Slice of the Kidney Pie

August 29, 2009

Will Wilkinson and Bryan Caplan are debating why people oppose organ markets. Caplan believes that all (or effectively all) people that understand the economics behind organ markets support it over, I’m assuming, the current heavily altruistic system. Wilkinson attempts to summarize the moral argument against organ markets as follows:

Human beings have a certain dignity that is central to the value of human life. That dignity ought to be respected, preserved, and protected. Allowing the sale of human body parts diminishes the dignity of those involved in the transaction and erodes respect for the dignity of human beings generally. Therefore, markets in body parts ought to be legally prohibited.

I think Wilkinson’s argument about human dignity is accurate but it is only part of the argument against organ markets. I think the larger argument is about cheaters and disadvantaged individuals who are exploited.

As an aside, the movie Dirty Little Things is specifically about a fictional black market in kidneys. The movie focuses on the exploitation of illegal immigrants and others but it is easy to argue that the scenarios presented in the movie are the result of the lack of a free market in kidneys. It is a surprisingly good film, especially if you are interested in the topic.

The straw man argument of the left is that human life is precious and all good people should give altruistically without the need for money polluting the exchange. It is easy to counter that if you truly value life then you should only focus on outcomes, that is, how many lives are saved regardless of the type of system used. This anti-profit worldview normally views all profit as a form of cheating. Although few hold this extreme view, many have a view that is similar to some degree. A middleman that makes money trying to convince poor people to donate a kidney is seen as repugnant by some. A person with this worldview will often trust that government or a not for profit organizations to make decisions for the common good.

Exploitation of the disadvantaged is another concern. We know that free markets work extremely well for high-volume/low-value transactions. When it comes to infrequent transactions with very large sums relative to lifetime earnings, the incentive to game the system increases. This is true for automobiles, homes, mortgages/loans for large purchases, and retirement investments. I think people who understand the economics of an organ market can reasonably argue that the externalities will outweigh the benefits. Keep in mind that “argue” is different than “prove” and the same disclaimer should be applied to proponents of organ markets.

So who could be cheated or exploited? Two categories are 1) extremely desperate donors,  and 2) poor recipients. Desperate people often make bad decisions. Its a type of paternalism that aims to protect these individuals. The young, the poor, and those in a “bad” mental state fall into this category. On the recipient side, rich and/or famous people “jumping the line” is also a concern. A superstar athlete (think Alonzo Mourning) outbidding others for a new kidney every off-season while others unable to pay die prematurely is a moral issue.

Caplan’s argument for an organ market may very well be correct, however, I think his view that those who oppose organ markets can not grasp the economic argument is a straw man.


2 Responses to “Slice of the Kidney Pie”

  1. tom s. Says:

    I agree that exploitation is a bigger problem than an abstract notion of dignity. In the articles I’ve seen in favour of markets in organs (mainly by those on the free-market right, of course) there is little mention of details like standards enforcement. I suspect that’s because standards enforcement would be a massive job, and because it would have to be done by the government. Unless you trust the companies involved to do some kind of self-management, but that seems far fetched.

  2. RAD Says:

    I’m assuming that laser eye surgery is effectively unregulated and I think the industry is far more transparent than other healthcare services.

    What makes it different? Perhaps the heavy dependence on technology, the fact that patients pay out of their own pockets, or the fact that it is a purely optional procedure that the consumer can safely choose to walk away from.

Comments are closed.