Making the Case for Organ Markets

New Zealand economist Eric Crampton recently posted an interesting interview on organ markets that he did with Radio New Zealand. Like the United States, New Zealand faces a shortage of organs available for transplant, as a result of which many people die before appropriate organs can be found for them.

Crampton describes several types of economic incentives that can be used to increase the supply of organs. Along the way, he makes several good points. For example, critics of organ markets decry the idea of allowing donors to profit from organ transplants. But, as Crampton notes, many people already profit from transplants, including doctors, nurses, health care administrators, manufacturers of medical equipment, and so on. The only party not allowed to profit is the one who endures the greatest pain and risk: the organ donor. It’s not surprising, therefore, that that is exactly where we face a serious shortage.

Interestingly, the interviewer seems sympathetic to various economic incentives for donation, such as defraying the funeral costs of people who commit to donating organs after they die. But she balks at payments of money, worrying that it would lead to poor people selling organs in order to “put food on the table.” Crampton rightly points out that we allow poor people to undertake far greater risks in order to help make ends meet. He notes that the risks of organ donation are no greater than the occupational hazards of, say, being a professional fisherman. Yet we do not ban the poor from entering the fishing industry – or others that are far riskier. For example, the risks of kidney donation are far smaller than those associated with playing professional football. If it is morally permissible to pay poor people to take serious risks in order to provide football fans with entertainment, surely it is permissible to pay them to take much smaller risks in order to save lives.

I don’t know to what extent Crampton managed to persuade the interviewer or his listeners. But it is a good sign that the idea of organ markets is now mainstream enough to be taken seriously in public debate both in the US and abroad.

In this 2009 post, I gave a more detailed critique of the argument that organ markets must be banned in order to protect the poor. Here’s a summary of my argument:

This is an issue I teach every year in my Property class. Each time, one of the most common objections raised is the claim that organ markets must be banned because they will lead to “exploitation” of the poor…

There are several major problems with the argument: it is inconsistent with allowing poor people to engage in far riskier activities for pay; it doesn’t even begin to prove that preventing the “exploitation” is an important enough value to justify the deaths of thousands of people for lack of organs; and it overlooks the fact that poor organ donors are likely to benefit from organ markets. Finally, even if all these points are unpersuasive, the exploitation argument still can’t justify banning organ sales by the nonpoor as well.

In a more recent post, I addressed the visceral emotional objections to organ markets that underly much of the opposition to them. It would be presumptuous and unrealistic to tell people to simply ignore their “gut feelings” on the subject. But, to paraphrase Darth Vader, I would urge those who feel this way to search their feelings more carefully before concluding that they are justified:

[M]any social and technological changes that are widely accepted today were once greeted with similar visceral hostility. Consider cases like equality for women and interracial marriage. Some leading critics of organ markets, such as medical ethicist Leon Kass, also once argued that in vitro fertilization should be banned, because they found it disgusting as well. Today, IVF is an almost universally accepted method for enabling otherwise infertile people to have children. Even Kass has made his peace with it. That doesn’t prove that all negative visceral reactions are necessarily wrong. But it does suggest that we should be very careful about basing policy on them….

[E]ven if you think that your visceral hostility to organ sales is well-founded, it is still necessary to ask whether satisfying it is worth the sacrifice of thousands of lives every year. Many otherwise distasteful practices may be defensible if they save innocent lives. To justify a ban on organ sales, it’s not enough to prove that such sales are somehow flawed or even immoral. Whatever values are promoted by a ban have to be weighty enough to justify condemning thousands to an early death.