The problem may not be new, but it has become no less painful for patients and clinicians. There is an acute shortage of organ donations in the UK. Every year several hundred people die while on a waiting list, and many more spend months in a debilitated and deteriorating state. There were over 6,000 patients waiting for an organ - kidney, liver, heart - in the year ending in March, with 400 of them having died before being given a transplant. Many more will have died without reaching the waiting list. The frustration and despair is not restricted to patients and their relatives. For the specialist medical teams, who have the skills and facilities to carry out more operations than currently are completed, the shortage must be exasperating. In the four decades since the early transplants, the success rates of the operations have improved dramatically.

As we reported yesterday, some doctors believe it is time the British Medical Association, which represents doctors throughout the UK, changed its policy against payments for organs. The arguments for change were set out by John Harris, professor of bioethics at Manchester University, at a closed medical meeting of the BMA yesterday. He believes thousands of lives could be saved through creating "an ethical market" in live organs. It would be permissible within the UK - or possibly within the European Union - for live donors to provide organs or tissue in return for a tax-free payment. Donations could include a kidney, part of a liver, or tissue. Within the UK, the NHS would be the monopoly buyer, and the sole body determining who should receive them, based on the greatest need. One benefit of a legal market would be the curbs that it would apply to the black market in organs from third world countries. These would continue to be prohibited.

The first thing wrong with the proposal is that although it seeks to protect the poor in developing states, it would not protect the poor in the UK. These are the only people who would be selling parts of their bodies in Britain. A group who are already suffering from widening health inequalities would experience further disadvantages. Research shows that many live donors suffer a decline in their own health. A more eloquent argument against the plan was put by Professor Alastair Campbell of Bristol University: "Our body is not a piece of property, in the sense that our house is. We inhabit our house and, if we own it, we can sell it. But we are our body, we are embodied selves. So it is right that the law regards the body as not a marketable commodity to be traded away at will."

There is a third argument, which was set out in 1970 by the great social philosopher Richard Titmuss, which points to a solution too. In his book on Britain's voluntary blood donor service, The Gift Relationship, he noted that not only was our system less vulnerable to contamination or unethical behaviour compared to commercial systems, but it was more practical too. Examining the US system, he found there were four times as many cases of hepatitis, because offering money attracted poorer and sicker donors, who lied about their health. The book helped change the US system. Commercial blood banks were curbed and "cash blood" shrank to just 2% by 1986.

There are 10 million people on the organ donor register in the UK, but more are needed. The BMA is not going to support organ sales, but is rightly pressing for the introduction of "presumed consent", under which it would be assumed that individuals wished to donate organs after their death, unless they registered an objection during their lifetime. This opt-out system already applies in eight EU states. Families are still consulted, but it has resulted in a much higher number of donated organs than the UK achieves. It works in the EU; it would work here.