Making a Case for Legalizing a Market in Human Organ Sales

I can hear the arguments against creating a market for selling human organs. "It turns humans into commodities. You'll most likely exploit the poor for their organs. Simply despicable! How dare you put a price on something like human organs?" This is yet another instance in which people feel like their personal beliefs should dictate public policy. Rather than give into something like a repulsion towards an individual selling one of their organs, we should take a look at whether providing a legalized market for selling organs is the preferable policy option to the status quo of banning the sale of one's organs.     

Basic economics can predict what happens in this scenario. Although current law allows you to donate an organ without financial compensation, by banning the legal and voluntary sales of human organs, what the government does in this instance is create a de facto price ceiling of $0. What happens when you put a price ceiling on a good? Much like with anti-price gouging laws, when prices are artificially depressed, there is a shortage of a good (e.g., transplantable organs). We can see theory lines up with practice because there is a shortage in the organ market. As of today, there are 117,959 patients in the United States on the waiting list for organ donations (U.S. Department of Health and Services). In 2011, there were under 18,000 transplants performed, which is well below the number required to fulfill all transplant needs.

We don't live in a world with an unlimited supply of organs. Although one would be more likely to donate a kidney to a close friend or family member, we also don't live in a world where the vast majority of people are altruistic to the point where they would donate an organ to a complete stranger. Since most are not incentivized by altruism, using the price mechanism in a liberalized organ market would incentivize more people to donate than what is currently being donated. Increasing the supply of kidneys [or any other organ that could be donated] would mean more transplants, which would mean fewer people dying while waiting for a kidney, not to mention that less people have to pay for palliative care (e..g, a very expensive dialysis treatment).

What about taking into consideration those who donate? Poor people will be more likely to donate their organs than rich people because of financial strain. Wouldn't this be an exploitative practice? Well, no. Even if there are certain financial pressures or incentives for poor people to donate, there is still a reasonable trade-off between donating an organ and creating an opportunity for improving one's financial stability. Life is full of instances in which we have to make trade-offs, even when they are dangerous ones (e.g., fighting in the military, working in a coal mine or at an oil rig). Life is also replete of examples in which we commoditize valuable things. We can treat art or music as "priceless," but we have nevertheless markets in which paintings and concert tickets have prices.

We shouldn't treat adults like children. Selling one's organs should be treated like any other health care decision in which one is informed before going ahead with a certain procedure or treatment. If the money accrued from donating one's organ helps improve the economic welfare of an individual without harming others, who are we to say otherwise? If the idea of "my body, my choice" were to mean anything, wouldn't this be a good example of illustrating the importance of personal choice? Furthermore, does it make sense to pay the nurse and the doctor for service provided, but not to compensate the donor, who undoubtedly plays a vital role in a lifesaving procedure such as a transplant? We pay teachers who provide our children with education and firefighters who save children from burning buildings. We don't question the purity of the motive with the teacher or the firefighter when their service is complemented with financial compensation, so why should we view the organ donor any differently?

If you're still worried about the wellbeing of the individual, keep in mind that one is not going to trade an organ if it means certain death. As of date, 80% of those on organ transplant waiting lists are waiting for a kidney. Although it's preferable to have two kidneys, only one is necessary. Another 12.86% are waiting for liver transplants, and a partial liver transplant (i.e., a removal of a lobe of a liver) can heal some of those in need of a liver transplant. As for the other organs that cannot be traded while alive, a futures market in organs could be created.      

What happens when cases of fraud occur, like those of Levy Rosenbaum? First, fraud is fraud. Those who defraud should be prosecuted like any other criminal. Second, and more to the point, scenarios like this occur when there is a black market. When demand is so high for a good and that good is not provided in licit/legal markets, where do people go? To the black market. There are many unintended consequences when you drive goods to the underground market. One of those consequences is that suppliers charge exorbitantly high prices. It is so much easier to exploit people in need [of an organ] when the exchange takes place in the black market.

People also like to bring up the possibility of organ thefts or people being murdered for organs, for which my response is two-fold. One is that legalizing organ sales would address the shortage, thereby lessening or even eliminating the need for said theft or murder. Two is that the transplant would be unsuccessful not only because finding a match between donor and recipient in a random theft or murder is next to nil, but because getting a qualified surgeon and adequate facilities is also arduous. Bringing organ sales out of the black market would be the best way to assure that people are not intimidated or defrauded because market forces and social pressures would kick in. By bringing organ sales to a legal market, prices would plummet in comparison to what the going rate is for an organ in the black market, which would make a kidney more affordable.

Some people have an issue with permitting a legal organ market because it's repulsive. To harken back to Thomas Jefferson, "if it doesn't pick my pocket or break my leg," what do I care what another individual does with their life? If you don't like marijuana, don't smoke it. If you don't like same-sex marriage, don't marry someone of the same sex. If you don't like the idea of selling your kidney for profit, then don't do it. If anything should be morally repulsive in this case, it should be that 6,500 people die every year because repulsiveness towards selling organs is a driving force that prevents people from getting transplants they need.

[Another thing that is intriguing is that out of all the countries in the world, the one that legalizes organ sales is Iran, and to add further intrigue, it worked well enough where the Cato Institute wrote a policy analysis on the Iranian organ market.]

Postscript: Wisdom of repugnance, also known as the "yuck factor," plays a huge role for many in terms of how they feel about certain practices, whether it is organ sales or even something like sweatshops. It becomes difficult to look at a policy more objectively when the yuck factor is in play. Regardless, transcending sentiments such as the yuck factor is what makes for good policy analysis. An organ sale is a voluntary transaction in which a consenting donor is compensated for providing a patient with a lifesaving transplant. Both parties benefit from the procedure. When comparing a liberalized organ market to the alternative of a government-induced organ shortage, it's no contest as to which one I would select.


Addendum 3-13-2015: The American Enterprise Institute published an article making a case for compensating kidney donors.