Rosen says that he received quite a bit of criticism and even threats because of his decision, but he has no regrets.

“Everyone was against this because people don’t understand altruism,” he said. “Most people wouldn’t [donate an organ] and it pains them to even think about it. My point is that you can do something altruistic and get paid for it.”

Rosen says that he didn’t do it just for the money. He was neither in debt nor desperate for money. He says that first and foremost, he wanted to make a difference in someone’s life, but he feels that compensation in this case was perfectly appropriate since there are many professions in which people save lives for a living and get paid for their contributions.

While Rosen thinks his donation was a step toward revolutionizing the organ donation system, he says that his life hasn’t changed much.

“I am still the same person and I still do the same things,” he said. “I spent all the money long ago and I am living a simple life.”

Dr. Eli A. Friedman, a recognized nephrologist and a kidney specialist at Downstate Medical Center in Brooklyn, says that the average wait for a kidney from a deceased donor is nine and a half years –longer than the life expectancy of many people suffering from kidney failure.

In 2008 alone, the United Network for Kidney Sharing reported that more than 4,000 people died while waiting for a kidney transplant.

“I am in favor of compensation for the donors,” Friedman told Bay Currents. “It’s not just a rogue concept- it’s an attempt to bring fairness to those who are helping others to live by giving an organ.”

Friedman says that although it’s difficult to predict, the waiting list for kidney transplants is likely to grow with time, and there aren’t enough deceased or live donors in the United States to meet the demand for viable kidneys. There are about 20,000 kidneys available each year (roughly split between live and deceased donors), while the need reaches 60,000. Based on that, Dr. Friedman says that it may be time for the government to support and regulate the compensation of organ donors.

“Think for a moment about the transplant operation and who is compensated,” he said. “The nurse, the doctor, the person who sweeps the floor in the operating room; everyone is compensated except the donor of the organ -- that’s considered unethical and inappropriate.”

Friedman also says that in 2009, some 60 leading organ-transplant surgeons signed a letter published in the American Journal of Transplantation, favoring “a regulated plan for compensation of organ donors.”

The idea raises many ethical and political issues, but the key question is, how would it work?

Aside from establishing the amount of payment and the terms of the agreement between the donor and the recipient, Friedman says that if this type of organ compensation system can be set up in the United States, it’s crucial for government administrations to be involved.

“I think this compensation plan – because it can be exploited, because it can go the wrong way – has to be governed and watched closely by a government agency,” he said

Currently, any compensation for organ donation is outlawed in the U.S. and most of Europe. In the United States, it carries a punishment of up to a $50,000 fine and five years in jail. Nonetheless, Friedman says that about 10-15 percent of the kidney transplants that are performed in the United States fall into the category of “illegal,” though that figure is based on the number of transplants performed, in which no clear linkage exists between the recipient and the donor, and in cases where it seems that a payment was negotiated.

Although a kidney transplant is considered to be the most effective treatment for kidney failure, there are alternative methods.

Kidney failure patients can undergo dialysis, a process that washes out the blood and removes all the waste that the diseased kidney did not remove. The procedure takes about three hours, and should be done from three times a week to every single day, depending on the condition of the kidney.

Dialysis is a very time-consuming treatment and usually limits the mobility of the patient; in 1976, Friedman invented the “Suitcase Kidney,” a machine that permits en route dialyzing, enabling patients with kidney failure to travel and live more freely. In 2009, Victor Gura developed another version of the machine, the Wearable Artificial Kidney (W.A.K.), which provides dialysis through a belt at any time of the day. Although the machine is not yet on the market, Friedman says that such machines will be available in the near future.

In the U.S., the price of treating one patient through dialysis for one year is about $75,000, while the price of a kidney transplant is about $125,000 for the first year, and about $10,000-$20,000 per year thereafter in medication, Friedman said.

Despite the innovative treatments, Friedman says that the best and most effective treatment for kidney failure is a transplant.

“If your life expectancy at the age of 40 is about 30 years, just within a general population, and it’s about 10-15 years with good dialysis, it’s about 20-25 years with a kidney transplant,” Friedman said. “So not getting a kidney transplant, staying on dialysis – it increases your risk of dying.”

Risks of kidney transplants have decreased tremendously within recent years – about 98 percent of recipients are alive one year after the transplant. The transplant procedure for donors has vastly improved overall;,now only about a 1-inch cut is made and the kidney is transferred without large incisions or the removal of ribs. Additionally, there has been no evidence of shorter life expectancy or any particular long-term side effects for the donors.

Regardless of the medical and technological improvements of organ transplantation procedures, there still aren’t enough live donors to save the lives of those suffering from kidney failure. So what can encourage more people to donate one of the few organs that they can safely live without?

“Compensation for donors might increase the donor supply,” Friedman said. “The people who know the most about the need for organs are very much in favor of a trial for compensation.”