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.

19 thoughts on “Should Selling Kidneys Be Legal?

  1. You know what’s just as dangerous as donating a kidney? Commuting 40 miles to work for a year. The risk of death by driving 20,000 miles is about 0.03%, the same as being a live kidney donor. So exactly how is commuting for a $50,000 salary less exploitative than selling a kidney?

    Also related, the value of a human life the government uses when calculating if an environmental regulation is cost-effective is $8 million dollars. At a 0.03% risk, it means the “value” of a kidney is about $2400. So for the moral problem you brought up (poor people valuing their life less) to really become relevant, the price would have to drop below $2400.

    Obviously riskier things can bring up real moral issues (the most extreme case I can think of is a parent committing suicide so their family can sell their organs). But to argue that selling a kidney goes too far is nothing more than an appeal to people’s learned repulsion of selling organs.

    The total restriction on selling organs is another misguided targeted-antipoverty tool. It is just like rent control, minimum wage, etc, in that they it is extremely distortionary compared other tools we have (namely a progressive income tax).

    Banning people from doing something has safe as selling a kidney in the name of protecting poor people is foolish. If you want to do something, extend the earned income tax credit, don’t stop people from saving a life.

    1. Austin,

      Thanks for your comment. It’s good to know that my argument would go through if the price drops enough, which is what I was worried about in the first place. And I’m not arguing that “selling a kidney goes too far” – simply making a point that you seem to agree with: if the price drops enough (as I think it will, given vast numbers of poverty-stricken folks who’d be willing to sell their kidneys) we will be in a moral pickle. I’m not advocating a total restriction on selling organs either; I’m pointing out that a market like this, created in the economic circumstances of this nation, would be a market that would have too many entrants who would be too desperate to enter and who might drive down prices too much.

      1. The free market answer is that there’s no such thing as a price that’s “too low”, only a market clearing price. I’m not necessarily arguing this, but why is it wrong? We allow football and hockey players to set their own prices on what their brain damage is worth, is this really different?

        Iran allows paying for kidneys, and the average price there is around $1,200. Iran’s per capita income (PPP adjusted) is about 20% of the US’s, so I’d imagine that number would scale linearly. Is $5,000 too low for an American kidney? I don’t think there’s a right answer. The cost a dialysis is $30k/year, so some people are willing to pay more. Should we set a price floor on organs? Then we’d have a waiting list of donors instead.

        Speaking of PPP, the next question is what about importing organs? If an Iranian is willing to sell it at $1200, why shouldn’t we buy it from them? We buy goods from poorer countries where workers have lower opportunity costs all the time, is this different? (pretend we can trust that it was voluntarily donated)

        I think the biggest reason donating organs is banned is because it’s the easy answer. We’re uncomfortable with people valuing their lives less than we value our own. This is why some people are don’t like dangerous working conditions in China; they don’t think that people should be allowed to decide what their own life is worth. But that is fundamentally a poverty issue that shouldn’t be addressed with targeted rules like this.

  2. You are exactly wrong about who serves in the the most dangerous military positions – combat arms. Soldiers in combat positions are most likely to be the sons and daughters of white, middle class families. Although black service members are over represented in the service as a whole (a relatively recent phenomenon) this does not hold true for combat arms or for combat casualties in our recent conflicts.

    1. What is the economic standing of those white soldiers that do fall in combat? The word “middle-class” does not appear in the document you have linked to. Or did I miss it?

  3. Those of us who have served are insulted both by the factually incorrect nature of your assertion as well your description of “any old compensation”. We served the nation. That is our compensation. Please, don’t speak for us.

    1. Jonathan,

      Thanks for your comment. I don’t speak for anybody; I speak for myself. How about you don’t speak for all soldiers? I know some soldiers who don’t agree with you for instance.

  4. Times are desperate but for some, times are always desperate. Let it not become acceptable to say sell eggs to help pay on a student loan, or other body parts to prevent foreclosesure or to get money for food. Let us not go into something waiting for abuse.
    with the desperation I’ve seen in the last couple of years, ‘Organ Donations For Cash’ would result in a never-ending line in most cities and towns.

  5. I don’t understand where subjective valuation of life enters into this equation, or how a willingness to work under dangerous conditions in order to secure the basic necessities of life (or a willingness to sell off one’s own organs to the same end) indicates a less-than-first-world (or world-of-Austin’s-“we”) value of life. If the choice is between, e.g., certain starvation and a terrible way of making money that could – but won’t necessarily – result in death, then a high valuation of life leads to: taking the terrible job. The fact that a factory worker tolerates dangerous conditions has no bearing on his or her value of his or her life. Given a choice between sitting on a padded chair in a comfortable room shuffling paper for 8 hours a day or working in the factory, I’m going to go ahead and guess that most of the factory workers would choose the same thing you or I would. The idea of advocating for better working conditions has to do with understanding that severely limited choices force people into doing crappy things in order to survive – not with regarding people who accept the crappy options they have as aliens who value their lives left and therefore have no objections to the crappy options available to them.

    As far as the free market argument, I would imagine someone would come back at this and say that from a free market perspective, an organ market is undesirable because it would ultimately be subsidized by the state – the people most likely to be in straits dire enough to prompt them to consider selling their organs for money (see also: egg harvesting ads in the back of weekly papers) would likely be on public assistance and/or medicaid – especially if a glut of willing “donors” reduced the market rate of kidneys, making the option desirable only to those most in need of cash. While the mortality risk of donating one kidney is quite low, our hypothetically impoverished individual, who values his/her life highly enough to sacrifice his/her own organs to preserve it, might well see value in selling BOTH kidneys, especially if medicaid will end up handling the expenses of resulting dialysis. (This is an a**hole argument, imo, but I’m just saying – someone could make it.) Admittedly an extreme example, but still.

    Also, disallowing a market for organs doesn’t *prevent* anyone from saving a life. People are entirely free to donate their organs. It just prevents them from doing it for money.

    1. Melon,

      Thanks for the comment – very thoughtful. The last point especially, I think, focuses on something that at times s getting brushed aside in this discussion.

  6. Nice post. Freakenomics (or Superfreakenomics… i get confused) says that because Iran is the only country that permits selling such oragans, it is the only country that does not have a waiting list. (Presumably then it is the only country where others besides rich people can afford transplants.)

    But Samir, we (the USA army and every other army) does do it. You and I might not be happy about it, but it is done in the name of defending us. I doubt that we can aford to pay an army that would be appealing to rich kids to join the army.

  7. Noson,

    Thanks for your comment. I think the “we” I was rejecting was that I was indeed “worrying” about being taken advantage of; it seems to me that something exploitative is going on: create an educational and economic system that renders these people with fewer and fewer options and then send them off to fight wars.

  8. People are already being paid for “donations” of bio-elements like blood plasma, sperm, eggs, etc. Has the price of those gone down in the way you fear kidneys might? I don’t think so. You are making a distinction without a difference. There is already corruption and favoritism in the current system of organ transplanting; see the Steve Jobs and Mickey Mantle stories. Making a fair market is hardly a radical step.

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