Pitiless

by Don Boudreaux on June 26, 2009

in Markets in Everything

Here’s a letter that I sent recently to USA Today:

Although you suspect that Steve Jobs received special consideration to move to the front of the line of the many Americans seeking liver transplants, you agree that “Paying for organs is properly banned in the U.S.” (“Wanted: organ donors,” June 25).

What’s proper about a policy that reduces the supply of life-giving transplant procedures and, thus, artificially raises the cost of such procedures?  What’s proper about condemning tens of thousands of people to lives of misery, and very often to premature death, when many of them would otherwise save their lives by agreeing to mutually beneficial exchanges with willing donors?  What’s proper about allowing real people to suffer real agony and real death simply to protect an aesthetic sensibility that is hostile to certain kinds of voluntary commercial contracts?

Far from being proper, this ban on organ sales is pitiless.

Sincerely,
Donald J. Boudreaux

Be Sociable, Share!

Comments

comments

41 comments    Share Share    Print    Email

{ 41 comments }

Sam Grove June 26, 2009 at 8:42 pm

That dreaded fear of many, that someone might profit from a transaction.

Stewart June 26, 2009 at 8:50 pm

Your letters are always superb, Don, but this one is especially stirring.

MHodak June 26, 2009 at 9:46 pm

"The Invisible Liver"

Russ's next book?

MWG June 26, 2009 at 9:55 pm

Simple really…

seanooski June 26, 2009 at 10:49 pm

Well said, sir, and I agree fully, but you will be tarred as heartless and inhuman.

Mace June 26, 2009 at 11:35 pm

Professor Boudreaux,

Can I use your letter in my principles class this summer?

Sam Grove June 26, 2009 at 11:44 pm

And what's with a policy that results in pretty much everyone involved getting paid off except for the donor of an organ?

BoscoH June 27, 2009 at 2:13 am

Professor, if you let people sell their organs, the natural consequence is that we'll be importing cheaper organs from China while proud American organ donors sellers are underutilized. It's a slippery slope.

Don Boudreaux June 27, 2009 at 5:58 am

Thanks for all of your comments. Please feel free to use anything that I post at Cafe Hayek.

Don

Stephen June 27, 2009 at 6:39 am

I think people are more repulsed by the idea that the rich would be afford to pay the highest price (the organs would obviously be sold to the highest bidder) and thus continue living while the poor would die because they would not be able to afford it.

People would much rather the outcome be determined by something other than one's wealth when it comes to health care, and especially so when it is a life or death matter.

I don't think people really are against the idea that someone is making money off of the transaction, although that might be a factor for some for those who are against profit.

SheetWise June 27, 2009 at 9:28 am

"I think people are more repulsed by the idea that the rich would be afford to pay the highest price (the organs would obviously be sold to the highest bidder) and thus continue living while the poor would die because they would not be able to afford it."

Whatever market evolved, it would be driven by the medical community and would probably be pretty stable. The advantage of wealth would be the ability to bribe the market maker (doctor), not the seller.

indiana jim June 27, 2009 at 11:33 am

I think David Crosby's move up the donor lists many years ago was no exactly in line with the way ordering on the list is supposed to go (Crosby of CSNY was not only a hugely popular singer, he was a heavy user of control substances as he reports in his book Long Time Gone).

If markets for organs existed, Crosby (and Jobs, etc.) would get theirs, but so would lots of others. The notion that allowing price to allocate resources will leave only the rich consuming high quality goods is folly of the first order.

A market for organs will INCREASE the quantity supplied Stephen; this is the law of supply.

Charles Platt June 27, 2009 at 11:53 am

I proposed a free market in donor organs to a widely respected expert in intensive care medicine during a conference question session. I said I would like to see organs auctioned on eBay. After all, the organs belong to the people they are in. Why shouldn't those people have the right to do whatever they want with them?

He was utterly horrified, and described the idea as "the cult of the individual gone mad" or similar. His concern was that if poor people could make money by disassembling their healthy bodies, other people would exploit them. Society would be dehumanized. He felt that the medical profession has a strong ethical obligation to protect the world from this kind of rapacious exploitation.

The trouble is, so long as we are thus protected, more people die through lack of organs.

People already sell their blood. It seems a small step to allow the occasional kidney. But should a financially desperate person be allowed to blind himself by selling both corneas? Note that he will then become a burden upon the State.

Marcus June 27, 2009 at 12:05 pm

"And what's with a policy that results in pretty much everyone involved getting paid off except for the donor of an organ?"
– Posted by: Sam Grove

Ain't that the truth!

It's just like blood, everybody profits off it except the person who donates it.

There's a shortage of blood? Let people sell their own damn blood!

Hello? This isn't rocket science.

Daniel Kuehn June 27, 2009 at 5:19 pm

I completely agree that there should be a legal market for organs, but isn't part of the concern with this the dangerous, involuntary/criminal organ harvesting if an organ can fetch a high price?

Granted – that's not a reason not to make a market for it – you would just want to regulate it. Perhaps only allow organ purchase from licensed, carefully watched harvesters who only collect organs from clearly willing participants.

indiana jim June 27, 2009 at 6:03 pm

DK,

I'm not sure what you mean by "high price", but there are currently black markets in organs and in these the prices are much higher than those that would prevail if black markets were made obsolete by legalizing organ sales. That is legalization would reduce the problem you are raising rather than increase it as you seem to be implying.

indiana jim June 27, 2009 at 6:04 pm

DK,

I'm not sure what you mean by "high price", but there are currently black markets in organs and in these the prices are much higher than those that would prevail if black markets were made obsolete by legalizing organ sales. That is legalization would reduce the problem you are raising rather than increase it as you seem to be implying.

K Ackermann June 27, 2009 at 7:02 pm

It might be profitable to keep people alive so bits and pieces of them can be sold off.

Douglas June 27, 2009 at 8:32 pm

Had some trouble posting…sorry, this is just a test.

SheetWise June 27, 2009 at 9:36 pm

"It might be profitable to keep people alive so bits and pieces of them can be sold off." –K Ackermann

aka Aldous Huxley?

Maybe the primary question here is when consent occurs. And then, there are the questions of whether the consent was voluntary …

Leave those to the legal scholars (or not), but if there's voluntary consent — from an AC viewpoint, I have no problem.

If people want to voluntarily calculate an expected value for the continuation of their life vs. the sale of a vital organ and its expected value to their family and heirs — allow them.

We should distinguish behaviors we find abhorrent and deviant from those we find simply foreign.

Jesus said that 'The poor will always be among us' — this wasn't a political or economic statement — it was simply an observation. It's politicians and economists that consistently promise remedies to this universal reality, and this reality apparently has little regard with how it's honestly measured. It doesn't matter how successful political programs are, because the bottom quintile of the past will always be replaced by the bottom quintile of the present or future. How convenient.

/End rant

Certainly there's a better solution.

indiana jim June 27, 2009 at 9:38 pm

K Ackermann,

Free people can make what contracts they will as far as I am concerned so long as it harms others not. If I, in advance, contract to allow my brain dead self to be kept on a vent until my organs are auctioned and the money awarded to my heirs, who are you to judge? On the other hand, if against my contractual agreement, again in advance, not to have organs harvested you keep me alive to harvest my organs, I would hope my relatives catch up with you and that after they finish with you that you rot in ****.

Douglas June 28, 2009 at 2:21 am

I suspect I'm the only Orthodox Christian writing here (just going off statistical chance), but there's a Christian point here that I wonder whether or not resonates with secular libertarians.

The root of Don's argument is that his method would save more lives. From that it follows that whatever allows us the longest pain-free existence is morally good and that which diminishes it is morally bad.

That type of moral calculation is anti-Christic because it defines "good" on the basis of our own imagined needs and not God's. (Now I know secular libertarian eyes are rolling at this point, but stick with me.)

This is a morality that is not only entirely materialistic, but also entirely Marxist.

I imagine the libertarian response is that you can be an entirely materialistic capitalist and not be Marxist, but from where I'm standing it looks like all materialists
travel down the same one-way road. If secular materialism is a moral good, then the question between capitalism and communism is just a matter of which system does a better job delivering the goods. The more stuff, the greater the moral good. Imagine for a moment a purely communist system that DID deliver more stuff–who of us would want anything to do with it? Freedom is better than the stuff.

What distinguished the United States from Western Europe during the Cold War and today is primarily the influence of Christianity. France is far more materialistic than the United States, and the old Soviet Union was materialistic to the extreme.

I won't even try and make the Orthodox Christian case against paid organ donation; I just want to suggest that secular freedom-lovers have every reason to fear a nation that's free of Christians.

Benjamin June 28, 2009 at 3:14 am

It's quite a leap to go from "saving lives is good" to "materialism is good". It would be easy to have a pain-free life–just lock up everyone in cages and treat them like cattle or chickens. Guaranteed pain-free existence. I may be wrong, but I doubt that Don would propose that we put people in cages.

Besides, it's not even about creating a pain-free existence–it's about giving people a better chance at ANY kind of existence. Pain is only relevant to the living.

Gil June 28, 2009 at 3:49 am

Then again if everyone with healthy organs but otherwise dying freely donated their organs upon death then would there be an organ shortage? How many people are dying and are refusing to donate their organs? Similarly healthy people are free to donate a spare organ to someone else at any time. The big point is that some presume the donation rate would be higher if people could profit from the transaction. Then again organ transplant isn't the same changing a bulb. Not to mention how many who do need an organ transplant brought it upon themselves and are expecting the healthy to save their sorry arses?

K Ackermann June 28, 2009 at 5:07 am

There is a fundamental fallicy in this post. To make a market, there must be buyers and sellers.

We naturally focus on the sale of the organ and do not examine the other half of the equation.

The prioritization of recipients would obviously be based on ability to pay, and if demand outstrips supply, then pay indeed is what would happen.

If a 70-year-old person and a 30-year-old father of 3 are essentially competing for the same organ, would money be the proper arbitor for deciding who gets the organ?

I would find that absurb.

Daniel Kuehn June 28, 2009 at 7:46 am

indiana jim -
Exactly. There are black markets now which is why I'm agreeing with Don that it should be made legal. What I'm saying is that a big part of the reason why it was illegal to begin with was safety concerns. Even if we legalize we still need to take that into account, because (unlike other needed legalizations like pot), when organ sales are legalized I'm sure they'll still fetch a relatively high price. No question there is a black market now!

Daniel Kuehn June 28, 2009 at 7:52 am

And K Ackermann makes a good point too on whether we even want price to determine who gets organs.

Just because markets are efficient by some definition an economist comes up with doesn't mean they're ethical. In some situations we're totally fine with "ability to pay" determining who gets organs. In other cases, deciding on that basis would be objectionable.

I still support organ sales but this is just another thing that's important to consider.

sethstorm June 28, 2009 at 8:09 am

The only things that will happen in this case are an increase in people killed/maimed for organs, an increase in people denied organs(due to skyrocketing prices), and an increase in Third World countries who will certainly produce junk quality organs.


The notion that allowing price to allocate resources will leave only the rich consuming high quality goods

But that's already the case. Knockoffs in medicine mean a death sentence for the recipient.

The way you would structure it, money would not be a good direct/indirect arbiter of who lives and who dies.

sethstorm June 28, 2009 at 8:13 am


Just because markets are efficient by some definition an economist comes up with doesn't mean they're ethical. In some situations we're totally fine with "ability to pay" determining who gets organs. In other cases, deciding on that basis would be objectionable.

The only case I'd ever consider it be anywhere close to correct is when cloned organs are readily available and have proven reliability. Even then, I'd forbid Third World sourced organs, even if cloned.

Gil June 28, 2009 at 8:14 am

"No question there is a black market now!" – D. Kuehn.

Huh? Organs aren't like soft drink cans whereby you put some in an esky full of ice and forget about it for about a week and it's all good to drink. Organs can't be stored for long, the recipient needs be a medical match with the donor, etc. It'd all be interesting to wonder what the price for organs would be in a free market as healthy people aren't going to give their spare organs away not to mention the money required to find someone who's also a medical match and don't forget the anti-rejection drugs. The free market organ buying might be too pricey for most people to afford anyway.

Sam Grove June 28, 2009 at 11:45 am

The prioritization of recipients would obviously be based on ability to pay, and if demand outstrips supply, then pay indeed is what would happen.

If a 70-year-old person and a 30-year-old father of 3 are essentially competing for the same organ, would money be the proper arbitor for deciding who gets the organ?

I would find that absurb.

Why?

IAC, the point is to increase the supply so that the 70 YOP doesn't have to compete with the 30 FO3 for the same organ…the way it is now.

Benjamin June 28, 2009 at 2:50 pm

What is the alternative to money being the arbiter? Shall a bureaucrat determine who lives and who dies?

K Ackermann June 28, 2009 at 3:29 pm

What is the alternative to money being the arbiter? Shall a bureaucrat determine who lives and who dies?

Next on the list is probably the only way.

K Ackermann June 28, 2009 at 3:38 pm

I would find that absurb.

Why?

IAC, the point is to increase the supply so that the 70 YOP doesn't have to compete with the 30 FO3 for the same organ…the way it is now.

Is money the only way to increase supply? I can think of no faster way to corrupt a life-saving process.

I think money should stay out of it. If there was money in it, then people like Dick Cheney would have yet another excuse to kill people for profit.

Martin Brock June 28, 2009 at 5:08 pm

I don't necessarily oppose a living person selling an organ that he can live without. If my son needs an organ, I'll donate one to him if I can. In this scenario, I effectively exchange the organ for the value I place on my son's life.

If my son doesn't need an organ but does need costly cancer treatment that I can't afford, I might donate an organ to Don's son in exchange for the cost of my son's cancer treatment. I make essentially the same bargain in both cases. What's the difference? Without the benefit of this exchange, both my son and Don's son go without the needed treatment.

Desperately poor people selling organs, at considerable rick to their own health and lives, to rich people is a troubling scenario, but it's a separate issue. In my way of thinking, it's one more argument in favor of a progressive consumption tax. Statutory lords of propriety should not be entitled to endless life extension in my way of thinking. I would limit the health insurance benefits of retired civil servants for the same reason.

On a related note, I'd make organ donation at death compulsory. If you die in an automobile accident or something, your viable organs immediately become available for transplant. That would solve a lot of the problem. The idea that dead people have rights worth respecting in this scenario is the most incredible and life-denying superstition.

Martin Brock June 28, 2009 at 5:21 pm

I'd even deny that "compulsory" makes any sense in this context. The whole idea of "compelling" a dead man to donate his organs is nonsense. The man is dead. The morally relevant being no longer exists. "Compelling" him to do something is like "compelling" the air to move out of my way as I walk through it. It's just a silly, meaningless notion. A living ant has more "rights" than a dead man in my way thinking.

Sam Grove June 28, 2009 at 7:35 pm

IAC, the point is to increase the supply so that the 70 YOP doesn't have to compete with the 30 FO3 for the same organ…the way it is now.

Is money the only way to increase supply? I can think of no faster way to corrupt a life-saving process.

You can't? You suppose that money doesn't already have its say and that the process is not corrupted because those who give up an organ receive no remuneration for it.

Do you believe love of money is the root of evil?

K Ackermann June 29, 2009 at 1:02 am

On a related note, I'd make organ donation at death compulsory

Yes!

Would it really kill anyone?

sethstorm June 29, 2009 at 9:20 am


On a related note, I'd make organ donation at death compulsory

Then expect a rise in murders.

Matt June 29, 2009 at 11:07 am

"On a related note, I'd make organ donation at death compulsory…"

Would you do the harvest yourself? Without their consent to donate prior to death, it might be great fun to find out what I'd do to you when you went digging around in the body of someone I care about.

yet another Dave June 29, 2009 at 1:11 pm

The root of Don's argument is that his method would save more lives. From that it follows that whatever allows us the longest pain-free existence is morally good and that which diminishes it is morally bad.

I'm not sure that's truly the root of Don's argument, but your logic from that point doesn't quite work. You're making an over-large leap. Don's description of a policy that imposes much suffering as heartless is very different from stating that "whatever allows us the longest pain-free existence is morally good and that which diminishes it is morally bad."

I would be curious to hear your Orthodox Christian case against paid organ donation. Is the problem the organ donation or the payment? Why?

Previous post:

Next post: