For markets in kidneys

Daniel Tuck has become the first English victim of a bad law - the Human Tissue Act, which forbids the sale of human organs.
It's a bad law because it both violates liberty and causes unnecessary suffering.
The law denies the principle of self-ownership, that an individual should own himself, and have a right to do what he wants  with it.  It therefore kicks away a foundation of freedom.
And it causes unnecessary suffering, because there's a shortage of kidneys in the UK, with the result that at best patients can spend years taking uncomfortable dialysis treatment, and at worst can die. Allowing the sale of kidneys would  increase their supply, thus relieving  this suffering. Amy and Eli Friedman put a longer case for doing so in this pdf. Gary Becker puts the case here.Virginia Postrel - who has more authority than I - has more here.
Of course, it doesn't follow that the trade should be entirely unregulated. If a man wants to sell his kidney, we should ask: is he a fraudster? (The judge thought Mr Tuck was, but in that case he should have been prosecuted for fraud.) Is he mentally unbalanced? Is he coerced? If the answers are "no" then we should permit the transaction.
The argument against this was put by Richard Titmuss in the Gift Relationship. He argued that allowing the sale of blood would crowd out altruistic donations, thus reducing  both the quantity (and quality) of blood donated.
But it's unclear that this argument holds. Whereas blood is donated  mostly to strangers, kidneys are donated - insofar as they are at all - mostly to relatives, where altruistic motives are stronger and so less vulnerable to crowding out.
This leaves only the concept of blocked exchanges (doc) or the "yuck factor" as arguments against organ trading. But are these really strong enough when lives, and not just liberty, are at stake?

Comments

[Tim Worstall]

1) Iran has a regulated market in kidney sales.

2) Iran is the only country with no waiting list for kidneys.

A possible connection there you think?

[pseudonymous]

"He argued that allowing the sale of blood would crowd out altruistic donations"

I wonder if he would apply this argument to, say, bread.

"We would all eat better, if no one could buy foodstuffs."

[dearieme]

At least in this country we could, could we, be confident that there would be no coercion; that kidneys wouldn't, for example, largely come from women and go largely to men?

This is one of those reforms that could be more attractive if only our standards of civility and governance hadn't been so Blaired of late.

[tom s.]

Best book I've read on this is Kieran Healy's "Last Best Gifts" (http://www.lastbestgifts.com/). He convinced me that the sociology is more important than the economics when it comes to organs. My take on it and on Becker is at http://whimsley.typepad.com/whimsley/2006/08/economists_and_.html

[Alex]

Hmm. Saturday evening empiricism: we actually tried this with blood products in the early 80s . The NHS imported blood (and other stuff) from the US that had been bought from casual donors, despite warnings that the commercial blood-donor population had all kinds of interesting diseases. And they proceeded to make a lot of people very, very ill.

[tom s.]

Talking of imported blood and making people ill, you may or may not care that here in Canada I am unable to give blood because of an 18 month stay in the UK 18 years ago, and the fact that I don't eat meat doesn't make a difference.

[Maynard Handley]

I take it, then, that you would support slavery, or at least bonded servitude? Surely my labor, like my kidneys, are my property to contract out as I wish, including a contract that commits to doing whatever my "employer" requires of me, till the end of my days?

If so, this is certainly an extreme position. In the US, land of a million nutty libertarians, they always seem to carve out an exception for contractual slavery. Someone like Richard Epstein, who never met a social problem he didn't think best solved through private contracts rather than government "interference", specifically says when he talks on this issue, something along the lines of "well of course there are limits to contracts, in that we can't allow for contractual slavery" as though this were an obvious corollary to his position.

Personally I think this copout is pathetic and without foundation, but then I consider the whole libertarian agenda to be borderline insane, so perhaps I'm not the best judge of their thinking.

I think I have no problem with kidney sales (basically because I think the expected good outweighs the harm) but I can see the point of view of opponents. The various arguments one might marshall against contractual slavery are just as valid in this case. Coercion, as some have mentioned, but also the fact that many people vastly underweigh the future in their life-planning. The fact that we tolerate many evils that exploit this weakness doesn't mean we should tolerate yet one more.
I'd be interested to hear the true story of how this plays out in Iran --- how many case does one come across of later remorse? How many people who sold a kidney for heroin or amphetamines?
Of course Iran being Iran, we're not going to get reliable statistics any time soon.

[Chris]

The worry is that we end up with a situation where poor and destitute people (and believe me i've met people desperate enough) start selling off unnecessary body parts to get enough cash to see them through another miserable year. In China this leaves people donating one eye because they can survive with one.

Personally, whilst it certainly has the 'yuk' factor Chris mentioned, I fail to see any strong argument against compulsory donation on death. Granted it seems horrible, but an infringement on the liberty of a deceased person (and some pain to the family) seems inferior to someone else's right to life.

[Michael A Hunter]

Daniel Tuck commited suicide this weekend due to the pressure of the courtcase & publicity.

RIP Dan.