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.