But is altruism ever truly "selfless"? Intangible benefits of organ donation certainly exist; the sense of moral rightness (even superiority), a sense that you alone are responsible for the well being of another can be an intoxicating high. Moreover, the tyranny of the gift can be a burden that ties a recipient to his/her donor for life. This sense that one owes another person something of such value, a gift that was completely unsolicited and philanthropic, can be an overwhelming burden to bear for the recipient.
So what if we offered compensation for donors (either tax breaks or lifelong free health insurance or cold hard cash) and commodified the act of organ donation to some extent? Would the organ shortage be solved? Would the recipient be liberated from this stifling sense of indebtedness? Would poor people rush to sell their organs for pure financial benefit, risking their own lives? The consequences are not all entirely foreseeable but I think it's important to at least consider the possibilities of compensated donation. As Satel concludes:
To be sure, these skeptics have a right to their moral commitments, but their views must not determine binding policy in a morally pluralistic society. A donor compensation system operating in parallel with our established mechanism of altruistic procurement is the only way to accommodate us all. Moreover, it represents a promising middle ground between the status quo—a procurement system based on the partial myth of selfless altruism—and the dark, corrupt netherworld of organ trafficking. The current regime permits no room for individuals who would welcome an opportunity to be rewarded for rescuing their fellow human beings; and for those who wait for organs in vain, the only dignity left is that with which they must face death.