The NYT editorial board is concerned about the shortage of kidneys for transplants. As one might expect, the most obvious solution to the problem is automatically dismissed:
While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways to increase the supply without paying for human organs, which is prohibited by the 1984 National Organ Transplant Act and generally opposed by the World Health Organization.
Most of the NYT editorial focuses on technical issues (e.g., how to assure that organs are not wasted) but there is some limited attention to incentives. Some proposals are modest (e.g., covering the expenses incurred by live donors). But as the benefits increase (e.g., proposals for “a tax credit, college tuition, early access to Medicare or a contribution to a retirement fund”) the NYT’s enthusiasm disappears for a simple reason: these latter benefits “clearly have monetary value” which might induce the poor to sell organs.
I remain convinced that the best means of securing live organs for transplants would be the creation of markets. If two adults voluntarily consent a transaction (money for a live kidney—and a life is saved in the process—where is the harm? For extended development of the case for organ markets, see the citations at the end of this post.
Outside of live donations, one could get the incentives right by making organs for transplantation a club good available only to adults who have signed an organ donation card (and their minor dependents). Although such a system would work the best if universalized, one example of a group that has pushed forward more modestly on this front is LifeSharers (its advisory board includes Richard Epstein, David Henderson, and Alexander Tabarrock, among others; I am a member). Lifesharers members get priority access to organs from other members, in essence, jumping the cue that is filled with many who have never agreed to donate their organs.
Bottom line: in organ donations—as in so many areas of life—one can make remarkable progress if one gets the incentives right.
For a useful overview of the issue, see Alex Tabarrok, “Meat Market” (WSJ).
For an analysis of a functioning kidney market, see Nejamin E. Hippen “Organ Sales and Moral Travails” (Cato).
For an interesting analysis of the impact of monetary incentives, see Gary S. Becker and Julio Elias, “Introducing Incentives in the Market for Live and Cadaveric Organ Donations.”
One thought on “Organ Markets”
The problem with monetary and like incentives was shown back when they paid for blood (I’m speaking of whole-blood, not the plasma-buying companies). The quality of the blood was much lower because of the number of poor who gave blood that was marginal or unusable (but that wasn’t discovered until it was far enough into the system for significant time and money to have been spent on it) out of desperation for money. When they switched to “volunteer only,” the quality of blood improved, because those who couldn’t afford to take time out of their lives for no financial compensation stopped coming.
A second problem is that taking out a kidney doesn’t leave the donor with a spare. Unlike taking blood, most organs don’t regenerate (the exception being the liver, but you don’t hear a lot about living liver donation), so the donor spends the rest of their life with increased risk of death due to injuring the remaining organ.