Soliciting kidneys on web sites: is it fair?

The Internet serves as a meeting place where people in need of kidney transplants can find strangers willing to donate. While Good Samaritan donors located via the Internet increase the number of kidneys available for transplantation, they also raise ethical issues. This practice alters the pattern for distributing kidneys from unrelated living donors and raises questions of justice in the allocation of organs. It is unclear if commercial forces are at play in the arrangements made between potential donors and recipients via the Internet. While it is unfair that some recipients do not have suitable willing living donors, Web sites help to balance the inequity by increasing the opportunity to find a living donor; they also benefit other potential recipients by reducing the waiting list. However, although these Web sites are probably here to stay, Internet donor-recipient matches can have negative consequences that we need to minimize. Suggested strategies include regulated, monitored Web sites and the development of more anonymous organ donor programs.