Organ transplants

Reason Writers in the Boston Review: Matt Welch Responds to the Claim That Markets Are Crowding Out Morals (and That Kidney Sales Should Be Banned)


Boston Review has a cover package out centered around a lead essay by Harvard University professor of government Michael J. Sandel on "How Markets Crowd Out Morals." Sandel's piece starts like this:

We live in a time when almost anything can be bought and sold. Markets have come to govern our lives as never before. But are there some things that money should not be able to buy? Most people would say yes.

Consider friendship. Suppose you want more friends than you have. Would you try to buy some? Not likely. A moment's reflection would lead you to realize that it wouldn't work. A hired friend is not the same as a real one. You could hire people to do some of the things that friends typically do—picking up your mail when you're out of town, looking after your children in a pinch, or, in the case of a therapist, listening to your woes and offering sympathetic advice. Until recently, you could even bolster your online popularity by hiring some good-looking "friends" for your Facebook page—for $0.99 per friend per month. […] Although all of these services can be bought, you can't actually buy a friend. Somehow, the money that buys the friendship dissolves it, or turns it into something else.

This fairly obvious example offers a clue to the more challenging question that concerns us: Are there some things that money can buy but shouldn't? Consider a good that can be bought but whose buying and selling is morally controversial—a human kidney, for example. Some people defend markets in organs for transplantation; others find such markets morally objectionable. If it's wrong to buy a kidney, the problem is not that the money dissolves the good. The kidney will work (assuming a good match) regardless of the monetary payment. So to determine whether kidneys should or shouldn't be up for sale, we have to engage in a moral inquiry.

I was among the people invited to respond to said inquiry. An excerpt from that:

Every day, eighteen people die in the United States while waiting in vain for a kidney transplant, according to the National Kidney Foundation. The Department of Health & Human Services reports that nearly 92,000 patients were on the kidney waiting list as of April 6 (up from 66,000 six years ago), but that only 16,812 transplants were made in 2011. That deadly math is part of the reason that, according to the National Institutes of Health, more than 380,000 Americans are on dialysis, a punitively expensive and physically grueling death-postponement procedure. The imbalance cannot be meaningfully addressed via cadaver-harvesting alone. As the writer (and kidney donor) Virginia Postrel observed in 2009:

Sweet Virginia

If every single person who died the right way became an organ donor, an optimistic estimate would be that 7,000 more kidneys a year would be available for transplant. Since the [waiting] list is now increasing by 6,000 a year, that would be enough to end it—in 80 years.

So we know that maintaining prohibition—letting the law be guided by our moral revulsion toward placing price tags on human organs—will certainly increase the body count. We know that boosting the number of kidney donations from the living is the only real way to whittle the waiting list down. And we also know, from such procedures as egg donation, that legalizing monetary rewards is a guaranteed method for expanding the pool of living donors. Your morality may vary, but mine says that sentencing more than 6,000 people a year to an avoidable death falls well short of the Golden Rule. My inquest therefore concludes that the burden of argumentative proof on the legality of kidney sales should fall squarely on those who back the lethal status quo.

My whole response here, the entire package here. Read Reason's archive on organ sales, and watch this old-school video on the topic: