Event: Virginia

In 1984, a Virginia physician named H. Barry Jacobs announced a plan to broker human kidneys on the open market. Congress responded within months. The National Organ Transplant Act (NOTA) made it a federal crime to “knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation.” Up to five years in prison. Up to $50,000 in fines. And the Senate report was blunt: “Human body parts should not be viewed as commodities.” That was then. Open the website of any commercial surrogacy agency in 2026, and you will find a fee schedule. Base compensation for the surrogate: $40,000 to $90,000. Additional compensation if she loses her uterus: $3,000 to $20,000. That is a published price for a federally protected human organ. And it is not the only organ involved in the transaction. The uterus has been classified as a human organ under NOTA since 2013, when the Department of Health and Human Services (HHS) added vascularized composite allografts to the statute’s coverage. The Organ Procurement and Transplantation Network confirmed the classification in 2018 and gave the uterus its own transplant category in 2021. Paying a living woman for her uterus (for transplantation into another woman) is unambiguously a federal crime. But paying that same woman for nine months of gestational use of that same organ, with an explicit bonus if the organ is destroyed, is the basis of a multibillion-dollar American industry. Commercial gestational surrogacy violates NOTA, not because Congress intended to regulate surrogacy in 1984—it could not have, since gestational surrogacy was not performed until 1985 and produced no births until 1986—but because the statute Congress wrote covers the conduct the surrogacy industry practices. The argument turns on a piece of human biology that almost nobody in this debate has been willing…