now debate phasing out cadaver dissection entirely in favour of virtual reality and high-fidelity models, in part because the supply chain has become harder to vet. A school that pays a recovery fee to a body broker is not breaking the law. It is also not always certain where the body came from.
Reform efforts that keep stalling
Successive Congresses have introduced versions of an Organ Donor Family Tax Credit or pilot-payment proposal. None has passed. The transplant system itself has been undergoing a separate overhaul since 2023, when HRSA broke up the decades-long monopoly held by the United Network for Organ Sharing and brought in Raymond Lynch and a new oversight structure. That reform is about how organs are allocated, not whether donors or families can be paid. The 1984 prohibition remains untouched.
Bills to regulate the body-broker industry have moved faster. A bipartisan proposal in the current Congress would require federal licensing of non-transplant tissue banks, mandatory disclosure to donor families of commercial end uses, and a ban on the sale of body parts across state lines without traceable consent documentation. The bill does not, in any version, prohibit the sales themselves.
The asymmetry, stated plainly
A kidney that could save a patient on dialysis cannot be bought for any price. A torso shipped to a trade show so that orthopaedic surgeons can practise installing a new brand of artificial hip can be bought.
The first transaction is a felony. The second is a tax-deductible business expense.
Congress drew the line in 1984 around the word “transplantation” because that was the technology it could see. Forty-two years later, the line still holds, even as the human body has become a commodity in every part of it that does not happen to fit inside a living patient. Those waiting for a kidney are, in a strict legal sense, the only ones to whom the prohibition still applies.
