Markets in kidneys

In this paper, Eli and Amy Friedman advocate legalizing trade in kidneys. Katie at Inkycircus says the idea's  "insane." 
I think Katie's wrong.
She says the idea "will surely lead to the poorer members of society selling body parts." But what's wrong with that? Why should we deprive the poor of a source of money? Based on this paper (pdf), the Friedman's reckon a fair price for kidneys would be $40,000 (£23,000).
Nor am I as squeamish as her about letting people risks with their health for money. People do this all the time. Why should we allow people to (say) work in coal mines but not sell body parts?
Indeed, we allow people to do all sorts of things that endanger their health - drinking, smoking, ski-ing, driving fast. Why not allow them to take useful risks - ones that save others' lives?
For me, the clinching argument in the Friedman's paper is their description of the alternative to a legalized, regulated trade. It's a black market, in which only the rich buy kidneys from only the desperate, whilst others die for want of kidneys; 17 a day in the US alone, say the Friedmans.
Surely, a legal market in which poorer people with kidney disease can buy (via Medicare or the NHS) kidneys from people who have been carefully assessed and advised by doctors is superior to this.
I'll grant that there's a big "yuk factor" in kidney trades. And there might be practical problems - there'll be fewer voluntary donors -  but I reckon the idea's  got a lot of merit. After all, trade is mutually beneficial.

Comments

[Tom Slee]

Not sure I have a good answer to your questions, but here is what I'd say.

First, the comparison with "drinking, smoking, ski-ing, driving fast" is not really a fair one because these are single-person activities, while organ trade involves other people (the organization you sell it to). And that means there are all kinds of problems (liability, information, and so on) that we would need to think about before legalizing this kind of trade.

In particular, the sale of a kidney is prone to asymmetric information regarding the risks of the operation itself, so the trade would surely have to be highly regulated. People selling kidneys will not have the resources to get restitution for mistakes or malpractice through courts (else they wouldn't be selling their kidneys). And a regulated trade means a real public commitment to it, because ensuring standards is a public good, so this is not just a question of whether people are "allowed" to pursue the activity, it is also a matter of whether this is a good use of government resources. In Becker and Elias's paper they just ignore this so far as I can tell: he asserts a current rate of risk from kidney operations and assumes it would still hold in a commercial context; they assert that care would be better in the US than in Iran or India without looking at why, or what regulatory framework is necessary for this.

Second, but related, there is another side of the coin when it comes to your argument about coal mines and so on. Sure, there are lots of dangerous things we collectively allow people to do. But there are lots of other things we don't let people do. Any market involving standards, for example: we don't let people sell meat that is not inspected, or run restaurants without health and safety checks, or rent apartments that don't meet minimum standards regarding hot water and so on. And there are good reasons why we don't permit such things that apply in spades to selling kidneys.

As for the black market argument (and, speaking of that, have you seen the Stephen Frears' film "Dirty Pretty Things" - you should) that can also cut both ways. It's a case-by-case thing whether legalizing something will get rid of a black market or not. Heroin trade, sharia and other religious rules as an extra-legal method of resolving disputes, prostitution, alcohol during prohibition. Sometimes you legalize a black market, sometimes you don't, but without really specific reasons I don't think you can use the "hey there's a black market anyway, so everyone is better off if we legalize it" argument.

As I say, there is other stuff here to do with exchange between very unequal participants that I have not been able to put into words, but which I and many other people feel is the case. At the least, when exchange is between unequals, the bulk of the benefit goes (Nash bargaining solution tells us) to the better off, so while the opportunity for trade may make some people better off, it won't be by much, so the market would have to work very well in order for this slim advancement to be realized. And, as I have said above, there are reasons to believe that the market would not work well.

[dsquared]

If I legalised the selling of children, I would expect more children to be kidnapped. If everyone walking down the street is worth $80,000 for their kidneys, I would expect this to have at least some effect on the murder industry.

[Tom Slee]

dsquared - you are not thinking this through. The only problem here is that the murder industry operates as a black market. This leads to murder being carried out in unpleasant and painful ways.

The obvious solution is to legalize murder so that people can gain money by submitting to the procedure - money that their families can use. That way, the market will ensure that murder is carried out in a clean and hygienic manner. I imagine old people, in particular, will find this an attractive option as the expected value of the rest of their life diminishes.

[Alex]

More importantly, perhaps, at the macro level, should it be considered child abuse to bring your kids up to be monetarists?

[DR]

Watch the movie 'The Island' (http://www.imdb.com/title/tt0399201/) and think again. It may seem extreme now but in 50 years will be reality.

There are always alternative ways to increase the supply of human organs such as investing in R&D in biological/medical sciences (e.g. synthetically/lab produced organs). But i guess it is the long and painful way. Again this may sound extreme today but taking into account the vast progress in the medical sciences during the last decade, i reckon that in 50 years it can be reality.

[חופשות סקי]

There is another side of the coin when it comes to your argument about coal mines and so on.