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November 13, 2007
Legalize Organ Sales
Don Boudreaux
Although common, the argument that society's "repugnance" at the idea of body-organ sales is a sufficient reason to prevent such sales is also curious, even cruel.
In this Econ One On One debate (at WSJ.com), Harvard's Alvin Roth says that
It is illegal to sell horsemeat for human consumption in California, not because a persuasive case was made that the costs exceed the benefits, but because 4,670,524 people voted to make it illegal in a 1998 referendum. This and many other examples persuade me there is something about repugnance that we economists need to understand.
Indeed so. Voters no doubt do feel repugnance at commerce in such things. But one question is: how much? When voters are asked to cast a ballot about such things, they do so largely free of charge -- that is, they get to express their opinions on the cheap, without any obligation to reflect seriously upon the issue before them.
I wonder how likely it is that any randomly chosen voter would let repugnance prevent him from buying a kidney if such commerce were necessary to save the life of his child or his wife or one of his parents? Put differently, suppose that each of the persons who philosophically and abstractly votes to prevent organ sales were confronted with his or her own real-world circumstance -- a circumstance full of personal costs and benefits. If many (most? all?) of these persons would in these real-life, actual situations choose to buy a kidney in order to save a loved one, then it is untrue that voters feel sufficient repugnance of such sales to justify morally the prohibition of such sales.
Many years ago I explored the different meanings of the verb "to want," and arguing that the most trustworthy pollster is the market.
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Comments
I have seen commercials for a National Geographic with Lisa Ling reporting about the black market for body parts.
Explorer: Inside the Body Trade:
http://channel.nationalgeographic.com/channel/ET/popup/200711142000.html
I am sure that it will be about taking advantage of the poor so that the rich could live. Nothing like playing off the government intervention that causes high prices to knock down a free market. That's the impression that I got from the commercials anyways.
Posted by: Matt C. | Nov 13, 2007 11:29:12 AM
Don,
Tomorrow night there is a National Geographic TV special about the black market in organ donation! The commercial I saw for it talked about how the organs were often from the poor or recently executed criminals.
BTW, I have a daughter with Type 1 diabetes. She is at risk for kidney disease later in life. You were right about what what at least some of us would do if faced with the choice of buying vs. waiting to receive an organ for a loved one...I'd go on the black or legal or whatever-other-market to procure a kidney for my daughter if she needed one (and for whatever reason, we couldn't donate our own).
I have more repugnance for those who don't think about, as the commercial for the National Geo. special suggested, the 17 people who die every day waiting for organs that are not made available (and of course, not all organs are safe or as relatively easy to donate/sell as kidneys).
Lest anyone think it's repugnant for someone to take the risk of giving up a kidney...people do it as a donation. And they do fine, though there is of course some risk. But so there is there in parachuting, climbing mountains and driving a car...and thousands of voluntary actions that no one suppresses (yet).
Posted by: Maurice | Nov 13, 2007 11:56:47 AM
I find it disturbing how much egalitarian, anti-market, anti-wealth biases play into this debate. Supposed "ethicists" essentially are arguing that they support a system that kills thousands of people a year, because at least those people are dying regardless of their wealth. All of these people would live if a market for kidneys existed, but we can't allow that because we can imagine a case where a few who still died might be disproportionately poor. It's a stark statement on the human costs people are willing to impose in order to support their egalitarian world-view.
Posted by: kebko | Nov 13, 2007 11:57:26 AM
I have friends in the law profession and in medicine who are repulsed by markets in organs because of the unfairness of such a system to the poor.
My response is usually something like:
(1) Current rich people are in a better position to “plead” for kidneys on a donor basis - the poor have no such mouthpiece.
(2) The cost of a kidney would be about $15,000, while the total cost of the operation exceeds $100,000. Thus, the kidney cost is a small share of the overall cost. There is no difference in the poor’s ability to pay whether there is a market system or a UNOS system - in either case they cannot afford it.
(3) You are ignoring the most important economic part of this - that the supply of kidneys would increase substantially. And more kidneys means more poor people can get them.
(4) The biggest real factor however, is that the cost of treatment and dialysis of current kidney diseases far exceeds the costs of the transplants. The poor are in no position to incur those larger costs over longer time periods - particulalry since their job situation does not allow them the “luxury” of time off to do it. If all kidney patients went off dialysis and drugs and had transplants, the total cost of incurring a kidney disease would fall dramatically. How are the poor currently paying the hundreds of thousands of dollars for these treatments? Would that money NOT be available to help them with a transplant?
Using the poor as a way to keep market forces from improving medical care is a straw man.
And using a least common denominator in terms of access to medical care is an awfully stingy way to look at things - and awfully short sighted in an economic sense. If a new drug is invented tomorrow that costs $2,000,000 per pill and which cures all kidney ailments, you would propose making it illegal because the poor couldn’t afford it. But, having Alonzo Mourning be able to buy that treatment gives other drug companies an incentive (and the means) to find ways to produce this more cheaply. Without the rich first buying such a drug, it would NEVER ever have a chance to make it to the point that the poor could afford it. This has happened with thousands of goods and services through time and very few people have appreciated it. One easy to see example is thepersonal computer - an IBM 286 desktop in 1985 would cost the equivalent of over $6,000 in today’s dollars. Without the “rich” buying these things up, today’s poor would have no chance to purchase a new Dell for $400 - and the machine is immeasurably better than the IBM 286 that the poor unfairly could not buy.
Inequality between rich and poor has in fact enabled the poor to consume things that over time that they could only have dreamed about in the past.
Of course, I get no response back to this … just a pithy note saying I need to read more closely later.
It is easy for many to throw out liberal aphorisms to make people like me seem reprehensible. But few people I know are willing to spend the intellectual energy to make reasoned arguments. Which makes me want to expend more intellectual energy exposing this weakness.
Posted by: wintercow20 | Nov 13, 2007 12:28:09 PM
And who ever said that legal organs would be expensive?
Posted by: dave smith | Nov 13, 2007 1:14:21 PM
I find the idea of registering as a Republican repulsive, but I am considering doing so in support of RP.
Posted by: Sam Grove | Nov 13, 2007 1:46:32 PM
Right now, if you are rich and willing to take the risk, you no doubt can get an organ from someone in India or somewhere else on the black market. A legalized market would increase supply, and cut out the criminal element.
Posted by: kurt | Nov 13, 2007 2:31:58 PM
Don, just because there is legislation doesn't mean there it's law. Here in California, there is a thriving black market in horse meat. Just the other day, I went into a rough area of Santa Ana, gave a guy $300, and had two semi-frozen hindquarters loaded in my SUV in just a couple of minutes. I'll cut them up into smaller pieces and sell horse meat steaks to my neighbors for about $20 apiece. The small leftovers will be ground with some off-the-shelf beef and sold to unsuspecting newbies. Gotta pay the bills...
Posted by: Brad | Nov 13, 2007 2:46:26 PM
Cato just published a new policy analysis on the sale of kidneys. Look under publications on the Cato website. www.cato.org
Posted by: Sigrid Fry-Revere | Nov 13, 2007 3:24:25 PM
"The small leftovers will be ground with some off-the-shelf beef and sold to unsuspecting newbies. Gotta pay the bills..."
And, after all, what's a little fraud when you gotta pay the bills?
Posted by: anon | Nov 13, 2007 3:27:18 PM
Does this make cannibalism OK?
Posted by: Al | Nov 13, 2007 4:35:16 PM
I guess that I am being dense, but I don't understand Roth's comment. The issue isn't whether cost/benefit analysis applies. The issue is what should be included, and economics takes tastes as given. If the point is that we need a model to explain where tastes come from, my guess is that we have something to say about that also (e.g., Becker and Stigler, work on learning information and that people's views are a function of the information that they receive, and what promotes survival), but it isn't central to the issue of cost/benefit analysis. So people don't like to eat animals that they see as pets? Economists can at least try to measure the various costs and benefits and tell people what they are giving up to protect horses from not being eaten. As wintercow20 writes so well above, economists can also give people a better idea of who wins and who loses from the types of bans that he discusses. If people still don't want to sell organs even if it means that a number of lives will be saved, they at least know the cost of their decision. Don could you please tell me what I am missing?
Posted by: John Lott | Nov 13, 2007 6:12:42 PM
There already is a market for organs. It is a pet peeve of mine to suggest that there is not a market. It is just 100% controlled by doctors and hospitals who bundle the sale of organs in with the surgery to install them.
As with all things, there is a supply and demand for organ transplants. Hospitals and doctors (well and insurers to some extent as well) just capture 100% of the supply-side profit.
The reason that the sale of organs to the doctors and hospitals is not legal (in my view) really is that the doctors/hospitals don't want to have to share the profit.
In other words, if the demand/supply curve meets at $100,000 for a new liver, but the hospital has to pay $10,000 for the organ, they will only get to charge $90,000 instead of $100,000.
True, making the sale of organs legals by individuals would increase the supply (which is one of many reasons to allow it) so it is a little more complicated than this.
As things stand right now, people somehow find it 'repugnant' for a poor person to sell their organs upon death, but don't find it 'repugnant' for hospitals and doctors to sell the organ that they get for free 'bundled' with the surgery to install it.
People are crazy.
Posted by: Ed | Nov 13, 2007 6:55:01 PM
Well said Wintercow.
I agree that unequal access to any given mechanism is not a reason to forgo it, so the following question is beside the point: why is insurance, private and public, consistently overlooked when discussing access of the poor to a kidney market?
It seems to me entirely straightforward that an insurance company would add the purchase of an organ to its coverage. Some companies will object on grounds of ethics, but given there is demand you can't expect all companies to ignore it. Heck, I'll set up a company specialising in insuring just the purchase of a kidney, I'll charge a competitive rate and make money doing it.
Posted by: ben | Nov 13, 2007 6:55:24 PM
I should be clear. I did not mean to suggest that Mr. Boudreaux said there was no market. He correctly was referring to sale by individuals. I was mentioning my pet peeve that others get wrong about there being no market for organ sales.
Posted by: Ed | Nov 13, 2007 6:58:03 PM
While it is something a bit disturbing to notice, there is a certain irony from this - provide humanity, the result is some form of cruelty; provide cruelty, the result is some form of humanity.
While not a perfect expression of what goes on, that seems to be the basic idea.
Posted by: sethstorm | Nov 13, 2007 7:52:44 PM
Wait a second. In other posts, you've claimed that voters were irrational to vote (because an individual voter's vote is extremely unlikely to affect the outcome). In this post, you claim they get to express their opinions on the cheap which doesn't sound at all irrational to me - it sounds like good economic value.
Which is it?
Posted by: Bret | Nov 14, 2007 12:03:40 PM
Most people will behave differently when they are personally involved. Many oppose abortion until it becomes a "necessary" option for themselves or a family member.
Posted by: RickyP | Nov 15, 2007 6:39:28 AM
