Sunday, August 23, 2009

Organs for Sale

What do these three news items have in common?

An op-ed about kidney dialysis which notes that Medicare coverage for this procedure has extended thousands of lives.
The recent New Jersey corruption scandal, which includes the allegation that a NY man named Levy-Izhak Rosenbaum has been arranging sales of kidneys from donors in Israel.
A story in a Swedish newspaper claiming that Israeli soldiers have harvested organs from dead Palestinians.
No, it is not that they all involve people who are Jewish.

It is that they all miss the role played by government bans on organ sales.

If organ sales were legal, people with renal disease would enjoy longer and better lives, and governments would save expenditures on health care. Dialysis has been incredibly valuable and will in any case continue to serve many patients. But bans on organ sales are limiting the use of a newer technology - transplants - that works better for many people.

If organ sales were legal, the man from Brooklyn would have had no incentive to arrange kidney sales. This was a small part of the overall scandal, but it illustrates how prohibitions breed black markets and corruption.

If organ sales were legal, Israeli soliders would have little incentive to harvest organs from dead Palestinians (I take no position on whether this story is accurate).

Laws that ban organ sales make no sense, as Alex Taborrok of Marginal Revoulation has argued compellingly. It is legal to sell blood. It is legal to sell eggs and sperm. Why should organs be different?

20 comments:

Anonymous said...

"It is legal to sell blood. It is legal to sell eggs and sperm. Why should organs be different?"

I don't take a position on your conclusion, but there DO seem to be some differences conceptually.

Blood is regenerated...
Sperm are continuously remanufactured...
The removal of eggs doesn't compromise the ability of the donor to conceive (AFAIK).
But removal of an organ would seemingly and permanently compromise the hardiness of the donor. At minimum, some redundancy would be lost (as in the case of a kidney).

Anonymous said...

I would also point to the work of Richard Epstein. He has a mind like no other academic alive. He also argues compellingly against government prohibiting the organ markets.

Mike Huben said...

All the marketization arguments overlook most of the important factors.

First, you are legalizing taking yet one more resource from the poorest members of society. Enclosure and other privatization of land forces the poorest to rely only on their ability to labor for others, rather than self-provisioning. Now their bodily integrity (already threated more severely than anybody else's because of the circumstances of poverty) would merely be another asset that they would need to sell to survive.

If organs are transformed into truly liberal property (and libertarians have no reason to stop short of this), then we'll have truly arrived at the position of Shylock. Loans will be guaranteed with organs, debts will be collected with forced collection of organs, etc. How would libertarians stop the operation of common law here? With government regulations?

Legal organ sales would immediately create a large opportunity for fraud: sale of low-quality or diseased organs. As opposed to today's high-quality organs, where there is no incentive to fool the system.

Increasing volume of organ transplants by legalization of sales would also undercut the important research (government funded) to find alternative therapies to transplantation.

We have experience with legalized sales that show some of the problems: poor outcomes for donors in India, and private blood banks with low-quality blood in the US.

There are plenty of alternatives to legalization which easily would increase the supply. For example, we could take the libertarian solution and legalize riding motorcycles without helmets again. Or we could simply fund a PR campaign to encourage more donation. The latter solution avoids a host of problems due to moral hazard and perverse incentives to game the system.

matt b said...

Mike, there isn't a part of your comment that isn't ludicrous. Every problem you raise can be leveled against any other good or service on the planet - markets perhaps with the help of regulation (perhaps not) solve all the problems you raise.

I think the most egregious of your ideas is that legalisation could hurt the poor. That is precisely the group being penalised by the current system.

matt b said...

Mike, another thought.

Increasing volume of organ transplants by legalization of sales would also undercut the important research (government funded) to find alternative therapies to transplantation.

So your idea to help research is to eliminate the competition?

Except, in this case that elimination means killing many innocent people.

Let's be clear, Mike: many, many people needlessly die right now because this market does not legally exist. Even if I thought the poor might be exploited by a legalised market more than they are under the current system, then I would support legalisation. This is a pluralist society and under legalisation you are free to opt out. Under the status quo many willing people, both paid donors and recipients, are not free to opt in.

Under what values could that outcome be preferred?

Mike Huben said...

matt b, 100 years ago you would have complained about child labor laws as harming the poor and scoffed at the idea that a scarcity of labor would promote research in automation of manufacturing.

The great flaw in your position is that there are alternative ways of benefitting the poor and making more organs available besides marketization. Alternatives not based on violating the bodily integrity of the poor.

It's sad that libertarians weep crocodile tears for the poor, when what they really want is to satisfy their ideological hatred of government.

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