Selling Transplant Organs Part II: Options

Yesterday, I started looking at the issue of buying and selling organs for transplant (e.g., kidneys). I looked at three considerations.

(1) The feeling of yuckiness at having a market in organs. However, we have to ask if the ‘yuckiness’ that people feel at the thought of a market in human organs is, perhaps, like the ‘yuckness’ people once felt (and some people still feel) towards interracial relationships. We have to ask whether this aversion to a market in organs is an aversion that people generally have many and strong reasons to promote, or whether it is an aversion that people have many and strong reasons to inhibit.

(2) Voluntary exchange among competent adults tends to fulfill the most and strongest desires of both participants. If it did not, then they would not engage in the trade. Realizing the desire-fulfillment consequences of trade we have reason to be averse to interfering in the voluntary exchanges of competent adults, including the exchange of cash for kidneys.

(3) However, markets, combined with large differences in income, create a situation where rich people can bid resources away from more highly valued uses (in terms of desire fulfillment) and into less highly valued uses. During a drought, unregulated markets allow rich people to bid water away from those who are dying of thirst to use in swimming pools, fountains, and watering their golf courses.

So, a market in organs such as kidneys would allow rich people to redistribute human organs away from the more highly valued uses (or, at least, equally valued uses) that poor people have for their kidney and towards the less highly valued uses (or, at best, equally valued uses) of the wealthy.

For example, if kidneys were bought and sold on a market, would a rich person with kidney failure be permitted to purchase two functioning kidneys? An unregulated market would allow this. To prohibit it would be to regulate the market.

Would wealthy people be permitted to purchase kidneys to keep them in storage just in case they might be needed at a later date – throwing them away once they have reached their expiration date? Allowing this would be an example of redistributing kidneys from poor people who have a more highly valued use for them, to rich people who values the kidney only as an insurance against possible future harm.

Assigning kidneys by lottery, rather than by willingness to pay, seems to respect the assumption that the poor people value their kidneys as much as rich people do, and that “willingness to pay” (or, more precisely, “ability to pay”) should not be used as a method for moving rich people to the front of the line (and poor people to the back).

However, rationing creates its own problems – it generates shortages.

How many hours would you work each week if the government prohibited people from paying workers? Let us say that the contribution of time to a company had to be completely voluntary, like the contribution of a kidney must be completely voluntary. I suspect that such a program would lead to an economic disaster. Nothing (or very little) would actually get done, and people would limit the work they did to that which would benefit themselves and their immediate family and friends.

We see this in the kidney market, where a prohibition on exchange leads to a severe shortage of kidneys, which has nearly 100,000 people in the United States alone suffering (and dying at the rate of 18 per day) for the want of a (market in) kidneys. It is not the case that, by allocating kidneys in the absence of price, the right and poor equally get to live. Rather, the current rationing system is one in which rich and poor equally get to suffer and (for some of them) die.

And let’s not kid ourselves. Even where the buying and selling of organs is prohibited, rich people have options that poor people do not have – from the luxury of being able to spend 30 hours per week on dialysis to the means to pay for it.

Our options are not limited to “completely unregulated market” or “outright prohibition on the selling of organs”. There is a wide range of options in between.

From a desire utilitarian perspective, there are moral facts. However, they are not always easy to discover. One of the things we may need to do to determine the moral facts is to allow a certain amount of experimentation. In this case, the experiments would involve allowing different states to try different methods for redistributing organs. One of the things that a desire utilitarian can all for is more data, which can then be used to help answer the question.

For example, allow a state to set up a system where the government pays money to the estate of a person who (1) signed up as an organ donor, (2) who died in a state in which her organs could be harvested, and (3) died of natural causes.

Such a law would almost certainly increase the number of organs available for transplant by increasing the number of people who sign up as organ donors. Taxpayers have many and strong reasons to support such a plan since it helps to ensure that an organ is available if the taxpayer (or somebody the taxpayer cares about) should ever need one.

People also have reason to support such a policy to the degree that they have reason to be concerned with the size of their estate and what can be done with the money. This is a gift that they can leave their spouse or children (or parents) in the case of an untimely death – like life insurance without the monthly premiums.

The plan would also side-step the problem of markets redistributing resources away from poor people who have a higher valued use for the product but who cannot afford to outbid the rich person. We may assume that, after death, an individual will have no further use for these organs – that the only options left to the person who died would be low-valued uses.

One major reason not to adopt this policy is a feeling of ‘yuckiness’ associated with the selling of organs. However, there are enough people who report not having this sensation that we have reason to conclude that this is a learned reaction. We can choose whether to promote or inhibit this feeling of yuckiness. Since the feeling is one that tends to thwart other desires (or so it seems) it is a feeling that we have more and stronger reason to inhibit than to nurture.

Some readers brought up some interesting ideas concerning the ‘human dignity’ argument that I would like to address. However, given space limitations, I would like to make that the focus of tomorrow’s post.

I would like to see some state legislature experiment with this option and see if it does not improve the quality (and even the quantity) of life for some of its citizens.

This is just one idea. It is a mistake to think of this issue to be one in which only two options are available - a completely unregulated market and a complete prohibition on exchanging organs for other things of value. When we look at the issue and find problems with a particular solution, it does not automatically follow that, "We have aproblem here. We must completely prohibit a market in transplant organs." Another option is usually available - to design the law in such a way so as to avoid the problem without blocking the availability of transplant organs to recipients.

The main point being that when we step into a realm of moral uncertainty, we have reason to collect data by allowing different states to experiment with different methods to determine which actually helps to promote the life, health, and well-being of its people.