Back in the summer it was revealed through freedom of information requests that organs from 50 National Health Service donors had been given to foreigners paying privately for their surgery. Most were EU nationals from Greece and Cyprus but some were from Libya, the United Arab Emirates, China and Israel. The Healthcare Commission said no rules were being broken; but after consideration, last week some British transplant surgeons and patient groups called for the practice to end.

“While there is a surfeit of UK residents awaiting transplant,” said Professor Peter Friend, president of the British Transplantation Society, “it is correct that these patients should have priority.” Two big London hospitals defiantly continue with the practice, though, and one figure suggests 97 British organs given to foreigners this year alone, even though we have a serious shortage. Not all hospitals do it: at St James's in Leeds a consultant said baldly: “We cannot cater for the whole of the EU and beyond.” We do not, it seems get any organs incoming from the EU in return. Let alone from the wider world.

Before going on, it is worth pointing out that organs have to be given - rapidly - to the patient who is the best match in size and type; we have no figures to prove that in each case there were equally suitable Britons waiting. Though, given the numbers, one must reluctantly suspect that there were one or two. It is also worth musing on the weird EU regulation that organs may go outside the bloc if they are “not of a high enough standard” for EU citizens. But hell, if a liver can save a Libyan... I'd go with the chance.

All in all, it is a morbid but fascinating question, combining medicine, politics, money, national identity, psychology and the philosophy of body ownership. By 8.15 yesterday morning the messageboard next to the online story had grown 25 replies; three argued that it is wrong to refuse fellow humans in need just because they are foreign private patients; one was a mother in Boca Raton who says she got a British liver transplant herself. All the others were angry. Eight said they had just torn up their donor cards or planned to, and another announced that he was putting a condition on his (which he can't legally do), saying his innards can only go to a Brit.

The most outspoken respondent said that she ripped up her card because “I do not want my organs to go to some spoiled UAE prince”. Many were particularly annoyed that - while the actual liver is not paid for - surgeons doing these private operations earn an extra £20,000. Possible conflict of interest was raised, which may make medical staff bridle and take offence, but is entirely understandable.

While messageboards are not the most reliable of straw polls, all this should make the Department of Health think hard, and likewise the hospitals that are so willing to take foreign money for transplanting British donor organs. The Government is about to splurge £4.5 million on a “public awareness campaign” to boost voluntary donation; and the Prime Minister has refused to rule out his pet project, a change in the Human Tissue Act to create “presumed consent”.

If this went through, doctors could take organs unless the individual had explictly opted out. Earlier this year a wise and gentle report told the PM that such a move might not boost donation rates. People would just opt out en masse, rather than let it be cavalierly assumed that the State owned their newly dead bodies as a resource to be dissected and reallocated as it chose (even to rich people from far away, profiting NHS budgets and eventually the Revenue).

Elizabeth Buggins, of the task force, said: “We found from recipient families and donor families that the concept of gift was very important to them, and presumed consent would undermine that concept.” She recommended better co-ordination and education, and warned also that presumed consent could erode trust in doctors.

She's not wrong: you do not want to think, even for a second, that the team struggling to save your heart's best love has already got a beady eye on the undamaged bits. Or - to return to the foreign private patients - that the medics are hoping for a nice little earner. I hasten to say that I do not believe that doctors behave or think like this (indeed they often seem overanxious to prolong untenable lives). But public policy has to work with the people it serves, and Mr Brown would be very unwise indeed to forget that this is the country where even pathologists are regarded with superstitious horror, and where after the Alder Hey scandal some families insistently held multiple “funerals” for scraps of tissue on microscope slides. Gentle education and the “concept of gift” will slowly change that attitude. A sledgehammer law will harden it.

As to the question of foreign recipients, it is unfair to castigate the indignant as mere xenophobes. I think we have to be gentle - gentler than government, gentler even than doctors - about the deep feelings that people have about their physical selves, and their national selves too. The relationship between biology and identity has developed great intensity lately: the double helix brings a new sense of physical individuality.

People are less at ease now with the idea of “ashes to ashes” and the soul alone as distinct and enduring. The body takes centre stage: Hollywood stars copyright their DNA lest some future fan try to clone them from hair-clippings, and morbid kooks embrace theories about “cell memory” and claim that their transplant spookily gave them an unprecedented taste for piccalilli and motorbikes. People are more - not less - ready to believe that some unique humanity rests in a cadaver.

Which makes that “concept of gift” even greater. So it is natural, not xenophobic or mean, for people in intense grief to want their difficult gift to be made, untainted by anybody's profit, to someone who walks their country's streets, pays its taxes, speaks its language, takes the same daily risks under the same sun and rain. As supposed champions of “Britishness”, ministers should understand that with a thousand compatriots dying every year for lack of a transplant, it is not wrong to hope that your gift will save one of them.

These are huge and profound emotions; not everyone feels them the same way. I don't, as it happens. But they are not wrong emotions. We are free people: our hearts and minds are as much our own as our bodies are. Tread very, very carefully.

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