Bryan Caplan  

Why Do People Oppose Organ Markets?

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Will Wilkinson writes:
It seems that Bryan thinks most opposition to markets in organs is a function of either ignorance of the likely consequences or perverse and exotic moral premises. This makes me wonder if he has ever debated this issue with anyone? Lots of people understand the economics well enough but continue to believe that markets in organs ought to be illegal.
I have debated the legalization of organ selling with quite a few people over the years.  In my experience, 100% of people who can correctly explain economists' standard case for legalization favor legalization, and 100% of people who can't correctly explain the case oppose legalization. 

I'll grant that my sample is a little unrepresentative.  I suspect that with a little legwork, Will could find a hundred Leon Kass-types who understand the economics of organ selling but still oppose legalization.  But I still think that at least 90% of people who can correctly explain economists' case are on board.  Am I wrong?


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COMMENTS (20 to date)
zc writes:

I think organ markets would be great. But, opponents can always put forth various scenarios that make the whole process sound look atrocious.
-How do we keep the kids from pulling the plug on grandpa to sell his liver?
-How do we keep illegal immigrants, or any impoverished person, from selling a kidney to get the money to pay for school/a new car/drugs?
-How many times can I sell part of my liver? (Since partial liver tranplants work, and the liver regenerates)?
-Is a kidney from a healthy 20 year old worth more than that of a 45 year old, or is it one organ for all pricing?
-If I have ALS, or some other terminal neurodegenerative disease that spares my organs, could I elect to have all my organs harvested before my last days, so they're still in good shape, and leave the money to my family?

There are opponents, because there are too many odd/frightening possibilites that can arise (although, they already exist to some extent on the black market).

BlackSheep writes:

I've heard horror stories on organ stealing, so liberalization is clearly a good idea in order to push the price down and have the courts/police work more effectively in that market.

The main reason for prohibition seems to be the idea of commoditization. Consider prostitution. People say that if it is legal, then men will start look at women as sexual objects. Likewise, if organ selling is legal then people will start looking at others as collections of organs. Sounds like a religious construct to me, but that doesn't stop the horde of intolerants of even allowing something as benign as gay marriage, so better luck getting voters to liberalize organ selling.

Daniel writes:

When I was in college, I did parliamentary debate, where cases about the legalization of kidney selling were somewhat common.

The standard economists' case in favor of liberalization of organ markets was well known (that was the standard set of arguments in favor). But I suspect that while the vast majority of people on the circuit would've favored at least some change in the system by which organs are distributed, and perhaps the majority would've supported the legalization of both private buying and selling of organs, I'm almost certain that the minority that would've opposed the legalization of both private buying and selling of organs was non-trivially greater than 10%.

That's just my rough estimate, and I agree with you on the merits of the issue.

Damien writes:

I've always been struck by how the same people who fervently believe that abortion should be legal ("every woman should be free to do whatever she wants with her own body"), can also argue that organs should not be sold.

To me, it seems quite incoherent. Either one is free to do whatever they want with their own body, or one is not. If exceptions are made, it would make more sense to start with abortion (which involves one's body AND one's fetus's body) rather than organ selling.

Why do people object to impoverished people selling their kidney to pay for school, but fight for impoverished women's right to have an abortion to, for instance, finish their studies without being burdened with a child?

It seems to these two situations are exactly the same: a poor person undergoes a medical procedure because circumstances lead them to. The difference is that, with organ selling, no only would they improve their circumstances, they would also save a life.

Kevin DeGuiles writes:

Some responces for ZC's opponents.

"-How do we keep the kids from pulling the plug on grandpa to sell his liver?"

: Same way you keep him from pulling the plug for the life insurance. You criminalize it and actively go after offenders.

"-How do we keep illegal immigrants, or any impoverished person, from selling a kidney to get the money to pay for school/a new car/drugs?"

: Don't see how thats any of our business.

"-How many times can I sell part of my liver? (Since partial liver tranplants work, and the liver regenerates)?"

: Not sure. Maybe once, maybe 50 times, what does this matter?

"-Is a kidney from a healthy 20 year old worth more than that of a 45 year old, or is it one organ for all pricing?"

: All else equal, I'd pay more for a younger/healthier organ, wouldn't you?

"-If I have ALS, or some other terminal neurodegenerative disease that spares my organs, could I elect to have all my organs harvested before my last days, so they're still in good shape, and leave the money to my family?"

: Sounds like a fantastic idea.

ZC writes:

Thanks for the not economically sound responses. Like I said, I think it would be a great idea. I was throwing out some random cases that could be advanced by those opposed to such a system.

"-How do we keep the kids from pulling the plug on grandpa to sell his liver?"

: Same way you keep him from pulling the plug for the life insurance. You criminalize it and actively go after offenders.

-- But you've changed the incentives. As it is now, grandpa on life support isn't your problem, because he's probably on Medicare, so you personally don't benefit from pulling the plug. But, if you stand to gain $10k as his heir if he goes today, you're more likely to pull the plug (which ties into the healthcare debate of when enough is enough).


"-How do we keep illegal immigrants, or any impoverished person, from selling a kidney to get the money to pay for school/a new car/drugs?"

: Don't see how thats any of our business.

: Don't see how thats any of our business.
Unfortunately, it becomes our business when they suffer health consequences as a result of their selling an organ for money. So, they individually profit, but then when their lone remaining kidney fails, they're thrust back onto 'taxpayers' to foot the bill for their continued medical care. Privatizing gains, making losses public - sound familiar?


"-How many times can I sell part of my liver? (Since partial liver tranplants work, and the liver regenerates)?"

: Not sure. Maybe once, maybe 50 times, what does this matter?
-- Same reason they have limits on how frequently you can donate plasma.

"-Is a kidney from a healthy 20 year old worth more than that of a 45 year old, or is it one organ for all pricing?"

: All else equal, I'd pay more for a younger/healthier organ, wouldn't you?
-- Sounds resonable. So at what age are you mentally capable to decide to donate? What if you're 18 but really stupid. Think the military luring impressionable 18 year olds is bad, offer then $50k for a kidney and see what happens. Also, you probably wouldn't pay more, because few individuals could afford the direct costs associated with procuring an organ...and once insurance and gov't get involved, then it really becomes a mess.

"-If I have ALS, or some other terminal neurodegenerative disease that spares my organs, could I elect to have all my organs harvested before my last days, so they're still in good shape, and leave the money to my family?"
: Sounds like a fantastic idea.
Unfortunately, the vast majority of states that have laws against assisted suicide would tend to disagree. Not to mention the ethics nightmare that any surgeon participating in such a procedure would encounter.

But thanks for trying, you make it sound so easy.


Nathan writes:

ZC--some responses to your responses:

You never rebutted the life insurance point about pulling the plug on grandpa. If you stand to inherit lots of money, there's lots of incentive to pull the plug now. But no one wants to outlaw life insurance. And what if grandpa isn't on Medicare? Maybe he's got a few million dollars that he doesn't mind eating up at the rate of 10k a day on a private nurse and the best medicine money can buy to extend his life a few months. Very tempting to off him now to increase your inheritance. Should we ban old people paying for their own healthcare? Or ban inheritance?

Illegals/ poor people selling organs: The issue is no different than poor people selling their labor at dangerous jobs. Construction, farm work, driving a cab, etc., are all very dangerous with high rates of injury. Poor people get all the benefits in the form of salary, but the costs of their injuries are socialized if they don't have adequate health insurance, which they probably don't. What should the law do about this?

18 year olds selling their kidneys: *shrug* If they do something stupid, that's their problem. Tons of 18 year olds drive recklessly, binge drink, take dangerous jobs, have promiscuous sex, and do other things they'll likely regret later in life. Either we're a free society or we're not.

Finally, so what if a few problems emerge as a result of legalized organ markets? The perfect shouldn't be the enemy of the good. Right now, thousands die unnecessarily, which seems to me a much greater evil than any of the hypotheticals you've listed.

hacs writes:

That remember me that some Amazonian primitive tribes bury alive their defective (any visible imperfection) newborns, that rules against the incest emerged at the end of the Neolithic, that primitives human groups in Europe, for thousand years, sway (cycles of thousand years of duration) between a simple nomadic life in hard times, wherein they did not have any manifestation of religiosity, science or culture, giving no value to the life or the death, leaving their dead over the ground, and a sedentary life in good periods, wherein they buried their dead in religious ceremonies and promoted science and culture. So, morality is not a signal of our primitivism as some amoral postmodernism herald like to describe it, but it is intrinsically related to our material and technological advance. It is a last minute pure nonsense that economic based amorality to promote a market of life (a basilar common value for almost every religion and moral) advertised as human progress.

Scott Sumner writes:

I don't have a statistically significant sample, but I've noticed people raise two objections:

1. It hurts the poor, who can't afford to pay for organs.
2. It is subtly coercive, as the poor feel pressured to donate in order to make money.

When I explain to people why it actually helps the poor, and why it is far less coercive than family members pressuring someone in the family with the same blood type, I find attitudes change dramtically. It also helps to point out that every year the prohibition costs more than 5000 lives, more than the entire US death toll in Iraq.

ryan yin writes:

I noticed Dan Hamermesh had a quite critical/dismissive comment on organ markets over at Freakonomics blog. (Unfortunately he doesn't really go into detail as to why he's opposed, and he certainly doesn't answer the "so, how many lives is your repugnance worth?" question.) I'm not sure if I know anyone else opposed to markets who could state the standard case for them.

liberty writes:

But can anyone here REALLY state the case against them? Or do most people here just assume its "repugnance"?

The idea that "the poor will be hurt because they will feel forced to sell their organs" was also stated as a case against--but was this not too simple? What about the longer term consequences (social and moral) of letting poor people do this, when they will be much sicker later in life? Externalities?

Also, what if a wealthy person or business bought up all the organs that people decide to donate at a fairly high price, thereby becoming a monopsonist purchaser, and then sold them to the wealthy and sick -- would this be alright? Would this outcome improve and save lives for everyone, or would the poor be made worse off in this case?

Have we seen anything like this already, in the middle east or the far east?
... just asking some questions to keep this fairly homogeneous group (so far) honest.

ryan yin writes:

Liberty,
When I said "repugnance", I was basically reciting Hamermesh's stated case, more or less in full. I wasn't omitting a more complicated argument.

Kevin DeGuiles writes:

Sorry ZC, I make it look easy because it IS easy. The economic case for organ markets IS easy. I never said the -Politics- is easy though, heavens no, thats not easy at all and to pretend such is akin to declaring the earth is flat.

However, what we're doing here isn't discussing the politics itself, you just posed some typical objections one might hear. If you want to have a discussion about how to make this possible politically then why are we discussing arguments at all? Politics isn't about sound economic policy...

Anyway, to address your concerns:

-- But you've changed the incentives. As it is now, grandpa on life support isn't your problem, because he's probably on Medicare, so you personally don't benefit from pulling the plug. But, if you stand to gain $10k as his heir if he goes today, you're more likely to pull the plug (which ties into the healthcare debate of when enough is enough).

: Like Nathan said, I don't see how this is an objection. There are a million reasons -TODAY- that you'd want to pull the plug, just like there are a million reasons for murder of all sorts, solving this is a problem for the cops and the courts. The incentives increased for doing something? Increase the costs and the chance of incurring them (getting caught).

-- Unfortunately, it becomes our business when they suffer health consequences as a result of their selling an organ for money. So, they individually profit, but then when their lone remaining kidney fails, they're thrust back onto 'taxpayers' to foot the bill for their continued medical care. Privatizing gains, making losses public - sound familiar?

: I am willing to bet you, a serious bet, that the increased likelihood of death (and thus, not having to pay their social security) outweighs the increased likelihood of having to pay for potential future kidney expenses. The same arguments have been made about smokers, and guess what, smokers cost taxpayers less.

-- Sounds resonable. So at what age are you mentally capable to decide to donate? What if you're 18 but really stupid. Think the military luring impressionable 18 year olds is bad, offer then $50k for a kidney and see what happens. Also, you probably wouldn't pay more, because few individuals could afford the direct costs associated with procuring an organ...and once insurance and gov't get involved, then it really becomes a mess.

: This isn't an economic argument, its a cultural/ethical/political one. I'd say some 10 year olds are mature enough to make the decision, and some 50 year olds almost certainly aren't. What do you intend to achieve with this line of reasoning? We need "some" sort of cutoff, and right now that cutoff is done by age. If you have some other idea as to how we might seperate adults from minors then I think thats a topic for a whole other post (read: BOOK).
And individuals procuring an organ? Why would they do that? Thats for 3rd parties to do, and we, individuals, buy it on a market.

--Unfortunately, the vast majority of states that have laws against assisted suicide would tend to disagree. Not to mention the ethics nightmare that any surgeon participating in such a procedure would encounter.

:Again, not an econ argument. I don't get morally perturbed thinking about this occurring, perhaps you, Joe the plumber, or the AMA do. Great, but this isn't an econ argument.

I'm enjoying this ZC. I'll keep making it real easy for ya :)


RL writes:

Bryan,

I, too, favor organ markets. But I'm not sure your more general thesis (that people who oppose "icky" things simply don't understand the economics) is fully defensible.

Do you favor (voluntary, adult) incest? Not merely in the sense that it shouldn't be legally actionable, but in the sense that it benefits those choosing to engage in it while harming no one else? It seems the economics/incentives arguments would favor it. Am I wrong?

ZC writes:

You guys are totally missing my point. I would love to see a market develop for organs. I think it's absurd we don't have one. I think the people that opposed it are crazy. I merely list examples that people will raise opposing it (there are no doubt many more). I AGREE WITH YOU - these things are stupid and shouldn't prevent the creation of an organ market, which would be a net positive for our society.

These aren't rational, economically defensible reasons to the development of an organ market. But, creating a formal national system (as opposed to black market as it currently exists), would require political action - and when the media gets involved and politicians need to have their say, reason frequently goes out the window. See the current national healthcare debate, Terry Schiavo, etc. All it takes is one alleged case of "Ashley, promising young college student, killed in a convoluted scheme to get a new liver for Steve Jobs: Tonight, at 11!" playing on news stations across the country and every ignorant voter out there will be up in arms, and suddenly Congressman Smith is up in arms about the atrocities of this proposal.

The provision and financing of healthcare, sadly, is rarely economically rational. And, when it comes to people needing organs, the vast majority of them aren't rich executives who can pay out of pocket for a new liver or kidney. Many are kids, but most are low socioeconomic status folks, many of whom owe their organ failure to bad choices - Hep B/C and alcoholic cirrhosis for livers, poorly controlled diabetes for kidneys. So this 'free market' won't be anything of the sort. Either it will be rich people only getting organs (politically untenable) or it will be Medicare/Obamacare/society paying for organs for those in need (which is basically what we have now, and the whole argument of a 'market' is because the system we have now doesn't work well). How many times should society have to pick up the $100k+ expenses for transplanting a liver into an alcoholic who has not worked for 20 years, and has no plans to do so in the future (and not because he's independently wealthy) not to mention the costs of ongoing immunosuppression/follow-up? Because that happens in transplant centers across the country every week, and, presumably with a broader market for organs, would happen more frequently.

Yes, a market for organs makes great economic sense (as evidenced by a black market existing today), and sounds wonderful in theory. Again, I TOTALLY AGREE WITH YOU GUYS. But 1. Most people are too stupid to wrap their minds around it and 2. Most people can't individually afford the costs associated with a transplant (which can easily run into the millions of dollars over a few years), so it becomes a political issue of who should play for whom. And when you politicize something at the intersection of healthcare and money, all holy hell breaks lose and you're never going to get anything remotely economically logical as an outcome.

Alan Crowe writes:

I was very impressed by Ilya Somin's point four

If you are worried about exploitation of the poor you should never-the-less permit the well off to sell their kidneys.

Interesting too is the total silence so far; nobody seems to have a reply.

Dr. T writes:

Scott Sumner wrote:

I don't have a statistically significant sample, but I've noticed people raise two objections:

1. It hurts the poor, who can't afford to pay for organs.
2. It is subtly coercive, as the poor feel pressured to donate in order to make money.


Why are they assuming that insurance, which already covers transplant costs, wouldn't cover the cost of organs on the open market? The cost of the organs would be trivial in comparison with the medical costs of not transplanting. (Example: A kidney transplant costs about the same as two years of renal dialysis.)

Why would the pressure to sell an organ to make money be any worse than the pressure to become a prostitute or a drug dealer or a gambler to make money? People come up with bizarre arguments.

odinbearded writes:

I am worried about the current state of property markets and how that will transfer to organs. Once you allow something to be sold, you make it a form of property. And while we can say that we would legislate organ rights differently than ordinary property rights, that is a bit naive. There once was a time when it was inconceivable that private property could be taken by the government to be given to another private entity. But one court ruling changed all that.

It is shortsighted to think that if we make this one change, that the government itself will change. Legalizing drugs, for instance, does not mean that we suddenly have a more libertarian government. Sure, politicians might respond to incentives from voters, but that doesn't mean a permanent shift. Likewise, we have to look at the precedent we are setting for future generations.

The congress that legalizes organ sales will not be the only congress that makes laws regarding them. We must consider any possible eventualities. If there is a market value on an organ, will insurance/banks/institutions depend on that value? Will a judge require a transplant as a condition of bankruptcy? Can government declare eminent domain to seize a kidney for a government official, or public figure?

Yes, these are mildly absurd. But why? Once we take the step towards declaring body parts as property, is it simply legislation that will prevent these scenarios from happening? What will make a kidney different from a car in a repo situation? The law? A simple look at how drastically laws have changed over the course of time leads me to believe that simple reassurances are not enough. The only real way to prevent these types of scenarios is to not allow the first (historically unprecedented) step.

Todd writes:

With respect to your fear of judges ordering transplants in bankruptcy, I would point out that we already have many different types of assets that are immune from bankruptcy proceedings. It hardly seems outlandish to imagine that such an exemption would be extended to body parts.


No doubt this libertarian crowd is opposed to regulations keeping people from selling themselves into slavery as well. But even someone who understands economics can argue that sometimes the best governmental policy is to protect people from themselves when they are likely to lack information about long-term risks/costs of their decisions, which they need to weigh against a short term obvious benefit. These are exactly the types of decisions people routinely make poorly.

Or is the point that one understands economics if and only if one is a libertarian?

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