Repugnant Transplants

November 16, 2007

Alex Tabarrok at Marginal Revolution has an emotional post about Repugnant Repugnance.

Many people find the idea of selling human organs for transplant to be repugnant which is why Roth argues that we should focus more on improving efficiency through kidney swaps. I’m all in favor of swaps and have also suggested that one argument in favor of no-give, no-take rules is that they are ethically acceptable to more people than organ sales.

Nevertheless, I think Roth assumes too quickly that repugnance is a constraint to be respected rather than an outrage to be denounced and quashed. People’s repugnance at inter-racial dating or homosexual sex is no reason to prevent free exchange – the same is true for organ donations. Repugnance itself can be repugnant.

Is it not repugnant that some people are willing to let others die so that their stomachs won’t become queasy at the thought that someone, somewhere is selling a kidney?

I think Alex’s posts are some of my favorites as he is not shy about wearing his repugnance on his sleeve :-) Nonetheless, organ transplant policies and irrational biases (repugnance being one form) are complicated.

For a long summary of organ transplants (yet succinct given the complexity of the issue) see Tom Slee’s post Juicy Kidneys and his review of Kieran Healy book Last Best Gifts where he concludes:

Healy convinced me that the big issue is not the economists’ issue — of markets versus altruism — but is the sociologists’ issue of coping with complex incentives in large-scale industrial organizations, and that alone was worth the price of the book.

I agree with Tom on this one. Well not the “large-scale industrial organizations” part . Hopefully Tom doesn’t mind my mental paraphrase substituting “overcoming innate biases” for the Chomsky-esque stuff :-) I believe it is important to recognize our innate biases and sometimes in rare situations it is appropriate to create incentive systems to overcome these biases.

As another altruistic health example consider the practice of fecal transplants as a superbug treatment. I think its hard to argue that the repugnance in this case is an “outrage to be denounced and quashed” especially since I’m positive that some (most?) of the repugnance comes from the recipients who benefit from the altruism. I’m guessing that a funny commercial or even mainstream media coverage like the CBC’s will do more to overcome the repugnance than heavy-handed approaches.