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In Reply: Drs Baines and Jindal suggest that a desire to enhance social status was a motivation to sell kidneys. However, all subjects mentioned economic reasons for selling their kidneys and none mentioned this symbolic motivation as even a contributing factor in their decision. In any case, we found no evidence that the social status of sellers improved. Posttransplant depression would be expected given persistent poverty and feelings of being exploited. We believe it is more important to address these underlying reasons rather than jump to psychological therapies.

Dr Chandra speculates that sellers' poor outcomes may be due to the 1994 law that removed kidney selling from the "marketplace." However, those who sold prior to the law had similarly poor economic and health outcomes as those who sold after 1994. Previous studies on cadaveric and blood donation have also defied conventional economic wisdom by demonstrating that marketplace transactions are less . . . [Full Text of this Article]

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