Sally Satel, the receipient of Virginia Postrel’s kidney (see also here), authored this amazing NY Times Magazine article in which she describes the overwhelming emotions that donors and would-be recipients go through under the current system of donating organs:

A week after my 49th birthday in January 2005, half a year after being given a diagnosis of renal failure, a friend and I were drinking coffee at a Starbucks when I wondered aloud if I would find a donor before I reached 50. I wasnít hinting. I knew she would never offer because she was so squeamish about blood and pain. My friend, whom I met a decade before when we were both new to Washington and worked together on an advocacy project, was a little older than I; she was charming, stylish, smart ó and a hypochondriac.
Nor, to be honest, did I want her kidney. Anyone as anxious about health as she was would surely view donation as a white-knuckle ordeal. And the bigger the sacrifice for her, the heavier the burden of reciprocity on me. The bigger the burden on me, the more I would resent her. Then I would feel guilty over resenting her and, in turn, resent the guilt. Who could survive inside this echo chamber of reverberating emotions? Thank goodness my friend would be holding on to her kidney.

But then to my amazement, within a minute or so of my speculating when or if a donor would ever appear, she offered to do it. Later that night we talked on the phone and she rhapsodized about what a ìmitzvahî it would be. Yes, her sentiments were lovely, but I felt secretly annoyed because I knew it was her habit to embark upon grandiose plans; when they fizzled, she would just shrug. I told her that giving me a kidney was out of the question ó ìIt would be too weird,î was what I kept saying ó but she persisted. I couldnít quite believe it when she told her family of her decision (they were graciously in favor) and then had blood tests and consulted with my transplant team.
Gradually, I began to believe that she meant it, and I decided to embrace her just as you might accept an in-law, as someone who could drive you a little mad but whom you loved because they were the source of something very precious to you ó in my case, not a spouse but a kidney. But then after a few months she stopped talking about it. When I finally broke the silence, she said her doctor had advised against it. More likely, I thought, she was scared. I felt sorry to have put her in this position, but I was also bitter: just when would she have gotten around to telling me?
Such near-transplant experiences are not uncommon. All of the transplant candidates I spoke to, as part of my own small nonscientific sample, mentioned at least one person who promised to donate, had some tests done and then developed cold feet. Transplant teams explicitly, and properly, offer face-saving ìmedical alibisî to potential donors who donít really want to go through with it, which suggests that bailing out isnít all that rare. They might tell the person needing the transplant and the rest of the family, for example, that additional tests on the prospective donor revealed a compatibility problem or some evidence that the donor might be putting her own health at risk.

Inasmuch as the supply-demand imbalance for kidneys and other organs is well known, it seems obvious that the simple solution is to allow markets to fix the problem. However, absent political leadership to change the existing obsolescent system, many patients who need a transplant will remain relegated to long waiting lists. Many of those patients will die before their name is called. As Satel notes at the end of her article:

“But unless we stop thinking of transplantable kidneys as gifts, we will never have enough of them.”