ABSTRACT
Much discussion of organ transplantation has been dominated, whether consciously or not, by two conceptual models. The market model conceptualizes organs for transplantation as commodities that could, at least theoretically, be bought and sold, with supply and demand balanced in the same way as other commodities, by variations in price. 1 The gift model, in contrast, conceptualizes gift-giving as the only ethical and just way of providing organs for transplantation. 2 Underneath both these models there resides a deeper and widely shared assumption, that once the need for an organ transplant is determined by medical authority, this need acquires some of the characteristics of a moral imperative. In other words, medically determined need results in a ‘demand’ for an organ, in both the economic and the everyday sense of the word. Such medically determined demand is a classic example of a black box. 3 What medicine has to offer is widely regarded as of inherent value, and few outside the field of medicine ever lift the lid and look inside the box at the factors determining demand for medical treatment.
