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The chronic shortage of transplant organs means that many potential recipients will endure lengthy stays on waiting lists. Those in need of kidneys face the lifestyle limitations of long-term dialysis; those needing livers often die before an organ becomes available. Understandably, these patients and their families are willing to take extreme steps to shorten this delay. Mass advertising, particularly via the internet, offers these individuals the promise of finding a donor within days rather than years.

In the United States, the medical community has already embraced directed organ donation from both living and deceased donors to anyone with whom the donor has a pre-existing emotional relationship.(Other nations, notably Mexico and China, restrict directed donations to family members, reflecting a concern that transplants between donors and recipients who are not related may conceal organ sales.) Once we accept …