What’s Truly Sick

by Don Boudreaux on May 31, 2008

in Health, Prices, Property Rights, Seen and Unseen

Here’s a letter that I sent today to the Wall Street Journal:

Louise Benson says that allowing people to sell their transplantable body organs would result in poor people being “enticed by the money” to become suppliers; she thinks this outcome would be “sick” (Letters, May 31).  Ignore Dr. Benson’s questionable presumption that her personal cultural aesthete should trump the freedom of other adults to make such choices.  Focus instead on the economics.  If organ sales were liberalized, the availability of organs would rise and their prices would fall. Transplant surgery would become more affordable and, thus, more lives – not only of the rich but of all classes – would be improved and saved.

What’s truly sick is government’s continued prohibition of organ sales.

Donald J. Boudreaux

By the way, my GMU colleague Lloyd Cohen (who teaches in the law school) writes insightfully about organ donations.  Many of his papers can be found here at his website.

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Jason May 31, 2008 at 10:37 am

Wouldn't this apply to any job, service or good that was traded for a price? We shouldn't pay sewer workers because that would make poor people work in the sewers.

What about the positive effects? Organs would only be valuable if they were healthy. If someone was overweight, drank, smoke and had blood-borne diseases, the demand for their organs would be very low. Isn't there already a market for human eggs? They don't target poor people, they target smart, healthy college women.

Think about it, when it comes to organs are people going to go for the cheapest option? I have a feeling if there was a free market for organs, Mr. Benson would be complaining that there isn't enough demand for the organs of the poor and that's grossly unfair!

David P. Graf May 31, 2008 at 10:48 am


The problem is that the poor would be priced out of the market. There's also the real possibility that unscrupulous providers will main or even kill others for their organs. Would you allow someone to sell their heart for a high enough price?

Given that we are going to have some sort of health plan provided by or paid for by the government, I think that a condition of participation should be the understanding that your organs will be used upon your death to help others unless there is a religious objection.

Gil May 31, 2008 at 12:10 pm

I believe there should instead be more interest in the concept of artificial organs and body parts. Organs aren't plug&play items like Flash memory sticks and printer/scanners – there has to be a medical match between donor and recipient, the operation has to be sterile, organs can't just be stored indefinity so it removal and transplant are done one after the other and finally the recipient has to take medication the rest of their life to avoid rejection.

Chris May 31, 2008 at 12:45 pm

David Graf –

Most of the poor are already priced out of the market, as are most of the rich due to a lack of supply. Of course, poor people generally have a tough time paying for the newest medical treatments. That's one of the disadvantages to poverty and a great incentive to avoid it.

Your suggestion would turn organs, which are now inalienable personal property into some sort of community property. If my organs are going to be used by somebody else at my death, then shouldn't I at least have some input on that use? I find your idea even more morally repulsive than the idea that I should be able to sell my organs.

Gil –

There are already a number of efforts to produce "artificial" organs. I was at a venture capital conference last year, where one of the presenters talked about successes in "growing" artificial organs. I remember two examples: there have been successful implants of artificial bladders in humans and an artificial uterus implanted in a mouse actually gave birth.

Billy May 31, 2008 at 12:47 pm


You are thinking of a legal organ market that still maintains the black market price. I think there is good reason to believe if the proper incentives were offered, organ donation would increase to the point where the price would fall dramatically. Furthermore, a lot of the research into organ markets has focused on procurement rather than allocation so it isn't necessarily true that the poor would face exorbitant prices.

Also, check out some of the research by the late Dr. David Kaserman (http://www.amazon.com/U-S-Organ-Procurement-System-Prescription/dp/084474171X/ref=sr_1_2?ie=UTF8&s=books&qid=1212252345&sr=8-2)

Brad Hutchings May 31, 2008 at 12:57 pm

This fits with Kling's recent find of a Thomas P.M. Barnett quote on his Kindle:

Before Tianenmen, we believed that freedom is 90 percent political and 10 percent economic. A few years later, we came to realize that freedom is 90 percent economic and 10 percent political.


People who oppose money for organs want to ensure that poor families stay as poor as they are and sick people stay sick (kidneys). Such people are the oppressors.

spencer May 31, 2008 at 12:57 pm

The organ is now donated and cost nothing, zero.

Consequently it does not contribute to the expense of the surgery.

But you argue that paying for something that is now free will lower the cost of the surgery.

Care to explain how this works?

And they let you teach economics to the children of Virginia.

raja_r May 31, 2008 at 1:13 pm

Consequently it does not contribute to the expense of the surgery.<

This page
and this page say that there are between 84,00 and 96,000 people waiting for an organ.

Don't you think time spent waiting for something is a cost?

Don Boudreaux May 31, 2008 at 1:51 pm

Spencer writes that "The organ is now donated and cost nothing, zero. Consequently it does not contribute to the expense of the surgery."

This claim is mistaken. Because the prohibition on organ sales keeps the quantity supplied of organs lower than it would otherwise be, it artificially limits the supply of transplant surgery, thus driving up the price of transplant surgery.

More organs means higher supply of transplant surgery and, thus, a lower price of transplant surgery.

Think of it this way: suppose a regulation were enforced that prohibited people from selling shoelaces. Such laces could be given away, but never sold. Would the price of shoes-with-shoelaces rise or fall? The naive answer is fall – because an essential input to shoes-with-shoelaces is formally priced at zero.

But the correct answer is that the price of shoes-with-shoelaces would rise, because the supply of shoes-with-shoelaces would fall. Therefore, by ending the regulation prohibiting the sale of shoelaces, the price of shoes-with-shoelaces would fall (because of the resulting increas in the supply of shoes-with-shoelaces).

Don Boudreaux

Keith May 31, 2008 at 2:24 pm

Quote from David P. Graf: "Given that we are going to have some sort of health plan provided by or paid for by the government, I think that a condition of participation should be the understanding that your organs will be used upon your death to help others unless there is a religious objection."

Now there's a recipe for abuse. Some government bureaucrat will have control over other people's organs. No chance for abuse there, because as we all know all bureaucrats are held to such high standards of performance and are so severely punished when they screw up.

And who gets to define what a "religious objection" is? What if you're an atheist and want to be cremated (with all your organs)?

You feel free to give up ownership of your body, but I think I'll keep mine.

Brad Hutchings May 31, 2008 at 7:50 pm

David Graf wrote: Given that we are going to have some sort of health plan provided by or paid for by the government, I think that a condition of participation should be the understanding that your organs will be used upon your death to help others unless there is a religious objection.

If we go down the path toward such a policy, no religious objections unless there is a capitalist religion that demands payment for organs that I can join. Otherwise they can take my organs when they can pry them from my cold, dead fingers. Or something like that.

Oh, and maybe doctors and nurses involved in transplants ought to donate their time and hospitals their space and drug companies their anti-rejection compounds and manufacturers their equipment. It's obscene that anyone make money off someone's failing organs, don't you all think? (I'm being ironic if you missed it.)

Per Kurowski May 31, 2008 at 10:28 pm

I would agree, not because of that nonsense of prices of operations going down, but more because allowing the sale of organs would permit a legal market to exist and therefore not force the desperate to go to the illegal market of organs, because if you are not able to intuit that a prosperous organ market already exists then you better wake up.

We have all a responsibility in ascertaining that the formal and legal markets grow faster than the informal and illegal, else, guess in whose hands we all end up?

Gil June 1, 2008 at 2:08 am

What is the illegal market for organs?

Brad Hutchings June 1, 2008 at 9:51 am

I don't get it Dave. Even incrementally, how does the LifeSharers angle get us to an organ donor market? It seems to me that (a) for now, it's just a giant mailing list because UNOS hasn't made such a change and medical culture is dead set against it and (b) if they did and it was effective, we'd be arguing against that coercive arrangement in favor of markets all over again when its effectiveness meets its limits.

I see the more important step being markets in redundant and renewable tissue, like kidneys and blood. Might evolve to include partial organs, like livers, or if stem cells can be make more of our organs renewable, just about everything. If we're forced to be incremental about markets for organs, we ought to have an eye on where technology is going as a path of least resistance.

ben June 2, 2008 at 7:30 am

Spencer: pwned. Apology or rebuttal please.

Eddie June 4, 2008 at 6:14 pm

Though I agree with a free market perspective, wouldn't you agree to some extent. That this system would underscore the serious drawbacks of commercial provision when the testing of organs for infectious agents is imperfect. Altruistic donors have no incentive to lie about whether their organ's are safe, but commercial donors plainly do.

ps June 5, 2008 at 11:27 am

Per: "that nonsense of prices of operations going down"

Should we accept your judgement that it is nonsense or do you care to explain why you consider it nonsenese?

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