Medical freedom / M4
Selling a kidney
The person wants to sell one of their kidneys to a willing recipient, with surgery by licensed surgeons.
What we score
Can they be paid, and what happens to the parties if they are?
Default assumptions: Unless a vignette says otherwise, the person is a 30-year-old citizen of sound mind with no criminal record, acting alone, on their own behalf and not for profit, in an ordinary residential area. Where subnational units (states, provinces, cantons, Länder) make their own law, each unit is scored and the result is weighted by population. 'The state' includes police, prosecutors, courts, regulators, tax authorities and anyone acting on their orders, including platforms obeying takedown orders.
Score anchors
Both the law score and the practice score use these anchors. Half points are used when a country sits between two of them.
| Score | What it means for this vignette |
|---|---|
| 10 | Legal, unregulated sale. |
| 8 | Legal with registration and medical screening. |
| 6 | Legal through a regulated compensation scheme (e.g. Iran). |
| 4 | Only reimbursement of costs; payment voids the transplant. |
| 3 | Payment is an administrative offence. |
| 2 | Crime: fine or under 1 year. |
| 1 | Crime: 1 to 5 years. |
| 0 | Crime: over 5 years. |
Evidence used: Organ-transplant law on payment; penalties; any compensation schemes.
How each country scores
| Country | Law | Practice | Process | Score | Why |
|---|---|---|---|---|---|
| Denmark | 3.5 | 4 | 0 | 3.8 | Danish law has no general offence of selling one's own kidney. But organs may be removed only by approved hospital doctors (sundhedsloven § 54), with informed written consent (§ 52). Advertising to seek or offer organs for payment is punishable by a fine (Organ Quality Act 2012 §§ 14-15). Organ trafficking with exploitation is covered by § 262 a straffeloven. In practice public transplant centres will not use a paid donor, so payment makes the transplant impossible. |
| Ireland | 3 | 4 | 0 | 3.6 | Under the Human Tissue (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Act 2024 s12 (in force from 17 June 2025), donation must be voluntary and unpaid, payment beyond reasonable expenses voids the donor's consent, and acting as a broker or advertising an organ for money is an offence (s107: up to 3 years). Paying or being paid is not itself an offence, so dj sits between the 'payment voids the transplant' anchor and the brokering crime. In practice transplant centres will not proceed with a paid donation, and no prosecutions are reported. |
| Netherlands | 2 | 4 | 0 | 3.2 | Under art. 2 of the Wet op de orgaandonatie, consent to donate given in return for payment above costs (including lost income) is void. Art. 32 makes it a crime, punishable by up to 1 year or a fourth-category fine, to arrange or promote such a paid donation or to offer oneself publicly as a paid donor. No Dutch prosecutions of willing sellers were found; in practice transplant centres simply refuse such donations. |
| New Zealand | 2 | 4 | 0 | 3.2 | Human Tissue Act 2008 s56 prohibits giving or accepting financial or other consideration for human tissue, punishable by up to 1 year or a $50,000 fine. Living donors may receive compensation for lost earnings and expenses under the Compensation for Live Organ Donors Act 2016, but not payment. No prosecutions were found; in practice paid donation is blocked by transplant-unit screening. |
| United Kingdom | 1 | 4 | 0 | 2.8 | Human Tissue Act 2004 s32 makes giving or receiving a reward for supplying an organ an offence, with a maximum of 3 years; only expenses and lost earnings may be reimbursed (s32(7)). Scotland's Human Tissue (Scotland) Act 2006 is equivalent. In practice the Human Tissue Authority's independent assessment of every living donation blocks any paid transplant, and prosecutions are essentially unknown. |
| United States | 1 | 3.5 | 0 | 2.5 | The National Organ Transplant Act, 42 U.S.C. 274e, makes it a crime to transfer an organ for valuable consideration, with up to 5 years in prison and a $50,000 fine. Only paired exchange and reimbursement of costs are allowed. In practice no donor has been prosecuted. Transplant centres screen for payment and refuse the surgery, so the sale cannot happen with licensed surgeons. |
| Singapore | 2 | 2 | 0 | 2.0 | Human Organ Transplant Act s13(1) voids any contract to sell an organ. Under s13(2), seller and buyer each face a fine of up to S$10,000 and/or 12 months' jail; brokers face up to S$100,000 and/or 10 years under s13(3). Only reimbursement of costs and lost earnings is allowed (s13(4)), and the transplant ethics committee must refuse paid donations (s15). In the 2008 kidney-purchase case the buyer, Tang Wee Sung, was jailed for a day and fined S$17,000. |
| Switzerland | 1 | 2.5 | 0 | 1.9 | Transplantation Act Art. 6 forbids offering or accepting any financial gain for an organ, allowing only reimbursement of lost earnings and expenses. Breach is punishable by up to 3 years for donor and buyer, and up to 5 years if commercial (Art. 69). Transplant centres will not operate on paid donors, so in practice the sale cannot happen in Switzerland. |
| Czechia | 1 | 2 | 0 | 1.6 | Criminal Code § 166 punishes offering, giving, requesting or accepting payment for removal of an organ, or for a transplant, with up to 5 years in prison, for both payer and seller. The Transplant Act permits only cost reimbursement. No reported prosecutions were found, because the transplant system's donor review stops paid donations. |
| Germany | 1 | 1.5 | 0 | 1.3 | Trading in organs is a crime under §§ 17-18 TPG: up to 5 years, and 1 to 5 years if done commercially. Courts may waive punishment for the donor and recipient (§ 18(4)). Living kidney donation is allowed only to relatives, spouses or persons with an obvious close personal bond, checked by a Land living-donation commission (§ 8 TPG). A paid stranger donation would therefore be blocked before surgery. |
| Mexico | 0 | 1 | 0 | 0.6 | LGS art. 327 bans commerce in organs and requires donation to be free and altruistic; only cost recovery is allowed. Selling or brokering organs, or obtaining them illicitly, carries 6-17 years in prison (LGS art. 462). Transplant committees screen for payment, and no paid route exists. Prosecutions of sellers themselves are rare. |