WASHINGTON – The national transplant waiting list has grown to more than 87,000 because organ donations from the dead have not kept up with demand. For help, frustrated patients increasingly are turning to the living – even to strangers. That worries bioethicists, surgeons, and federal officials who oversee the transplant system, which is designed to treat all patients fairly.

Most troubling is the possibility that people will buy and sell organs, an illegal practice that is difficult to uncover if participants are willing to lie about it.

Log onto an organ donor Web site and you will find desperate people looking for strangers who might give a kidney or piece of liver.

“My friend, Josh, is 26 years old and needs a kidney transplant. He has had cancer since the age of 2,” reads one message.

“Vietnam Veteran with 3 little children desperately needs AB+ liver,” says another.

“I have a cousin…that is very sick in hospital, he needs a liver transplant very urgently…my aunty came up with the idea to look in the Internet for one,” someone else pleads.

Last year, 86 people donated to people they did not know; in 1997, there were none.

Last week, surgeons in Denver transplanted a kidney into a patient who met his donor through Matching-Donors.com, a commercial site.

Denver doctors delayed the surgery for two days amid concerns about the for-profit site and questions about whether the recipient might be paying the donor for his kidney. After the hospital got both men to sign affidavits swearing there was no such payment, the surgery went ahead.

Still, hospital officials said there were ethical concerns they hoped federal officials would sort through.

The for-profit nature of Matching-Donors.com, where patients pay $295 per month to post a profile, made officials particularly nervous. But the same sort of matching is rampant on livingdonorsonline.org, a nonprofit site that provides a billboard forum for people looking to find or offer an organ.

“I imagine when people are in need of a lifesaving organ, they’ll do what they can to get one,” said Dr. Andrew Klein, a surgeon who is chairman of the transplant network’s living donor committee.

Some fear that could include paying someone to donate, which could be hard to trace if strangers simply explained that they met on the Internet.

That possibility “is a very real concern,” said James Burdick, who directs Health and Human Services Department’s transplant division.

Gregory Pence, a bioethicist at the University of Alabama, said it “almost seems inevitable that it would happen.”

Dr. Jeremiah Lowney, co-founder of MatchingDonors.com, said organ sales may be possible, but he is not worried. “You have to trust people,” he said.

Experts also are concerned about the open-market nature of the Internet. They say it is unfair to give an edge to people who are simply better at recruiting donors over others who are sicker and ranked higher on the national waiting list.

“We’re trying to keep the playing field as level as possible,” said Dr. Mark Fox, chairman of the ethics committee of the United Network for Organ Sharing, the national transplant network.

“I don’t think the fact that you can write the most appealing ad or got lucky and found someone on the Internet should give you special consideration,” Dr. Fox said.