[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.”