05/05/2014 05:48 EDT | Updated 07/05/2014 05:59 EDT

What If You Could Save 250 Lives By Feeling a Little Disgusted?

Picture having to eat a mealworm. Mealworms are the slimy, crawling larvae of the mealworm beetle. They are perfectly safe to eat. But you and I would probably not eat them here or there, we would not eat them anywhere. Not on a canape, and not with a fox. Not in a house, nor in a box.

Reflect for a moment on the feeling you get in your stomach at the thought of eating something so disgusting. That's uncomfortable.

Now suppose a large number of Canadians will suffer from that very same stomach-turning feeling for the next 24 hours. Let's say a million of us will suffer from that feeling. That's a lot of people feeling a great deal of repugnance. But imagine we could alleviate that stomach-turning feeling. All we have to do is let 256 people die. If we let 256 people die, a million of us will not have to feel repulsed or disgusted.

Would you trade the lives of 256 people in order to ensure one million people won't feel disgusted?

In Canada, that's what we do every year. Every year, we decide that we'd rather let about 250 people die than have to put up with feeling repulsed.

There are about 4,500 people waiting for organs in Canada. Most of those waiting -- nearly 80 per cent -- are waiting for a kidney transplant. In 2012, 256 people died on the waiting list. In the U.S., there are now 120,990 people on a waiting list for organs. 99,201 are waiting on kidneys. Last year, 3,381 people died waiting on a kidney transplant.

We have tried increasing altruistic donations. We have tried to get people to sign their organ donor card. But every year only about 2,000 transplants get performed, a number that has remained steady since 2006. In the U.S., about 16,500 people donate organs altruistically.

We could fix this. But it would mean allowing a market in organs. It would mean letting people sell one of their kidneys, like they do in Iran. Iran still has a waiting list. But no one waits for organs. Instead, there is a waiting list of people who want to sell an organ. We already know that a market in kidneys would work.

I know, I know: Gross! Repugnant! Repulsive! Disgusting! And so on.

But this really is the choice. 250 lives in exchange for your not feeling disgusted.

For every other concern, there is a simple fix.

Some of you might be worried about economic exploitation. Very well, we can restrict the market to all and only those people who make a certain amount of money per year. We can prohibit the poor from selling their organs.

If you're concerned about exploiting those who don't know enough, those who might regret their decision later, we can institute a waiting period of six to 12 months, coupled with a mandatory course. We can test how much people know about what they are getting into. If you pass the test, you get to sell a kidney, if not, then not.

That waiting period and test could also be designed in such a way that any worries about coercion or insufficiently informed consent gets taken care of as well.

If you're worried that only the rich will be able to afford organs, no problem: We distribute the organs according to the current standard, or based on need. We have a third party, like the government, or a charity, pay for the kidneys. So no one on the waiting list would have to pay for the kidneys at all. Whether or not you get a kidney would not depend on how thick your wallet is.

And if you're concerned about the meaning of money, or the symbolism of the whole thing, we can change how people get paid. Instead of a cheque, we could pay with a tax credit, or a tuition voucher. We could also insist that people can only use the tuition voucher, for example, on someone other than themselves. That would preserve the altruistic component -- you're not selling the kidney to benefit yourself financially, you would be exchanging a gift of life for a gift of education for someone else.

We can keep going like this for any worry you might raise, but I trust that you have enough imagination to figure out how to come up with a way to design the market to alleviate whatever concerns you can come up with.

All that's left is that uncomfortable feeling in the pit of your stomach. Would you really trade the lives of 256 people to avoid having to feel a bit uncomfortable?

If a market in kidneys disgusts you, so much the worse for your dinner plans. Get over it.


13 Things You Need To Know About Kidneys