The Altruism Requirement as Moral Fiction.

The article critically examines the widely accepted ethical stance—termed the Received View—that living kidney donation is morally permissible while living kidney sales are not, a position often justified by the Altruism Requirement, which holds that donors must act altruistically without expectation of payment. The author argues that the Altruism Requirement is not a moral fact supported by cogent argument but rather a moral fiction: a motivated falsehood accepted primarily to rationalize and preserve the Received View. In practice, transplant policies do not require genuine altruism but instead enforce a No Payment Requirement, permitting valid consent without compensation while prohibiting cash transactions. The article further critiques the main philosophical justifications for the Altruism Requirement as flawed or insufficient and suggests that its persistence serves to maintain ethical coherence by distinguishing donation from sale, despite lacking a sound moral foundation.