Sunday 4 April 2010

Fiesty comments on organs [updated]

Last week I posted a note on Israel moving to give priority to registered organ donors and on Andy Tookey's work here in New Zealand to improve our system. If you didn't follow the thread thereafter, jump back and flip through the comments.

Commenter "Anita" provides what seems the orthodox line from the New Zealand health service: that allowing directed donation through a system like LifeSharers opens the door to a horde of imaginable repugnant donor preferences and that allowing compensation would crowd out charitable donation. Of course, the Iranian experience on the latter has been entirely the opposite.

I note that, even in the worst case of horrible racists wishing only to donate to preferred-race people, that's still better than that those organs rot in the ground. And it's not just crazy economists like me who think this. Here's a nice piece from Bioethics.

Andy Tookey of GiveLifeNZ weighs in, reminding Anita that LifeSharers is open without fee to anyone who'd like to join, that current measures trying to encourage donation through moral suasion have been rather ineffective, and that LifeSharers gives folks a very strong incentive to become organ donors - donation rates ought to increase substantially as more folks join. Dave Undis from LifeSharers US also comes in.

I spend a week on organ markets in my Economics and Current Policy Issues course. Below I've copied in the reading list as well as some other fun sources. I'll particularly recommend Hippen's discussion of how organ markets work in Iran which suggests that worries about crowding out charitable donation are overblown; Becker and Elias's excellent discussion of how proper markets could work; and, the pieces by Kerry Howley, Sally Satel and Virginia Postrel.

The status quo is killing people because some ethicists would feel bad if we allowed incentives to come into the system. Perhaps the ethicists should be working for free if financial incentives are so corrupting. And the surgical teams, and the hospitals, and everybody else involved. Maybe we'd really have a few thousand transplant specialist centres in New Zealand if all the altruistic transplant teams hadn't been crowded out of the market by the ones that get paid to do their jobs. I rather doubt it though.

Required Reading:
  • Winter, Harold. 2005. “Do you want to trade?” Chapter 3, pp. 21-31 in Trade-offs.
Recommended Readings:
  • Barnett, Andy, Roger Blair and David Kaserman. 2002. “A market for organs.” Chapter 6, pp. 89-106 in Alexander Tabarrok, ed. 2002. Entrepreneurial Economics. Oxford University Press.
  • Barnett, William, Michael Saliba and Deborah Walker. 2001. “A free market in kidneys: efficient and equitable.” The Independent Review (Winter), pp. 373-385.
  • Hippen, Benjamin. 2008. “Organ sales and moral travails: lessons from the living kidney vendor program in Iran.” Cato Policy Analysis 614.
Supplemental Readings:

And here are a few other fun sources on the economics of transplant.
Note: Updated to add links to more of the articles. Enjoy!


  1. Professor Crampton:

    For a reading list on the idea of giving organs first to registered organ donors, go to I'll be happy to send you any of the papers you'd like to read.

  2. @Dave: Thanks! I'll add some of that to the supplemental reading list - Andy often comes in to tell my class about LifeSharers and how it works, and I try to have the main readings not replicate what's covered in class.

  3. Thank you for this post and reading list.

    Over a dozen people will die today on the U.S. organ transplant waitlist alone. Meanwhile, defenders of the status quo will tell us that preferences expressed through the market might result in people dying--or more grievously somehow, unfair organ allocations.

  4. Why don't we take this issue to the Human Rights Commissioner?


  5. it seems to me that those who support the status quo do so for three reasons:

    1- fears of the feeble-minded being conned
    into selling their organs (ie blatant paternalism at work);

    2- the poor selling theirs to the rich (ie blatant egalitarianism at work);

    3- Moral disdain for turning what "ought" to be selfless into a trade (ie blatant selflessness at work).

    Which is the most disgusting?

  6. Here's a direct link to the article I wrote about being a kidney donor:

    Here's a link to a piece I wrote about ending the shortage in the U.S.:

  7. Thanks greatly, Virginia. I'll update the reading list with those for next semester.