David R. Henderson  

Let's Make Homeowners and Those Who Need Kidneys Worse Off

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A Pessimistic Prediction... My First Austrian Moment?...

That's the gist of what Lorri Marquez Chapman of West Hartford, Connecticut wrote in a letter to the Wall Street Journal today. She was responding to a modest proposal by Sally Satel for people to be able to donate their kidneys to others in return for "contributions to retirement funds, tax breaks, loan repayments, tuition vouchers for children and so on."

Dr. Satel explained:

Were donor compensation legal, it might have been a good option for Donna Barbera of California. Last week, she wrote me asking how she could sell her kidney. She sent her phone number and blood type. "I do not find anything immoral about helping someone get a kidney and in return they help me out of a financial bind," she said by email, noting that she faces foreclosure on her house. "I have a donor card on my license, so my intentions have always been to help. I just thought maybe someone could help me too."

Killing two birds with one assault on free exchange, Ms. Chapman wrote:
Altruistic organ donation stands as the highest ideal and should be valued as such, rather than devalued merely because it cannot be employed with the level of perfection we increasingly clamor for in America.

Heaven forbid the day comes when a home foreclosure is forestalled by the sale of a kidney or a piece of a liver. Dr. Satel could more nobly use her pen and voice to encourage others to follow the high ideal that her kidney-donor friend did.


Heaven forbid? It's awful for someone to be able to avoid foreclosure by giving someone else a kidney or a piece of liver? Wow!


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CATEGORIES: Price Controls



COMMENTS (10 to date)
Bryan Willman writes:

I think I have an explanation for this, what follows is an attempt to explain the social forces, rather than a statement of my particular personal views.

Actually, as a long term "society facing natural selection" thing, a market in organs could be quite a bad thing. Or more accurately, I think most people in society will hold that view, for deep reasons.

First society may be better off with a number of people whose health is less at risk because they have a whole liver and two kidneys, but do not happen to own a house VS people who are "less firm" (though generally not infirm) but own property. Note that in this statement I fully realize that some number of people will be rendered very infirm, or die, for want of a kidney or liver or some other organ. But of course the giver here is presumed very healthy, and the recipient very ill. Perhaps for the species there is better utility in keeping the healthy organs where they are. (This argues against any live donor transplant.)

Second there is a real risk of a slippery slope - how do we know you gave your kidney or liver slice just to get money, rather than because someone who is manipulating you wants the money?
The example of "why can't I sell my kidney so I can keep my house" sounds compelling. But what about when it becomes "why can't I sell my kidney to pay my gambling debt? to pay my cocaine bill? to give to my pimp?"

There are some "obligations" that society (for the long haul) would prefer that you default on.

I think that similar forces are why societies (and religions) are opposed to suicide, usually in almost all cases. An argument that the group is stronger with some unhappy (or perhaps in great pain) people alive than with people escaping from their depression/debt/pain/grief by taking their own lives. In spite of what religion says, it's not about the person attempting suicide, it's about the rest of society.

David R. Henderson writes:

There are some "obligations" that society (for the long haul) would prefer that you default on.
Bring society to lunch and we’ll talk about it.

Roger Sweeny writes:

I wonder if Ms. Chapman believes in "a woman's right to choose."

Kathleen Tyner writes:

I think I can speak from an interesting perspective. I am what is called a living related donor. One of my kidneys was donated to a first cousin 17 years ago and she still lives. And I would still do it again. I suppose if we wish to measure my cousin's worth as to whether she should have been subject to survival of the fittest, it could be measured on one hand by the fact that she is a college and law school graduate. These degrees having been accomplished after she lost most of her sight to diabetes. She worked in her family practice and a legal aid society that helped provide low cost or free legal help to low income clients. However, even without the list of accomplishments she has, I do feel her life has worth.

My viewpoint about compensation for organ donation might surprise some, but I have no problems with it. To me, the greater good is that people's lives are preserved and that, having gained a measure of health they perhaps never have previously had, or lost, they usually go forward and try and do good things with their lives. Organ donation is woefully low, and often the death of someone has to occur for it to happen. Too many people die while waiting for a compatible donor. However, more and more strides are being made with kidney and liver donation and I do believe the more transplants are done, the more innovation will take place. There are careful screening protocols in place now, and I think this would help to keep someone who would sell their organs for supporting a drug habit or other irresponsible lifestyle choices. I doubt even a casual user would pass the rigorous physical testing that takes place, having gone through it myself. I also feel that those who have damaged their organs due to alcohol, drug abuse or other reckless actions that have cost them their previously healthy organs should go to the bottom of the organ waiting list.

Hopefully, at some point, with genetic progress, stem cell and cord blood research, it may be possible to either grow replacement organs or tweak the genes responsible for causing genetic problems with organs. But, in the meantime, I do feel the more organ transplants that take place, the better the techniques and science will occur. And if compensation for healthy donated organs moves that along, I am all for it.

Blake Johnson writes:
The example of "why can't I sell my kidney so I can keep my house" sounds compelling. But what about when it becomes "why can't I sell my kidney to pay my gambling debt? to pay my cocaine bill? to give to my pimp?"

The question is, does not being able to sell a kidney stop people from doing cocaine, gambling, or soliciting prostitutes? Or perhaps more importantly, what do the people who can't afford these things on their income, and can't sell their kidneys to finance them end up doing instead? Some of them when faced with the choice of giving up their vice will turn to crime. Its the same reason prohibition of some drug is almost invariably associated with an increase in the danger of that activity, and an increase in crime to finance that activity.

Ari T writes:

Yeah it is sad that people are dying because of sloppy thinking. I mean taxes are one thing but causing completely avoidable deaths for the sake of some people signalling their high moral values is just terrible.

"First society may be better off with a number of people whose health is less at risk because they have a whole liver and two kidneys, but do not happen to own a house VS people who are "less firm" (though generally not infirm) but own property."
Unfit for what exactly? Teaching? Engineering? Making music? Have you asked a biologist about the effect of kidney failures on human evolution. Something tells me that kidney failures are probably very likely after median reproduction age, and this kind of policy would be killing people just because we don't want these people to enjoy long and fun lives, without having any effect on human genetic structure, at least in any sensible proportion to the inhumane suffering caused. And that is ignoring any moral arguments for individual rights.

If you are worried about the "unfit", why start with kidney donors. That is weird. Why don't you just criminalize medicine to chronically ill people before they reproduce? That seems much more cost-effective, and I think they tried out this in one unnamed country in 1930s. Remember how that turned out.

Besides people who have produced capital, have contributed more to to the society, on average, ceteris paribus than those who have not.

Perhaps for the species there is better utility in keeping the healthy organs where they are. (This argues against any live donor transplant.)

Utility for species? How many people die before reproduction age because they donated a kidney? Probably very few and it likely has zilch effect on human evolution. As for the rest of the donors, I think they have the right to decide how they would like to to spend rest of their lives. I'd also imagine two people living with one kidney contributing more to the economy and society than one guy living with two and other one dying. Even if it weren't the case (I can hardly believe it were not), a tax can fix that. And this is is ignoring the massive difference in marginal utility (economic growth vis-à-vis death).

I haven't done the math, but I'd imagine that if anyone did CBA on this, the end result would be highly inefficient.

The example of "why can't I sell my kidney so I can keep my house" sounds compelling. But what about when it becomes "why can't I sell my kidney to pay my gambling debt? to pay my cocaine bill? to give to my pimp?"
So you are basically are saying the individiuals are better off if the donor is still in gambling debt and the kidney receiver is dead.
Second there is a real risk of a slippery slope - how do we know you gave your kidney or liver slice just to get money, rather than because someone who is manipulating you wants the money?
How do you know you didn't buy a moldy house. Please move outdoors.

These are marginal problems compared to the massive gains for people who actually need kidneys.

I think that similar forces are why societies (and religions) are opposed to suicide, usually in almost all cases. An argument that the group is stronger with some unhappy (or perhaps in great pain) people alive than with people escaping from their depression/debt/pain/grief by taking their own lives. In spite of what religion says, it's not about the person attempting suicide, it's about the rest of society.
Well first you advertise de facto euthanasia for people who would produce (otherwise you'd be just arguing for the price), but now you are saying people who are in great pains and probably cannot do much for the society, are not allowed to end their lives. This doesn't make much sense unless your objective is to maximize human suffering.
andy writes:

There are some "obligations" that society (for the long haul) would prefer that you default on.

Do you think the society prefers the kidney buyer to default on his life?

Tom West writes:

While I am on the side of allowing compensation for organ donation, I do think that Libertarians are once again in danger of ignoring social forces that can and have compelled people's behaviour.

The most radical example of that: suicide bombing is not something that was common 20 years ago. Social change has brought it into existence and social forces are what compel people to radically self-destructive acts.

Ignoring the long-term social effect of policy can be just as devastating as ignoring the long-term environmental effects. Pretending that something utterly fundamental to human behaviour doesn't exist isn't going to endear Libertarianism to anyone who isn't already convinced that freedom trumps absolutely every other measure of human welfare.

With respect to this topic, if an organ is freely convertible to cash, why *shouldn't* debt-holders be able to force the owner of such assets to relinquish them in debt, just as they can of any other asset?

bryan willman writes:

respondents to my coment appear to mostly miss the point - such questions as wether it should be legal to sell one's kidneys will be driven by people's feelings, often very deeply held, and expressed via law. this is what i mean by "society" - you can pick on the term all you want, but there is an emergent force, expressed at least in law, that holds this role.

it is rarely or ever a consistent thing - so my county demands i wear a bicycle helmet, but makes no serious attempt to regulate my poor diet, and things like rock climbing and hang gliding are legal.

likewise one person comments "moldy house, live outdoors" - but of course there are times when the civil authorities may demand that you leave your house (fire, flood, storm being the normal cases) in fact, it seems to me that if you have enough of the wrong kinds of mold the authorities may red tag your house and tell you to live elsewhere.

none of this strikes me as right, fair, rational, or even best for our society or humanity over even the medium term - but it is clearly a very real phenomenon and we would do well to try to understand it.

LivingDonor101 writes:

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