Unbiased Analysis of Today's Healthcare Issues

Should people be allowed to sell kidneys for money?

Written By: Jason Shafrin - Feb• 15•08

“In 1988, the first year for which data are available, there were fewer than 14,000 patients waiting for a kidney transplant and about 7,000 deceased-donor kidneys. Today, the waiting list has grown more than fivefold — an increase fueled partly by higher rates of diabetes — but the number of deceased-donor kidneys has only inched up.

There is a serious kidney shortage in the U.S.  Any economist can tell you that shortages generally occur from either a natural disaster or when the government imposes a below market price on a commodity.  In this case, the government has said that one can not sell organs; thus the market price for a kidney is set to zero.   Could a market for kidneys solve this problem?

The Wall Street Journal has a pair of interesting articles (“Kidney Shortage…” and “A Market for Kidneys?“) on whether or not we should have a kidney market.  Julio Elias of the University of Buffalo comes out in favor while Alvin Roth of Harvard University is against.  Dr. Elias makes a case based on economic theory:

“The current system of live organ transplants resembles an autarkic economy in which patients in need of an organ transplant are constrained to the organs available in the pool of friends and relatives. The kidney exchange system developed by Al and others is a barter system, and clearly will provide an improvement over the current system.

But a general conclusion of economics is that barter is an inferior system when compared to a money system, since barter requires the coincidence of wants. With the use of computers, and a national registry, multilateral barter is a good possibility, but still less efficient than using general purchasing power; i.e., a market. The main disadvantages of the kidney exchange system are the limitations that only kidneys from relatives and friends can be used and that the exchange must happen at the same time. A market-based exchange does not have such serious limitations.”

Dr. Roth believes that creating a market is politically infeasible and socially repugnant.  Although he does not reject the merits of an organ market, he does say that more practical steps–such as an organ exchange or making all individuals organ donors upon death unless they explicitly opt out–will currently be more politically feasible.

“There would be more live-donor transplants if everyone who wanted to donate a kidney to someone could do so, but a healthy person’s kidney is often incompatible with his or her intended donor. So, one way economists have helped is in helping organize kidney exchanges, which allow incompatible patient-donor pairs to exchange with other such pairs. “

 What do you think?

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  2. Matt says:

    I understand Roth’s desire to know the political constraints of reform, but I do not believe that this “repugnance” is the deep human characteristic he claims and consequently I disagree that repugnance is driving political infeasibility. At the margin, people may be “repugnant”. Ask them if they think selling hands or something should be illegal and they say yes. There are no costs involved in such a reply.

    If you ask someone who needs a kidney, however, they will surely overcome this supposed innate repugnance and say “yes, please open the markets.”

    If a politician is willing to stand up for the idea and make the cost-benefit case to the public, it can get passed. I don’t think it could be any easier for a spin team to sway public opinion: throw together some commercials with diabetics on waiting lists, surviving family members of people who died while on the waiting list. Easy.

    The political infeasibility of this idea comes not from this repugnance, but rather a simple calculation of political cost vs. political benefit. It would take a strong politician and a non-trivial campaign to pass such reform, but the (political) benefits appear quite low. Do we see any politicians going after the diabetes vote?

    Besides, these days the government would rather get more involved in interfering with markets than less involved it seems.

  3. D says:

    After searching around I found out that it is pretty much illegal to sell your kidney. That’s a shame! I thought that since I had three I could give one up to someone who needed it and make a little money as well. I was in a car accident a few years ago and the doctors had to open me up to get to the matter at hand. Upon doing this they found that I have a third kidney. It is unfortunate that the government has to have a say in EVERYTHING. I have a perfectly good, third, kidney waiting for someone to use.

  4. […] discusses the possibility of organ sales and organ chains.  This is something I have advocated for here, here and […]