Amitai Etzioni is the Director of the Institute for Communitarian Policy Studies at George Washington University. He is the author of The Limits of Privacy. He can be reached at etzioni@gwu.edu.

Pennsylvania is considering paying families of organ donors $300 to help cover the donors' funeral costs. The money will be paid directly to the funeral homes, to prevent it from being used for other purposes, thus openly introducing a market in organs. Such a market has been until now considered anathema in the United States, a sentiment backed by a law banning trade in organs. Could that be changing?

In the market for organs

A May Time magazine essay by Charles Krauthammer suggested that it is acceptable that the poor will be more likely than the rich to be enticed by the Pennsylvania gambit, given that most societal harms fall more heavily on the poor. Why not a cash benefit? And, Krauthammer argues, if paying for organs would lead to a flourishing market, one that licks the great shortage in organs, breaking the taboo against such a trade is a price well worth paying.

What about an organ market?

The experience in third-world countries, such as India and Egypt, should give pause to all those who favor an outright market in organs. Poor people have their kidneys taken without being properly informed of the risk involved. Rich people can buy all the organs they need or want; those less fortunate often cannot scare up any.

At the same time, the urgent need to increase the organ supply on these shores is well established. An estimated 4,000 Americans die each year because no organs can be found for them. And the quality of life of thousands more suffers because they cannot find needed corneas and kidneys. Increased organ donations also would significantly reduce health-care expenditures. For instance, it costs less to transplant a kidney and maintain a person on the follow-up treatment needed than to keep the same person on dialysis for four years. Many stay on dialysis much longer if no kidney is found.

Is there any way to greatly increase the number of organ donors without opening a market in human parts, which many -- myself included -- find ethically highly troubling? Before chapter and verse can be spelled out, the underlying principle needs to be explicated. Social scientists have shown that we are social creatures who deeply yearn for the approval of others. These can be members of our family, friends, neighbors, and more generally, community members.

The strong power of so-called significant others is exhibited in intense, sometimes extreme, forms through peer pressure on teenagers, gang members and soldiers in combat. Members of such groups will do practically anything their group prescribes, even endanger their own lives. Much milder forms of such social pressure are evident when we donate money to a church or a civic cause, both because we believe in the merit of doing so and because we yearn for the approval of those whose opinions matter to us. (Anonymous donations are surprisingly rare.)

The case for moral suasion

Currently the voice of the community that favors organ donations has no chance to be aired or heard. People who feel like donating on their own, and remember to do so, mark their Motor Vehicle forms accordingly, but nobody is there to encourage them to do so, to appreciate it when they do, and maybe look at them with regret when they do not. Typically the issue does not come up until someone is on the death bed and -- at this most difficult time -- physicians and other health-care personnel are expected to ask the members of their family to consent to organ donation.

The voice that favors organ donations has no chance to be heard

To give moral suasion more of a chance, two measures should be taken. First, we should provide a new form at physicians' and hospitals' waiting rooms, clinics, Red Cross stations and other places where volunteers gather. The form would state explicitly that "we the people would be most appreciative, and hold you in high regard, if you could find it in your heart to make a life-affirming donation by authorizing the use of your organs once they are no longer of service to you."

The text then would describe briefly the severe shortage of donated organs and its many dire effects. The main focus of the text, however, would be the moral virtue of donating organs. The forms would close by stating that if you decline, for religious or any other reason, no explanation is needed. All said and done, it is up to you.

Second, the names of those who made the pledge would be logged into computerized databases, accessible to physicians engaged in organ transplantation. (A new law may be needed to establish the validity of the endorsements of these forms and to prevent family members from overriding them.) If these lists also were open to the press, its reports might greatly increase the number of those who would sign up; it is the best tool to alert the community about who has -- and has not yet -- committed to make an organ donation. At the same time, at least initially, such publication might be considered too high handed.

The new forms should be promoted through public-service announcements, and by public figures -- urging people to come forward, announcing that "I myself have just made the commitment to save lives by donating my organs should I no longer need them."

The main point, though, is as elementary as it is important: Instead of waiting for each person to consider the matter, without any encouragement or recognition by their community, we should unabashedly stress that in our minds and hearts we cheer donating organs and celebrate those who pledge to do so. One need not a priori rule out a market in organs, despite all the ethical challenges it poses. But at least we should first give moral suasion a chance.