Price Controls on Organs & Tissues: Inefficiency Inevitably Costs Lives
Thomas LyonsIf you weren’t aware, last summer it was made known that a new reality show was being shown in the Netherlands. The idea was contestants would be vying for the organs of a terminally ill woman.I’m as big of an advocate of organ donation as there is. While this concept may appear a bit tacky, winning organs on reality television is one step closer to an ultimate ideal: a free market for organs and tissues.
Centering organ transplants around a donation-only system is the economic equivalent of a price ceiling; it just so happens that the price being ceilinged is zero. A great example of a price ceiling is rent controls. Common in some urban areas, a rent control stipulates the maximum price that an owner can charge for a given apartment. The advantage of a price ceiling is, of course, a low price, theoretically affordable for a larger number of people. In either case, organs or housing rentals, suppliers may not charge more than a legally codified price. No one can argue that rent controls make housing more widely affordable, or stipulating a donation-only system for organs does the same thing for the organ “purchase” (the service of a transplant is another issue). The disadvantage is a gap between the number of willing consumers at market price and the number of willing suppliers at market price – a shortage.
The reason is simple. A higher price motivates a greater number of prospective sellers into the market. The quantity of sellers is the largest supply-side indicator of total market-wide supply in a given industry.
The only current induction a prospective organ or tissue seller is altruism. Noble though it is, altruism is not, by and large, a sufficient trigger to meet market-wide demand for organs and tissues. The result is clear: we have a huge shortage of suppliers (donors) relative to the demanders (those in need of organs).
I’ve signed the back of my driver’s license, and I hope other readers and commentators of The Only Orthodoxy have too. That being said, in a market where an organ supplier can auction their organs and tissues to a high bidder – or, at their discretion, continue to freely donate — the number of suppliers will inevitably grow. Ergo, the number of people whose lives could be saved by organ and tissue transplants also inevitably grows.
The chief argument against free-market organs and tissues will be the inevitable inequality between organ sellers and organ buyers. Undoubtedly, buyers would predominantly come from a wealthier background, while sellers may only be doing so out of financial desperation due to being lower on the economic ladder. To counter this argument, I present the case of the greater good. My proposal leads to potentially saving the lives of x new people, who happen to be directly slanted upward toward the higher end of the socioeconomic ladder. The status quo – organs by altruism – will save the lives of some fraction of x people, call it z. Z people happen to be randomly sorted along the same ladder.
The question for the believer in the status quo, altruism-only method of organ and tissue delivery is simple: Is the loss of X-minus-Z lives worth having a randomized sorting of donors/sellers? I contend it is not.In the interim, consider complying with your state’s requirements to donate your tissue and organs, and tell your family of your decision. But whenever you’re asked, remember that the more efficient means to deliver organs and tissue is a market-based approach, and not the status quo.

November 13th, 2007 at 1:57 pm
The equation as you state it masks a third relevant variable: the fraction of Z who would receive a donated organ under an altruistic system, but would not be able to afford an organ under a market system–let’s call it Y.
The real equation, I think, is whether the loss of X-Z “rich” lives > Y “poor” lives. In other words, the system you propose isn’t simply an increase in efficiency that result in 50 saved lives rather than 25. Your system would save 50 rich lives at the cost of 20 poor ones (assuming an organ to be beyond the financial reach of 80% of people; 20 of the 25 who would be saved in an altruistic system). The fact that the system would save 25 more lives doesn’t necessarily justify using wealth as the arbiter of life and death. We would reject out of hand (for example) a system that proposed saving 50 white lives at the cost of 20 black lives, even though the system has a net gain of 25 lives saved.
On the other hand, can we justify not saving 25 additional lives just because we are reluctant to use wealth as a denominator? No system of determining who lives and dies (which is, ultimately, what an organ distribution program is) can be perfectly just. Any criteria for choosing one person over another is in some way objectionable, and randomness (the lack of criteria) is equally objectionable. Wealth may not be any more objectionable than any other criteria (or no criteria at all), and has the benefit of adding efficiency.
November 13th, 2007 at 2:47 pm
“We would reject out of hand (for example) a system that proposed saving 50 white lives at the cost of 20 black lives, even though the system has a net gain of 25 lives saved.”
Provided the white lives would otherwise not survive, and the loss of the 20 black lives is unintentional, I would not reject that system.
November 13th, 2007 at 6:00 pm
Forgive me for putting words in your mouth. I’m guessing that the overwhelming majority of Americans would reject out of hand (for example) a system that proposed saving 50 white lives at the cost of 20 black lives, even though the system has a net gain of 25 lives saved.
Morality isn’t democratic, but, if conscience is a rough guide to moral truth, something morally abhorrent to an overwhelming majority of people ought to at least be examined seriously for moral error. From a deontological perspective, saving lives is good, but saving lives at the direct cost of specific other, innocent, lives is problematic.
November 14th, 2007 at 8:46 pm
You have not adequately considered the effects of increasing the ceiling for organ sales on the donors. It seems dangerous to me to entice people to cut out body parts for money.
Also, you are assuming that allowing sales of organs will generate a larger base of suppliers. Consider egg (really ovum) donation. Women can make $5,000-$10,000 per egg. I think women can donate multiple timer per year as well. So why don’t more women donate eggs? They have thousands of them, and it is a relatively minor and safe surgical procedure. You would think egg donation would spread like wild-fire, so to speak, but I think people are just uncomfortable with giving up body parts. This is consistent with my experience of people who are not donors- that is, not comfortable with the idea of someone else taking their organs with no other reason for not being a donor. (As a side point, there isn’t really any enforcement of these regulations at present that I am aware of, so a woman could easily skip around from city to city and make a ridiculous amount of money if she were motivated)
A final reason I don’t think supply will change much will profit motive is because there are not many organs you can donate without dying (kidney, eye…I am running out of ideas already).
All in all, I don’t really see any reason to try a market-based approach. The supply may not change much, and it creates a niche for discrimination as well as more motivation for suicide and homicide.
November 14th, 2007 at 11:11 pm
Jeremy: The lives that would be “paid” are nonspecific.
Benji: If you can present me with data that suggests that more women, or even as few women, would donate ovum in a donation-only system, I will delete this essay immediately and apologize for starting it in the first place. Until then, you’re begging the question.
As for your “final reason”, that there are few organs that can be donated without first dying, I presume you present this because the donor of a liver or heart can’t enjoy the fruit of the organ’s sale? Plenty of people sacrifice funds today for the benefit of their estates; we call it life insurance. I don’t see the fact that funds would go to a donor’s estate as hurdle to increased quantity of supply, necessarily.