Understanding Moral Repugnance: The Case of the US Market for Kidney Transplantation

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Yves here. This post exemplifies why economists should not be in charge of anything important. Keynes was correct when he said, “If economists could manage to get themselves thought of as humble, competent people on a level with dentists, that would be splendid.”

Mind you, I am not disputing that there are many area of life where people can and do engage in transactions that raise serious moral issues. But what is troubling about this post is that it appears completely pre-occupied with more efficiency, as in “How do we get more kidney trades done despite public squeamishness about them?”

I have a well-off friend who had to have a kidney removed as a result of a bad infection. He is keenly aware of how the loss of that kidney increases his risk of mortality and takes steps to reduce his risk of impairing his remaining kidney, like giving up sushi and sashimi entirely due to hepatitis risk. Yet this article fails to acknowledge why selling one’s kidney is morally dodgy: the donor is potentially lowering his lifespan and the existence of a market allows the wealthy to take advantage of the poor. Even though this article gives survey responders a scenario in which money is given on a priority basis (flattening one side of “the rich are exploiting the poor” scenario), it fails to address what is a fair price to the donor as in what data is there on the health and lifespan loss for people who give up a kidney at a young age.

By Julio J. Elias, Professor, Department of Economics and Business School, University of CEMA, Argentina; Nicola Lacetera, Associate Professor, Institute for Management and Innovation, University of Toronto; and Mario Macis, Associate Professor of Economics and Management at the Carey Business School, Johns Hopkins University. Originally published at VoxEU

Imagine that you or a loved one were suffering from kidney failure. Receiving a kidney from a donor would be a far better option than dialysis – it would improve your life expectancy and the quality of your life, and it would also save money to you and the health system. Imagine that you cannot find any matches among your relatives, friends or acquaintances, or the donor registry – an all too common scenario in the US and elsewhere. There is, however, someone who is willing to give you a kidney in exchange for monetary compensation. You are willing to pay the requested amount and as such, you will be better off if the transaction occurred, and so will the donor. However, unless you happen to live in Iran (Ghods and Savaj 2006) you would not be allowed to do so. Alvin Roth defines this transaction as repugnant – because of moral concerns, individuals and societies oppose that such a transaction occur, even if the parties directly involved benefit from that trade (Roth 2007).

There are many activities and trades toward which there is a feeling of moral repugnance, often translated into laws that prohibit or restrict these activities. Examples include prostitution, commercial surrogacy, selling human eggs or plasma, as well as the trade of certain types of meat, and pricing practices for certain products. Attitudes toward these as well as other repugnant transactions vary across countries and over time; for example, indentured servitude contracts were once permitted but they are now universally prohibited, and conversely life insurance contracts were considered immoral in the past.

Repugnance considerations can therefore have important consequences on the types of markets and transactions that we observe, and pose challenges for policy and market design.

The Kidney Market: Repugnance-Driven Regulations and Costs

The market for kidney transplantation is one such example of the restrictions that repugnance imposes on the exchanges that are allowed to take place, as well as of the costs associated with these limitations. For example, although the US system allows kidney exchanges – whereby pairs of living would-be donors and recipients who prove incompatible look for another pair or pairs of donors and recipients who would be compatible for transplants, cutting their wait time – monetary compensation is prohibited by Federal law. The National Organ Transplant Act of 1984 prohibits transfers of human organs for ‘valuable consideration’ for use in transplantation, and punishes violations with a fine of up to $50,000 or five years in prison, or both.

To the extent that monetary compensations can increase the supply of kidneys and organs in general, as some scholars estimate (Becker and Elias 2007), prohibiting these transactions is costly. Each year in the US, approximately 35,000 new patients require a kidney transplant, but only about 17,000 obtain one (Held et al. 2016). Recent estimates indicate that each additional transplant leads to about $200,000 in direct savings; the social benefits rise to $1.1 million per kidney recipient if we add the value of the increased life expectancy and quality. The total cost of the kidney shortage in the US is estimated to be about $20 billion annually.

If indeed the population shared this repugnance, and considered it a sacred value – that is, a position that cannot be traded for other considerations – then the prohibition and the ensuing costs would be justified. Cultural and moral beliefs are important factors in the cohesion of a society and, as such, can themselves enhance welfare; the respect of deeply held principles, in particular, may trump considerations about the potential efficiency gains from a payment system.

There is, however, no evidence on the precise nature of the moral opposition to payments for organs, and in particular, on whether and how other factors, such as consideration for efficiency (the surplus created by these trades), enter individual positions about how kidney transactions should be organised:

  • What drives the rejection toward payment to donors?
  • How intransigent is the position of those against payment?
  • Does information matter?
  • Are there finite increases in the supply of kidneys for transplants generated by payments that would lead individuals to express a preference for a paid-donor system versus an unpaid-donor alternative, even if payments were considered morally problematic?

Understanding Repugnance: An Experimental Approach

We recently carried out a survey-based choice experiment to address these questions and quantify the trade-off between the morality and the efficiency of alternative kidney procurement systems. We found that although systems that allow for payments to donors do raise stronger moral concerns than a system with no payments, a majority of individuals would be willing to accept a more repugnant system provided that it produced a sufficiently large additional number of transplants.

The Repugnance-Efficiency Trade-Off

We recruited 2,918 US residents through Amazon Mechanical Turk. After providing an overview of the state of organ procurement and allocation in the US, we asked the participants to consider three alternative procurement systems to increase living undirected kidney donations:

  1. A system based on unpaid donors with allocation based on priority rules determined by the patients’ medical situation, age, time on the waiting list, etc. (corresponding to the current system).
  2. A system where donors would receive $20,000 from a public agency, with allocation based on the same priority algorithm.
  3. A system of individual, private transactions, where donors would receive $20,000 from the organ recipient (out of pocket or through privately purchased insurance, for example).

After receiving this information, respondents expressed their opinion about these systems related to their morality in terms of ethical concerns emphasised in philosophy and bioethics studies (e.g. Delmonico et al. 2002). We asked the subjects how coercive, exploitative, unfair to the patients, unfair to the donors, and against human dignity they thought each system was, and an overall assessment of how much a system was in contrast with the respondent’s values

Respondents were then asked to assume that each system would result in a given efficiency in terms of the kidneys for transplantation procured, and to choose their preferred system. The efficiency levels were randomly determined, and each participant was presented with three choice opportunities, in a sequential manner.

The unpaid-donor system received low repugnance ratings – that is, individuals, for the most part, did not express moral concerns about this system. The two paid-donor systems received, in general, higher repugnance ratings than the unpaid-donor system. However, there was a large difference according to whether the system contemplated payments by a public agency or by the recipients in private transactions, with the latter resulting as the most repugnant system.

Looking at choices, the results show that the likelihood of respondents choosing a particular combination of repugnance and efficiency increased with the level of efficiency and decreased with repugnance. Respondents thus preferred options with higher efficiency and those considered less repugnant, but also acknowledged, through their choices, a general trade-off between these two characteristics.

We estimated the size of these trade-offs employing discrete choice models. The median respondent would favour payments to organ donors made by a public agency if it increased the annual supply of kidneys by about 6 percentage points; this corresponds to about 2,000 additional kidneys, which would reduce the shortage by around 11% and would result in $250 million saved annually by taxpayers.

However, to accept a system based on private transactions, the median respondent would require about a 30 percentage point increase in supply, corresponding to 10,000 extra kidneys procured (which would reduce the shortage by more than 50%), and $1.26 billion in savings for taxpayers. This difference in the estimated trade-offs appears to derive from the fact that the public agency paid-donor system was considered less repugnant than the private transactions system along all of the morality features that we included. In particular, participants rated the public agency system as being equally ‘fair to the patients’ as the unpaid donor system (these two systems allocated organs to patients based on the same priority rules), whereas private transactions (in which the allocation is purely market-based) were considered highly unfair.

There was heterogeneity in the population, ranging from respondents with ‘deontological’ preferences who were not willing to allow payments, irrespective of the expected number of lives saved, to ‘consequentialist’ individuals who placed a large weight on efficiency over moral concerns. This heterogeneity did not generally relate to the respondents’ socio-demographic characteristics, but was correlated to broader attitudes as measured by a set of moral dilemmas typically used in psychology, thus providing further evidence that ethical views in these choices are central.


Alvin Roth stresses that “we need to understand better and engage more with the phenomenon of ‘repugnant transactions’, which often serves as an important constraint on markets and market design.”[1] The prohibition on payments to kidney donors is one important example of this phenomenon. Our research suggests that individual choices based on repugnance considerations respond in a predictable ways to efficiency information, but also that ethical views play a crucial role in these preferences.

Supplying evidence and promoting studies on such sensitive topics might therefore lead to greater awareness and improved policy design based on the actual preferences of a population. In the case of introducing regulated payments for organ donors and their families in particular, the evidence is particularly strong that informing society about the potential benefits of economic incentives does impact the acceptability of this transaction.

Because individual preferences appear to depend on expected efficiency in addition to ethical considerations, pilot trials testing the outcomes of different arrangements may enhance the ability of a population to determine the preferred organ procurement and allocation system.

See original post for references

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  1. Mark John

    I think your analysis at the beginning touches on the problem with organ transplantation, which is trust, or the lack of it. I personally am against organ transplantation of all kinds because I do not trust our system. I do not trust doctors. I am not an organ donor. If I am in an accident, I do not want those treating me to see me as a million dollars worth of organs ripe for harvesting for the organ market.

    It may sound paranoid on the face of it, but look at the callousness of the rest of our society. The ethics of the profit motive reigns, so why not in the market for human organs?

    In my opinion, it is far better for the species to humbly accept its own mortality.

    1. SpringTexan

      Agree, I will neither accept nor give an organ. I make an exception for cornea donation which can happen very simply after actual death (not “brain death”). That’s fine with me.

      1. visitor

        Whenever possible, dead donors are kept artificially alive (they are brain dead, though), while hospital teams find a proper recipient (not just according to priority lists, but also physiological compatibility constraints), prepare the operation room, and call surgeons and nurses for duty.

        Now, a single person may potentially donate several organs. As a result, the donor may be kept alive for days, being progressively harvested for cornea, then skin, a kidney, a lung, finishing with liver and heart.

        Technically, specialized hospitals can keep the process going on for weeks, but are somewhat squeamish about it.

        Where I live, people can formally express their will regarding organ donation in case of death, on an official credit-card size document which they keep with them. I hesitated for a long time about it, but learning about that kind of “organ mining” and thinking about where it could lead tipped me over to tick the option for a refusal of any organ retrieval whatsoever after my death.

        As for paying live donors, horror scenarios are easy to envision, even in the case of a state-controlled procedure.

        After all, precisely the kind of vulnerable citizens could be “nudged” with proper incentives to donate organs — if they are hopelessly unemployed and dependent on welfare, why should they not bring a tangible, duly appreciated contribution to society which, after all, is generously sustaining them?

  2. JohnnyGL

    Wow, I find the fact that someone was paid to think and write about this topic to be a “repugnant transaction”.

    As usual, with economists, they’re completely blind to considerations of power relations involved in any given transaction. The fact that deals are getting done means both side MUST be better off! After all they wouldn’t have done the deal if they weren’t benefitting?!?!

    No person would sell off a kidney unless they were either desperate or clueless about what they were doing. Either of those conditions makes the transaction “repugnant”.

    One can easily see a wealthy person requiring a kidney either 1) hosting an auction on ebay or 2) walking into a homeless shelter or local office for public assistance and waiving around a $100 bill.

    Oh, that’s right, 1) already happened….http://www.nytimes.com/1999/09/03/us/auction-for-a-kidney-pops-up-on-ebay-s-site.html?_r=0

  3. Some Guy

    Sounds ‘WEIRD’ to me – I recommend people read, ‘The Righteous Mind’ by Jonathan Haidt in order to better understand the disconnect with economists here.

  4. Terry

    Not sure what “tripwire” I triggered but my comments seem to be moderated out of existence these days :(

    Had written a critique of their study from a different perspective – that of the appalling reporting (which may or may not reflect appalling design and conduct) of their choice experiment.

  5. Jim A.

    This is what happens when you try and use free markets as if they provided moral guidance. Certainly societies have different ideas of what is morally repugnant. In the later days of the Roman empire, it was quite common for people to sell themselves into slavery, a transaction that would be unenforceable as morally repugnant today. OTOH in the middle ages the idea of selling land “fee simple” was considered morally repugnant, because land was inextricably tied into the power of justice over the serfs who tilled it, and the relationship with the feudal lord above.

  6. susan the other

    That was unnerving. It felt like a blockade. Against stem cell research; 3-D kidney printing; cloning. I’d prefer kidney manufacturing rather than kidney harvesting. We humans do some really repulsive things and organ harvesting is one. Another that comes to mind is the video I saw about bedoins taking a nice fresh steak from a goat and keeping it alive to take another. Better to just invent a refrigerator. And/or print up some tasty protein for lunch.

    1. nycTerrierist

      horrible story about the bedoins. i dimly recall that’s forbidden in the bible – guess it happened then, too.
      very very disturbing.

  7. Denis Drew

    A system whereby those who sign up to allow postmortem transplantation of their organs gave priority for transplants to their relatives or whoever they assigned might very wellk result in an surplus of available organs at any one time.

    Nobody thinks they will need an organ but everybody is afraid a relative or loved one would.
    * * * * * *
    Additional reading:
    At 18 years old, he donated a kidney. Now, he regrets it.


  8. Spring Texan

    An interesting book related to this topic is Margaret Lock’s Twice Dead: Organ Transplants and the Reinvention of Death

  9. James McFadden

    “Repugnance considerations can therefore have important consequences on the types of markets and transactions that we observe, and pose challenges for policy and market design.”

    It is rather amusing when an economist, who is trained to model humans as homo-economicus (selfish, amoral agents which have Trump’s narcissistic personality disorder and therefore only pursue their subjectively-defined self-interest), attempts to quantify and balance moral issues and market efficiency. Reading between the lines you can hear the author lament that it would be so much easier to model the solution if all of us could just be narcissists. It becomes clear that this economist thinks that the problem is that pesky morality which keeps getting in the way of efficient market design – if we could all just be a bit more amoral (i.e. ignore our “repugnance”) we could reach free-market “organlegging” nirvana.

    So I tried to consider the implications. If I put aside my repugnance to vigilante justice, I might be able imagine what the general public should do Wall Street CEOs and bankers, and their political and economic accomplices, who managed to steal trillions of dollars from the economy and who continue to use that money to manipulate the system. Perhaps a free-market bounty on the culprits might make Wall Street a bit more efficient for the rest of us. But I think I have a better solution. Why don’t we just fire all the economists like Prof. Elias who write this nonsense and start all over with a new system of moral economics – where morality and social justice replace the god of free-market efficiency (which is really the plutocrat’s god of control and fraud).

    1. ekstase

      Now here are some ideas! Really, if we could just put aside our cumbersome “moral repugnance,” why, think of the creative ideas that could be unleashed. All those artists and academics who waste their lives coming up with non-remunerative ideas could be designing carts to wheel around the spare parts people would be putting on the market. Pretty carts! Ones that would make you not throw up. Why do they hold the rest of us back from progress, these moralists?

  10. James McFadden

    Yves – thanks for your comment at the beginning. I read the article and commented before going back and reading your introduction (so not to be prejudiced before) and your comment was spot on.

  11. flora

    For his next act the good prof will explain, and attempt to show ways to overcome, the important market constraints on slavery, contraints on both the selling of others and the selling of self into slavery.

  12. Katniss Everdeen

    $20,000 for a kidney and $353,000 for the seat next to hillary clinton at george clooney’s dinner party.

    Sounds fair. And “repugnant.”

  13. vegeholic

    I think that Karl Polanyi’s concept of “fictitious commodities” applies here. Land, labor, and capital should not be subjected to market forces. Markets are only for things that we make or produce. Kidneys are a subset of labor (and management as well). Case closed.

  14. BigUncleBry

    As a survivor of ESRD and a kidney transplant recipient, I find the the moral standing of some of the commentators here quite amusing. Its all fine until you are standing face to face with your Nephrologist and he tells you its over and you have six weeks to live. The kidney “List” waiting period varies greatly from state to state. These “repugnant transactions you speak are happening now all over the world. Steve Jobs himself jumped the line to deal with his transplant needs. Now with due respect to the issues raised, this is truly a grey area. How do you assure a life or death transaction like this? The other issue is that transplants are not a cure all. I have about 10 more years on mine before the whole process starts again.The current wait here in CA is 7 years up from 3 years in 2010. Food for thought.

    1. Yves Smith Post author

      Let me clue you in: we are all gonna die. Each and every one of us. In the Mahabarata, the final and most difficult question posed to Yudhishthira in what was an urgent moral test was “What is the greatest wonder of the world?” His answer: that millions of people go about every day as if they will live forever despite the inevitability of death.

      Virtually everyone who finds out that they have a terminal condition wants to do something, anything, to stave it off. But since when does that give you the right to shorten someone else’s life to do so, particularly since the majority of people who sell organs for money are not making well-informed decisions about their choice?

      The only moral choices here are getting organs from people who died and consented to having their organs harvested and loved ones who are willing to make that sacrifice. A huge number of people in the US die in car accidents and of gunshot wounds, and many of them not immediately. Getting more people to consent to having their organs used for medical purposes upon death is a far better way to go, as well as investing in having more hospitals set up to hold organs (I have doubts that all hospitals are well provisioned on this front).

      1. TheCatSaid

        Yes and no. One of the best kept secrets on this planet is that there is no death. Raina Kilder Swedish physician has a book on this topic. It’s personal experience that clarifies this, though, not books. Our generally limited perspective contributes to pain and confusion around this topic.

        I do not mean to imply any religious structure. Rather the typical constraints here whose temporary limitations provide opportunities for learning and growth.

        1. Yves Smith Post author

          *Sigh* Anyone who is alive does not have a well-informed view. I know several people who have had the classic near-death experience and are pretty chill about dying as a result, but there are others who have been rescued from technical death who don’t have the same experience. And there are those who posit that the near-death experience can be explained in medical terms….

          If there is such a thing a bigger order and intelligence out there, our brains and senses certainly can’t comprehend them, so any attempts to step them down to a “this plane” explanation are guaranteed to be a massive failure.

          All I am sure of is if there is such a thing as reincarnation, I am not coming back here. I must have drawn a short straw to still be here. There are planes of existence under better management.

          1. TheCatSaid

            Experiences, recollection, perception and sensory system range vary tremendously from one individual to another. From the perspective of the “normal operating range” most people on this planet are consciously aware of (i.e., lowest common denominator in “advanced” Western society), there’s no reason anyone should take anyone’s word for a broader reality of which they have not yet had any conscious personal experience. (Though most people have had a wider range of experiences than what they discuss publicly–e.g., knowing when something bad has happened to a close friend or relative in a distant location.) We each have our unique framework for seeing/perceiving what we’re ready to deal with for our own growth.

            Since I have extensive personal experience–personally and in the past as a health care professional supporting others–my perspective differs. This impacts my view on many things, and my practical actions.

            Just a few days ago someone pointed out a recently posted video I found quite revealing. (I don’t know this person, but a good friend has seen her professionally on several occasions.) Some concepts that are different from any I’d considered.

            As for reincarnation, my current understanding is that although on this planet we have a linear experience of time, this does not accurately reflect the bigger picture. I think of time as having a flexible, “telescoping” nature, and we can access more (or less) of our full range of experience as appropriate. Mostly we’re flying blind–often frustrating but it presents interesting opportunities for growing and evolving, individually and as a society.

  15. verifyfirst

    Wrong. Billions around the globe live the most wretched existences imaginable. Their short brutish lives will soon end in starvation, infection or disease or death scrounging their subsistence. But you want to deny them the right to trade their organs (any and all organs) to provide a chance at a future for their loved ones. How noble of you.

    1. Mark John

      Your ethics certainly are not in accordance with mine.

      By your logic, we crush others with our capitalism and wars, and then harvest their organs because it will “provide a chance at a future for their loved ones.”

      Wouldn’t the moral thing be to not crush others in the first place? Wouldn’t that be far better for families than having scavengers running around offering money for their own and their loved ones’ organs?

  16. a different chris

    Jesus not even half way thru the first paragraph and we get the “imagine a can opener” moment:

    >you will be better off if the transaction occurred, and so will the donor.

  17. bob

    Optimism for a Randian downfall-

    “I’m a libertairan”

    Put a number on your liver, i want it.


    OK, done. Great public spending project. How can the rotary club anarchists object? In principle, or fact? They get the money.

  18. TheCatSaid

    Selling ourselves in any way is morally repugnant, yet we’re encouraged to see this as normal. For example, holding down a “job”. Or doing things to get approval, or to get something else I “want”. Usually there is no transparency on the trade-offs. We can go our whole life without realizing the price we “paid” for something.

    Our moral repugnometers have been miscalibrated and distorted beyond recognition. It’s encouraged by so-called “advanced society” on this planet. For some bizarre reason we’ve come to believe that money-tinted glasses are the normal way to perceive much of reality. It is crazy, dysfunctional–and unnecessary.

    It doesn’t have to be this way. There are people out there showing the way if we can take off enough of the blindfolds we’ve accepted or put in place ourselves.

    1. Arthur J

      It’s hard to imagine a lifestyle wherein you are able to supply yourself with all that you need to survive without trading with -anyone-. Perhaps you could name some of these virtuous ones that we might learn from them how it’s done.

      1. TheCatSaid

        My point was not about exchange but rather about our assumptions about money being the only way to do this. Our planet may well be an outlier in this regard.

        David E Martin CEO of M-CAM is someone who walks the talk. He uses what he calls Integral Accounting.

  19. C. Rowland

    I realize few will agree, but organ donation should be mandatory. Taking perfectly useful organs to the grave or crematorium when they could be used to vastly improve the lives of millions of your fellow citizens is foolish. People are entirely too squeamish about what happens to their bodies once they’re dead. It’s over for you. Trust me, you won’t feel a thing…

    If that’s a step too far, at least make organ donation mandatory for anyone who applies for motorcycle driver’s license.

    I can see the headlines now: Crazed madman goes on a motorcyclist killing spree in attempt to find compatible organs for sick wife!

    1. Yves Smith Post author

      I think a reasonable compromise would be an opt-out system. Some religions have prohibitions against what they see as mutilating the dead.

  20. PhilU

    First off, this would be much less of a problem if we had opt out organ donation rather than opt in. But just to be contrarian I am not totally opposed to this with some guidelines. I think suicidal people should be allowed to kill themselves and if they wanted to sell an organ first than by all means they should be able to. Obviously there needs to be checks to make sure that they really want to die. Something like this.

  21. MG

    My mother has a rare kidney disease that was an autoimmune response to which she was genetically predisposed due to a C. difficule infection she acquired in the hospital in 2009. Another example of the impact of a HAI (hospital-acquire infection).

    Buying and finding a kidney in Brazil, South Africa, and especially in Thailand or China is quite easy if you just know where to start and look. It varies on price but can be had for $25k on the low-end but $40k on the higher-end. The Chinese gov’t admits to forced organ extractions including kidney extracts for more than 10,000 ‘criminals’ last year but the real estimate is almost certainly 10x that at a minimum. Just one of the horrible realities of the Chinese criminal system which almost entirely gets glossed over.

    Yes creating a market for this in the U.S. certainly would go to help addressing the current shortfall but bring a ton of horrible moral and some criminal elements into the process too. I am a health economist by trade & horrified at some of the things my colleagues suggest including advocating paying people for their essential organs to address shortfalls.

  22. flora

    The current transplant wait list guidelines include:

    “Special allowances are made for children under certain circumstances. Factors such as a patient’s income, celebrity status, and race or ethnic background play no role in determining allocation of organs.”

    How long would these fairness guidelines survive – in practice – in an officially sanctioned organs-for-sale “market”?

  23. Cry Shop

    Dick Cheney gamed the heart donation system twice and in the first case used up two hearts (imagine, they had one on stand-by just in case the first one didn’t take – what a waste). Too many people don’t even get one try. That’s why I don’t support it in the USA.

  24. Nancy Sutton

    Didn’t Nassim Taleb make it clear that evolution/nature’s production of duplicate, redundant organs served an important purpose ? And increasing fragility does not pay off? (Does anyone remember Jesus’ parable of the Two Masters, and the alternative to ‘God’ ?)

  25. ChrisPacific

    I am happy to accept “lots of people who need kidney transplants don’t have access to organs” as a problem statement, and I am even OK with the idea of compensation for donors in some form. The idea of a market-based solution to this problem, on the other hand, I absolutely find morally repugnant (and I think anybody – who wasn’t an economist conditioned to think of everything in terms of rational actors with perfect information working to maximize single variable utility functions – would feel the same way).

    Think about everything that happens in free markets and imagine them in the context of an organ donor market. Driving down costs? Squeezing suppliers? Offshoring to reduce cost? Maximizing shareholder value? Value-added services? Preferred customer programs? Expanding to related business lines? Anybody who thinks this would result in anything other than a Boschian nightmare is living in fantasyland (or an economist, but I repeat myself *rimshot*).

  26. BigUncleBry

    YES Yves we are all gonna die! My point is everyone is a tough guy/girl until the proverbial gun is pointed at your head.

    Re: “The only moral choices here are getting organs from people who died and consented to having their organs harvested and loved ones who are willing to make that sacrifice. A huge number of people in the US die in car accidents and of gunshot wounds, and many of them not immediately. Getting more people to consent to having their organs used for medical purposes upon death is a far better way to go, as well as investing in having more hospitals set up to hold organs (I have doubts that all hospitals are well provisioned on this front).”

    Yves, yes,this currently how it works and yes it is a specialty that only certain hospitals can deal with. This also why we have huge waiting lists for kidneys etc. Many people also donate out of the goodness of their heart. Living with one kidney is not a big deal. Matching blood type and other DNA markers is the difficult part. It’s at least a 9 month process going thru the proper channels and live donors are always preferable to deceased.I personally do not have a problem with well informed parties making a deal with the proper medical safeguards in place. I do have a problem with the seedy and exploitative side of this so called market. I realize the author is an economist just trying to analyse the “marketplace” and make it more efficient.Problem is that in my opinion, people like the author are usually looking down from 30,000 ft and have no idea of the blood,stress and pain the people involved are going through. I worked in the markets long enough to that most economists need to be taken outside to view the real world at least once a month. Preferably put in stocks and have rotten vegetables thrown at them for effect.

  27. armchair

    Contra el Tiempo is the Colombian take on the issue. Considering Colombia’s lamentable gini number, its leftist critique and being the best smugglers in the world, and you get a chilling vision.

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