 The most important of these is that, at least as far as living donation is concerned, there is not a very large practice out there to be undermined. Given the pain and inconvenience involved, free donation is likely to remain a minority pursuit. Living donation is admittedly on the rise and, according to the National Kidney Foundation, almost a third of US kidney transplants in 2014 came from live donors.  However, this is still a 'drop in the ocean' compared to the 102,000 people on the waiting list and a majority of these live donors are friends or (more commonly) relatives of the recipient, or are part of a 'pairing arrangement' (where A's relative donates to B, and B's relative donates to A).  Given such people's strong interest in saving their friends' or relatives' lives, one would think that many of them will not be put off by the mere possibility of payment. And it is notable that fewer than 200 people in the US in the same year became unrelated anonymous live donors.