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To the Editor: Dr Goyal and colleagues¹ conclude that while the sale of kidneys might have increased the supply of transplantable organs in India, it did not help donors overcome poverty. They also found that donors often received less money than they were promised and that nephrectomy was associated with declines in both income and health status. The authors concluded that the sale of kidneys by poor people in India did not benefit the donors or their families socially or economically and therefore the concept of selling organs to increase the donor supply would need to be reexamined in western societies as well.

We suggest that the reasons for these findings may be more complex and subtle. First, while the incentive to donate appeared to be wholly economic as opposed to altruistic, the authors do not consider the psychosocial or symbolic value of the act of donation among their respondents. . . . [Full Text of this Article]

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