Tag Archives: market logic

Oscar Wilde on Kidney Markets

Reader Austin Donisan has a long comment worth reading in response to my post on why kidney markets might offend me. I’m not going to engage with every single point Donisan makes, because in doing so I would be repeating myself (please read the post which started this discussion). But let me make a few responses in any case.

First, Donisan suggests I have “an a priori opinion on the matter of paid organ donation.” Well, yes, I do. As I stated in my last post, I have a strong, instinctive revulsion to the possibility of poor folks in this country, in these times, selling their kidneys for pittances; my revulsion is not directed toward paid organ donations per se. Call it a preference if you like; no worries. But do indicate what my preference is for in more specific terms.

Second, Donisan is too keen to convince me in economic terms; that is not going to work in this situation. You are asking me to make commensurate two scales: one, which measures markets in terms of efficiency; the second, which reacts to markets in less tangible terms like distaste. We might be talking past each other.

Third, Donisan says:

The ability to donate a kidney may be poor’s biggest comparative advantage, and comparative advantage is the only way to get ahead in the world.

So, presumably, the best way to help the poor would be to encourage them to sell their kidneys. This doesn’t sound right to me; I can think of many other strategies that would enhance the “comparative advantage” of the poor, which do not require them to sell their vital organs.

I’d like to evaluate kidney markets in a broader context and Donisan wants to make the context narrower; it will enable a market-based argument to go through, but it does so at the cost of making the argument uninteresting to me. A poor man selling a kidney in the US today is just an abstract agent seeking comparative advantage for Donisan; not so for me.

Anyway, I’d like to stop repeating myself and let Oscar Wilde have the last word. So, from Lady Windermere’s Fan, Act 3:

CECIL GRAHAM. What is a cynic?

LORD DARLINGTON. A man who knows the price of everything and the value of nothing.

CECIL GRAHAM. And a sentimentalist, my dear Darlington, is a man who sees an absurd value in everything, and doesn’t know the market price of any single thing.

Why Kidney Markets Might Offend Me

Over at the Daily Dish, Andrew Sullivan notes my response to Alexander Berger’s NYT Op-Ed advocating the creation of organ markets, and provides a counter-response from Roger McShane:

[D]onors…see only the slightest increase in their risk of dying from kidney disease…their altruism is likely to lead to more than a decade of improved and prolonged life for the recipient. Donations are…cost-effective….such systems do fill the needs of the ill.

Let us grant all those points, all compatible with my original misgiving (Sullivan omits my final sentence where I say that organ markets might still work if there are not too many desperate entrants; incidentally, Frank Pasquale noted that in Pakistan, kidneys sell for $2000; that tweeted link points to an article by Pasquale that is worth reading in this context).

Let us now rewrite McShane (I have omitted McShane’s final sentence about Iran, which appears in Sullivan’s post):

Poor impoverished people that sell their kidneys see only the slightest increase in their risk of dying from kidney disease. Their altruism is likely to lead to more than a decade of improved and prolonged life for the recipient. Their donations are cost-effective….[a system which relies on purchases of kidneys from the poor and impoverished] fills the needs of the ill.

Fair enough? McShane’s words read a little differently now for me. The situation they describe strikes me as offensive; the society that is described by this picture is lacking in some vital quality. And that is because I did not render my original objection in the abstract; it was very much in the here and now, in this America, in this society, with its massive income inequalities, one that builds itself up on the backs of the poor, via the labor of those of whose attempts to organize themselves into collectivities is frowned upon, where Government and Corporation are indistinguishable.

I am not exclusively concerned with the efficiency of the market in being able to arrive at “optimal outcomes;” rather I am merely complaining, in perhaps a “unscientific”, “irrational” way, that the situation that might result from organ markets in the US–a society with gross income inequality whose poorest line up to sell their organs so that those who can afford organ transplants within the constraints of a grossly inefficient healthcare system can live longer–is likely to cause me to hold my nose. Perhaps it is because I suspect this same society will do nothing to improve the health of those who will find themselves selling their organs. I do not find an organ market, in the abstract, to be inherently offensive; in this society, I do.

Update: Fixed a grammatical typo; changed “non-scientific” to “unscientific”; changed “non-rational” to “irrational.”

Should Selling Kidneys Be Legal?

In today’s New York Times, Alexander Berger, who will be donating a kidney on Thursday, argues that a market associated with kidney donation would lead to better outcomes than the current voluntary-unrecompensed donation model.

Berger’s is an interesting argument; I’m going to respond to one small part of it here. In addressing the fear that an organ market could be “predatory” (the associated nightmarish vision is that of the poorest members of society running to the nearest donor clinic, shedding kidneys in exchange for pittances), Berger writes:

[W]e regularly pay people to take socially beneficial but physically dangerous jobs — soldiers, police officers and firefighters all earn a living serving society while risking their lives — without worrying that they are taken advantage of. Compensated kidney donors should be no different.

My first response to this line was “Whaddya mean “we” kemosabe”? More seriously, the example Berger gives us undermine his case.

Consider “soldiers;” our all-volunteer Armed Forces attract a disproportionate number of “young, poor, minority” men and women, who are then sent off to fight wars, while similarly young, though not-poor, not-minority men and women, who do not find themselves in such dire economic straits do not need to do so. The compensation offered these young folks appears inadequate to me. And so, when it comes to service in the Armed Forces, something “predatory” is going on precisely because the economic circumstances of so many folks are so dire that their bargaining power in the military labor market is severely limited. This means then, that the burden of the wars our nation fights is disproportionately borne by the “young, poor, minority” men and women who quickly take on any old compensation offer and thrust themselves into the front lines.

My worry for the organ market that Berger has in mind is quite simple: in our current economy, it will rapidly devolve into a situation where the number of economically desperate donors will bring down the price of organs to a level that ensures that organ donors will receive little compensation for their contributions. The health of those that can afford organ transplants in our current healthcare system will be enhanced, yes. But it has been enhanced by an economic system that immiserates people sufficiently enough to make them want to give parts of their bodies to others for inadequate compensation.

An organ market might still be a fair one, but only when the entrants to the market are not too desperate to enter it.