To pay for organ transplant, especially to live donors, is sensitive and there will never be an absolute solution acceptable to all.
However, a 'win-win' solution can be achieved without Man playing the role of God.
I am against organ trading per se but if a sufferer can find a willing and matching donor for a fee without coercion and undue influence, the consummation as such could result in less suffering for both parties; the sick regains his health while the donor receive economic assistance. To those who are adamantly against 'paid' donors, please do empathize with the sufferers - the pain is suffered by both, the patients and their caregivers. The brutal outcome, at times, is that the caregiver dies before the patient due to stress overload, age, commitment financial demands and a host of other issues combined.
Let us not assume that the donor is always a poor person; he could be someone who is altruistic, sincere and willing! The aid that he receive goes towards covering his medical costs for a deed well-done. Why should he be made to suffer financially when he helps a fellow man?
On a similar issue, where organs are harvested from a decease under HOTA, it is commendable if the deceased family do receive some form of financial assistance too. The money can go towards paying for his funeral/burial expenses and to provide for his living family members just as an insurance policy does.
Payment as such is not compulsory but for those recipients who are willing and financially-able, it will lighten the load the deceased family going forward. The money received is not a reward but contributes towards the costs for the living; the living need to live.
Most importantly, if the donor is a condemned man and waiting out his last breathe, his intention to donate his kidneys (I guess the only salvageable organs are kidneys) to save someone is admirable and beyond doubt.
However, to eliminate even an iota of doubt, only one of the kidneys should/can be donated to a named person/patient in lieu of some form of payment.
The other kidney must go the the long national waiting list of patients who enjoys an added chance of benefiting from this alternative source. This will hopefully put to rest all those who doubts the donor sincerity and that he 'auctioned' of both his kidneys to the two highest bidders.
I am in no position to discuss the advantages of patients who can afford to pay but I do like to see some balance of chances for those in the national waiting list.
Perhaps, we can even out the tough and rough road for those patients-in-waiting.
We can't avoid totally the "Pay" part of this equation; either you pay for medical fees, pay for dialysis, pay whilst suffering, pay others to secure a matching, working condition replacement ...
but if an acceptable solution is available, it will allow the sufferer and the caregiver a less demanding living condition.