Teaching the Ethical Foundations of Economics

Lesson 7: Should We Allow a Market for Transplant

Organs?

Are some

markets too

repulsive to

consider?

ewww!!!!

prostitution

gambling

pollution permits

interest on loans

ticket scalping

horse meat

illicit drugs

uterus rental

dwarf-tossing

selling human organs

Should We Allow a Market For Transplant Organs?

Or. . .

Brother,

can you spare

a kidney?

Kidney Transplant Background

• From the first kidney transplant in 1954, both transplants and those seeking transplants have grown over time.

• Transplants• 1990 10,000• 2005 13,700• Most of this increase came from live donors.

Background. . .

• Waiting list• 1990 17,000• 2006 65,000• Reasons for the increase?

– Technological advance.– Inability of the current system to procure enough

organs.

Background. . .• In 2004, there were 50,000 on the official

waiting list, but 335,000 on dialysis.

• The median waiting time for people placed on the kidney transplant waiting list is more than 3 years.

• People suffer and die while waiting for a kidney transplant:

• 1990 1,000 people died• 2005 4,000 people died

Background. . .

• In 2004, 80% of living donors and recipients were related.

• The opportunity to buy and sell kidneys has the potential to save lives and improve the quality of life for many people.

The Demand for Kidney Transplants Has Grown Faster Than the Supply

Source: Becker and Elias, 2007

Government mandated price ceiling of $0.

Prohibition places a ceiling price on kidneys.

20,000 kidneys supplied (donated) at P= $0

How many kidneys are donated at P=$0?

20,000 kidneys supplied (donated) at P= $0

80,000 kidneys demanded at P= $0

How many kidneys are demanded at P=$0?

60,000 kidney shortage

What is the shortage, and what caused it?

What would happen if the ban on kidney sales was lifted?

Objections to a Market Solution

• Unfair to the poor• Exploitation• Coercion

• Objectification• Illegal (black) markets• Fewer altruistic donors

Fair to the poor?

– No!• Poor are priced out of the market.• Poor may be “coerced” into selling kidneys.• Poor may not understand the risks.

– Yes!• Is it ethical to deprive the poor of the opportunity

to increase their standard of living – and save lives?

• We allow markets in: blood, hair, and the use of a uterus.

Coercion and Exploitation?

• Coercion in the absence of monetary compensation?

• Is it coercive to pay people higher wages for more dangerous employment?

“It is an unethical approach to shift the tragedy from those waiting for organs to those exploited into selling them.”

Objectification?

• Money can transform a “good” deed into a “bad” one.

• Treating the body as a commodity?

“…any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an ‘object’ is to violate the dignity of the human person.” Pope John Paul II, 2000

Organ theft?

• As opposed to prohibition, a market would make kidneys more available, lowering the price, making theft less profitable.

• A live donor market could virtually eliminate the possibility theft.

• Under prohibition, what is the black market price of a kidney?

The Black Market price of kidneys?

Would there be fewer altruistic donors?

S

Public campaign to increase altruistic donations?

S

If it is obvious that a market would save lives, why don’t we allow it?

Agent Action Consequences

Ethical Theories

• Outcomes-Based: Right Consequences• It’s results that matter.

• Duty-Based: Right Action• Proscribed ethical principles.

• Virtue-Based: Right Agent• Intentions and personal virtues matter.

Policy Options

• Current voluntary system

• Free market

• Regulated market

• Communitarian approach

Further Reading• Becker and Elias, “Introducing Incentives in the Market

for Live and Cadaveric Organ Donations, Journal of Economic Perspectives 21(3), Summer 2007, p.2-24

• Howard, “Producing Organ Donors,” Journal of Economic Perspectives 21(3), Summer 2007, p. 25-36.

• Roth, “Repugnance as a Constraint on Markets,” Journal of Economic Perspectives 21(3), Summer 2007, p. 37-58.

• http://freakonomics.blogs.nytimes.com/2007/11/13/kidneys-for-sale/#more-2089