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.”

3 thoughts on “Why Kidney Markets Might Offend Me

  1. Here’s a re-wording for you:

    Poor impoverished people that work in construction see only the slightest increase in their risk of dying from a workplace accident. Their paid job is likely to lead to more than a decade of improved life for the recipient of the building. Their jobs are cost-effective….[a system which relies on purchases of labor from the poor and impoverished] fills the needs of those without buildings.

    And another:

    …rather I am merely complaining, in perhaps a “unscientific”, “irrational” way, that the situation that might result from labor markets in the US–a society with gross income inequality whose poorest line up to get a job so that those who can afford to pay them within the constraints of a grossly inefficient labor market can make money.

    Your paragraphs are only offensive if you have an a priori opinion on the matter of paid organ donation. With this simple word replacement, you could just as easily be against rich people giving poor people jobs. Just like jobs, it’s a good thing if poor people are lining up for them from an income equality standpoint. Would you rather have only rich get a job? Now, before you think this isn’t a fair comparison, let me tell you why it is.

    You dismiss the economics of the situation without realizing that doing so disproportionally hurts the poor. 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. This is the classic “you’re too poor for us to give you a job” argument you’re making, and it results in rich people feeling good about themselves and poor people staying poor. You complain about income inequality, and then proceed to argue against a way to reduce inequality.

    Now, the $2000 for a kidney in Pakistan isn’t PPP adjusted, doing so gives you $5,200. But consider that the PPP adjusted per-capita income in Pakistan is $2,700, vs $46,000 in the US. Would selling a kidney for $88,000 in the US offend you? Probably not, because then even non-“poor” people would be donating. But being poor is relative, and if you don’t scoff at $88,000 in the U.S. you shouldn’t scoff at $2,000 in Pakistan.

    That is unless you want to talk about absolute poverty, in which case my argument just gets stronger. Absolute poverty is living on $450/year (PPP adjusted), and 25% of the world does it. Now 1.7 _billion_ people each have something that is relatively useless to them (an extra kidney), that they could sell (at mere Pakistan prices) for 9 years worth of wages. Considering that 50,000 people die every day due to starvation (compare this to 6,200 deaths/day total in the US), not allowing people to buy kidneys from these people is flat out inhumane.

    Now you’re probably thinking that these people would be “exploited”, but let’s go back to the idea of comparative advantage. What can a person in absolute poverty do for you? What service or good can you buy from them? Pretty much nothing. But if you let them sell their kidneys they now have a ticket out of poverty. Lest you think that these people would be “exploited” forever, just take a look a sweatshop countries. In 1980 China, PPP adjusted per capita income was $500, now it is $7,500. This is largely due to people being “exploited” in sweatshops. The principle is the same: pay somebody to something less money than you would want to do it yourself, and you _both_ get richer.

    In conclusion, here’s a reason why banning the sale should offend you: the estimated value of what a kidney would sell for in the US ($50,000) is more than the net worth of most Americans. The ban on selling it may be the most regressive law ever, as it disproportionally affects the poor. You seem to think that’s a good thing. I don’t see how the equivalent of a $3,000/year (6% real returns) regressive tax (worse than a flat tax!) is a good thing.

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