Black Markets Kill
By Jason Brennan
Should governments allow individuals to sell their extra kidneys on the market? Right now, about 99,000 US Americans are on the active waitlist for kidney transplants. Most will not get kidneys. People are simply not willing to give away the organs others need.
However, some people are willing to sell kidneys, and others are willing to buy them.
But markets in kidneys are illegal. The government sets the legal price of organs at $0, far below the implicit equilibrium market price. Thus, an economist might say: of course there is a shortage, whenever the legal price of a good is set below the equilibrium price, the quantity demanded will exceed the quantity supplied.
Many philosophers and economists thus think that markets in organs will eliminate the shortage. You aren’t kind enough to give away your extra kidney to a stranger, but you might do it for $100,000. Defenders of organ sales believe it will save hundreds of thousands of lives annually and will help make the poor richer.
Making kidney markets illegal is quite literally killing people.
Many people think that markets in kidneys would have certain undesirable or exploitative features, but these problems can be overcome by designing and/or regulating the market appropriately.
Consider this: some object that if markets in kidneys were legal, then the price of a kidney would be so high that only the rich could afford it. But, in parallel, some poor people can’t afford food. We don’t as a result forbid markets in food.
Instead, we subsidize the poor by issuing food stamps. We could issue means-tested kidneys stamps as well. Further, on a free market in kidneys, the price would likely be much lower than it is on the current black market.
Others object that the poor would be exploited by the rich. Even if so, this at best shows not that markets in kidneys should be forbidden, but that only people who are sufficiently rich — for instance, who make over $60,000 a year — should be allowed to sell kidneys.
Others object that people will rush to sell kidneys without a full understanding of the risks involved. But, again, at best this shows we should require would-be kidney sellers to be licensed. Before being allowed to sell, they must pass a test, akin to a driver’s license exam, showing they understand the costs and benefits.
In the end, some people feel that selling kidneys is just plain wrong, because it somehow violates human dignity or the integrity of the body. But this kind of disgust at kidney markets is quite literally killing people. There is no wisdom in repugnance.
Many things we now regard as normal or the hallmarks of responsibility — such as life insurance, anesthesia, or being willing to work for a wage — were once seen as undignified, or disgusting, or “commodifying life.” People’s lives are at stake here. It’s time to grow up and get over our primitive aversion to kidney markets.
Jason Brennan is Robert J. and Elizabeth Flanagan Family chair and associate professor of strategy, economics, ethics, and public policy at the McDonough School of Business. He is also associate professor of philosophy at Georgetown University. He specializes in political philosophy and applied ethics. He is the author of Markets without Limits, with Peter Jaworkski.
A Perfect Market Is Impossible
By Pedro García Otero
EspañolHow much is a human life worth? Are the lives of Bill Gates, Nelson Mandela, and Lionel Messi — beyond their contributions to humanity, relevance, or fortunes — worth the same as mine?
Is my life worth the same as that of a common prisoner in China or Azerbaijan? Furthermore, is human life susceptible to economic valuation? Who sets the price?
If we begin from the premise that all human lives are equally valuable — only totalitarian states, such as communist and fascist regimes, argue otherwise — we would have to conclude that the free sale of human organs from living donors is impossible.
Even in countries that are spearheading organ donation and transplantation, supply doesn’t come close to meeting demand. According to the United Network for Organ Sharing (UNOS), the number of patients waitlisted for organs in the United States in 2015 was nearly 123,000 (approximately 70 percent of them awaiting kidneys). Last year saw only about 30,000 donations.
This means five in six people likely have not found a donor.
And in an extreme case, according to the World Health Organization, the figures in Latin America should amount to 40 donors per 1 million patients requiring a transplant, yet it is actually less than four donors per million.
Even in Venezuela and other countries with opt-out policies, this figure isn’t any better, and efficient policies are required for data collection on potential donors and recipients. Moreover, it’s necessary to break cultural taboos surrounding organ donation.
It’s impossible to prevent black markets from emerging when demand so decisively exceeds the supply. Consequently, in a black market, the wealthy will inevitably have an advantage over the poor. Currently, transplant candidates must meet a set of criteria to become a recipient. In the sale of organs, these criteria would be replaced only by a person’s ability to pay.
From a recipient’s perspective, how much would a kidney be worth if he or she were dying? Priceless, no doubt. What about from the donor’s perspective? No sale would ever be voluntary. It would always be motivated, or more likely coerced, by desperate economic circumstances. This makes way for corruption.
For over two decades, the Chinese government have been rumored to trade in organs harvested from prisoners. Obviously, these prisoners have not voluntarily agreed to sell a kidney, part of their liver, or their corneas.
In India, where the organ market has been falsely regulated since 1994, hundreds of wealthy individuals undergo transplant surgery under poor sanitary conditions each year.
Considering one life to be worth more than another based on wealth goes against the Universal Declaration of Human Rights, which states that “all human beings are born free and equal in dignity and rights.” Two of these fundamental rights are the right to life and the right to health.
A market will not exist until supply is brought up to the same level as demand. And without a market, the free sale of organs will continue to be subject to trafficking and privilege.
Current solutions lie in opt-out policies, education, and efficient mechanisms for donation from deceased patients. Meanwhile, science can continue working to develop tailor-made organs, something that will surely one day come.
Pedro García is the Spanish managing editor of the PanAm Post. He is a Venezuelan journalist with over 25 years of experience in local newspapers, radio, television, and online media. Follow @PedroGarciaO.