The average wait time for a kidney transplant—the most common organ transplant— through donation was 1,732 days in 2012. In 2014, that number went up by nearly a 100, to 1,822. That is a five year wait. For thousands, or even millions, of people around the world anxiously waiting for an organ transplant, this could signify their inevitable death. Looking for a solution? And under the current transplant system, there are no answers for those waiting. But outside the system, there just may be an answer.

In the case of organ transplants, could money be the solution people are seeking? Looking at how many people need organ transplants and how few are available, one wonders if altruism can solve the problem. One can say with confidence that it won’t. But bringing money into the realm of organ transplants is sure to bring about a bout of moral controversy. Before considering that, let’s look at why people have to wait so long for a new heart or lung.

One of the major reasons why it is so difficult to receive an organ transplant is that finding a compatible donor is not easy. Take the example of kidneys. For kidneys, one needs to have the right blood and tissue type. There are four major types of blood types, and tissue compatibility requires a mix of six different kinds of proteins. Without organ sales, there is bound to be a lack of supply. Organ sales could boost the amount of nearly all types of organs available, potentially solving the problem for those who can afford to buy organs. However, there are many who warn that such a solution poses new complications.

According to the Harvard Gazette, a survey of kidney donors (sellers) in Pakistan’s organ market showed that nearly 70 percent of donors were slaves or bonded laborers. 90 percent were illiterate and 88 percent had no improvement in economic status from the donation. These statistics tell us that a market for organs may pose a threat to the poor and vulnerable. The most likely sellers will also be least able to receive organ transplants. The World Health Organization believes kidney sales should be banned. “Transplant commercialism targets impoverished and otherwise vulnerable donors,” says their Istanbul Declaration. “It leads inexorably to inequity and injustice and should be prohibited.”

Could there be a reconciliation between saving hundreds of thousands of people from the grip of death and preventing exploitation of the poor? Iran poses a potential solution. Since 1997, the country has implemented a mixture of administrative regulation and a free organ market. In Iran’s system of “organ donation,” people wishing to sell their organs first sell it to the government.

The system was begun by the Rewarded Gifting Act. The government pays donors an incentive, about 490,000 won, and provides free health coverage for one year. But most of the “giftings” are done in private transactions.

One Iranian man paid 15 million toman (about 7.7 million won)—the seller originally asked for 20 million, the equivalent of two years’ salary for a state employee—only for his body to reject the kidney and for him to die a month later. However, the organ transplant waiting list in Iran has almost disappeared. Rife with moral controversy, the quandary of organ sales is one that will not be brought to a conclusion anytime soon.