The number of people who are in need of new kidneys in the United States is growing, but so is the waiting list for new organs. About 7 percent of the entire Medicare budget is spent on dialysis treatments for people with end-of-life kidney disease. The issue has become such a burden  that some are calling for the government to take a new approach: paying for people to donate their kidneys.

Last month, a group of researchers published in the American Journal of Transplantation a cost-benefit analysis for a government-funded program that would offer $45,000 to living kidney donors. They calculated that such an approach would not only fulfill the entire waiting list, but save a whopping $46 billion a year an amount that has attracted the attention of a handful of economists.

There’s one problem: Paying for human organs is illegal almost everywhere in the world. The U.S. strictly banned payments for organs in 1984 under the the National Organ Transplant Act. The medical industry has long referred to compensation for organs as taboo, as evidenced by the uproar following claims that Planned Parenthood has been selling body parts of aborted fetuses.

Some opponents take issue with the “commodification of the human body”: In 2002, a group of doctors even compared compensating donors to prostitution. Others raise more practical concerns, arguing that compensation would end up exploiting poor people or that it would may lead to a system in which donors are not fully aware of or pushed to disregard the risks involved.

Advocates for a change in U.S. policy, however, argue that thousands of people put on waiting lists for new kidneys don’t get considered which ultimately translates to their drawn-out, painful and expensive deaths. There are many cases of altruistic donations, but they barely make a dent in the 100,000 people currently on transplant waiting lists. As a result, up to 10,000 people die prematurely each year in the U.S.

The proponents for change also say that a ban on selling organs helped to create the global black market for organs, mostly in the developing world. The literature on this topic is terrifying: stories of political dissidents killed to have their organs harvested or impoverished citizens tricked into dangerous operations. Some advocates say that a government-regulated system of compensation could help end organ theft.

The discussion is bound to become more important in the future, especially as risk factors for kidney failure such as high blood pressure and adult onset diabetes continue to rise in the U.S.

This opens a debate: Should we shift the ethics of our healthcare system to improve the lives of people experiencing kidney failure? Or do we wait, and hope that science offers an alternative solution?

Over the next few days, we’ll hear from: