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To the Editor: I have 2 concerns about the study by Dr Goyal and colleagues.¹ First, although the authors documented worsening health in subjects after kidney donation, such a result may have occurred among extremely poor people even in the absence of donation. However, the authors did not obtain data on the health of those who contemplated donation but did not or could not.

Second, as the authors note, a 1994 Indian law banned trafficking in kidneys and required authorization committees to ensure that donations were made solely for altruistic reasons. The fact that a flourishing kidney trade still exits in India, and that almost all donors were extremely destitute, indicates that the passage of the law did little to affect the incentives to donate. Rather, it took a previously "legal" transaction between donor and recipient and relabeled it "illegal." Doing so raises questions about the quality of care (both . . . [Full Text of this Article]

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