Arnold Kling  

Organ Transplant Market?

Teacher Pay... Comments of the Week, 2003-03-...

Irwin M. Stelzer argues that the shortage of organ donors is due to price controls--in particular, the fact that organ donors do not get paid.

if we can begin to think about this issue in a clear-headed way, we might consider the advantages of establishing a genuine, ongoing market in organs. If someone in need of a kidney transplant can locate a donor willing to provide a kidney at a risk doctors find acceptable, what is the argument against allowing consenting adults to strike a bargain that benefits both? That practice is now quite common in many countries, adding years to the lives of the buyers, and undreamed-of wealth to the donors and their families. The fact that the buyers are rich, and the donors poor cannot obscure the fact that both parties are better off when the transaction is completed.

No one can deny that the world would be a nicer place if everyone thought only of how his death could be made useful to others. And if those in charge of allocating the scarce supply of organs were all-wise and uninfluenced by the level of contributions needy recipients have made to their hospitals' capital drives. But wishing won't make it so. Neither will appeals to altruism. As for "presumed consent," it is so close to outright theft that it should never be acceptable. Meanwhile, people die for lack of organs.

This is a controversy of long standing. In the related topic of blood supply, a classic argument against using market approaches is The Gift Relationship, by Richard Titmuss. He said that donated blood is of higher quality than paid-for blood.
For Discussion. Would opening a market in donated organs be a Pareto improvement, or would it make some people worse off?

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COMMENTS (6 to date)
Joe Lanter writes:

We'd essentially be talking about kidneys here, I assume. I believe it would be a Pareto improvement with respect to the kidney market in the short run, but the long-term result would be low-income folks running around with just one kidney-a situation which could lead to problems down the road.
On another note, I'm not so sure about the statement that presumed consent is "outright theft." Is your body your property after you die? I'd be inclined to say no. Perhaps this treads closer to spiritual matters than one would like, but is something has no utility property? I suppose that the family would have a limited amount of utility for the body, but unless someone needed an organ, it seems that that utility would be unquantifiable.

Robert Musil writes:

Richard Epstein has been on this one for years:

Bernard Yomtov writes:

This is a complex issue, and I don't think Stelzer's article addresses it very well. For one thing, he is criticizing the bioethics commission's report before even knowing their reasons. The commission includes some very serious people. Surely we can read their arguments before firing the ideological guns.

For another, it is not clear whether he is talking about transactions with live donors or the families of dead ones, or even transactions with living individuals who agree, irrevocably, to be organ donors upon their death. Suppose you offered to pay people to enter such an agreement, and have their names and essential data for matching purposes recorded?

I am uncomfortable with one-to-one deals. I notice that Epstein somewhat sneakily calculates the gains from trade in terms of years of life, yet we have no reason to think that a financial transaction would produce this sort of gain.

Agreeing to become an organ donor, at death, has always struck me as very close to a moral imperative. You accomplish a great deal of good for someone else, at no cost to yourself. I am surprised that religious leaders and others who spend a lot of time on moral exhortations don't promote organ doantion more vigorously.

Neel Krishnaswami writes:

I used to be strongly in favor of unrestricted organ markets, but reconsidered when I realized that there is a really nasty principal-agent problem latent in the idea. Now I am only in favor of kidney sales.

Consider the case of markets in a vital organ like hearts. The donor isn't going to see any of that money -- he or she will be dead, and the financial benefit will accrue to his or her surviving family members. Now, if someone is too injured to speak, a doctor will generally ask the family members which medical measures should be taken: the family acts as an agent on behalf of the sick person. If a family can't benefit from the person's death, then it's reasonable to expect they will know what the sick person would have wanted and tell the doctor. But if the family will see a financial benefit from the sick person's death, then their interests are no longer aligned, and you have a classic principal-agent problem, with the possibility that do-not-rescusitate orders will come more frequently than if the sick person could make the decision. That's really bad.

Kidney sales, otoh, admit the possibility of informed consent, so I don't have an objection to it. Perhaps liver markets are also feasible, since IIRC it's possible to take a piece of a liver.

Robert Musil writes:

And then, of course, one will have to deal with stories like this one as more than novelties:

oceania connolley writes:

i am planning to exit this world; will do organ transplant

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