I agree with Becker that a market in kidneys should be permitted. The “repugnance” that the idea of selling body parts engenders in many people seems to me to have no rational basis; it would be otherwise if one were talking about the sale of one’s eyes, heart, etc.
The only function of a second kidney is as a spare. A person who loses a kidney does not experience a loss of health as a result. What is true is that if you sell a kidney, you have no back up. It is sometimes suggested that the problem be solved by a rule providing that a donor seller of
a kidney goes to the head of the queue for a kidney transplant if his remaining kidney starts to fail and if necessary he is given the new kidney free of charge. But such a rule would be unnecessary, as I’ll point out.
The present system, much like the ban (frequently evaded though it is) on “buying” a baby for adoption (that is, of compensating the mother for giving up her birth child for adoption), has created a serious shortage of kidneys for transplantation. As a result of this shortgage, the
average waiting time for a kidney transplant is six years in the United States,
during which time the prospective recipient of the transplant is likely to be
on dialysis. Dialysis usually takes at least 12 hours a week, and the death
rate of dialysis patients is high. If kidneys were salable, the waiting time
for a transplant would drop precipitately, probably to zero (which is why it’s
unnecessary to guarantee a donor that he’ll go to the head of the queue if his
remaining kidney fails—there will be no queue), because demand is fixed at the
number of people who have advanced kidney disease, while the supply would be
highly elastic since many of the world’s poor, who are in the billions, would
regard giving up a “spare” kidney as a low-cost way of earning some badly
needed money. The market would be worldwide because the cost of shipping
kidneys long distances is negligible. (Kidneys from cadavers would have to be
harvested quickly, but I don’t think cadavers would continue to be a major
source of kidneys for transplanation, as they are now.) The U.S. demand would be small; there are fewer than 20,000 kidney transplants per year in the United States, although there would
be more if there were a market in them, because there would be fewer deaths of
people awaiting transplants and hence more transplant candidates.
I imagine that the equilibrium price of a kidney would be low, and the overall cost of treating kidney disease lower than today because there be so much less dialysis. Hence moving to a market would not increase overall U.S. health costs, and would in fact reduce them. Moreover, there would be attractive income-redistributive effects. The market solution would cause a modest shift
of income from physicians and other personnel of dialysis centers to poor people, assuming realistically that the poor would be the principal sellers of kidneys.
The financial collapse of 2008 and the ensuing economic depression that the United States is slowly crawling out of have created some second thoughts about the nation’s commitment to free markets. But there is an important distinction between the fallacy (associated particularly with
Alan Greenspan) that markets are self-regulating and a general skepticism about
the efficiency of markets. Markets are self-regulating only in the Darwinian
sense; competition weeds out losers, but the winners may be imposing heavy
costs on society that they do not bear (pollution, for example, or the kind of
macroeconomic damage that the highly competitive financial sector has caused
because of its competition-driven risk taking). A market in kidneys would have
to be regulated, but the regulatory challenge would be slight, given all the
experience we have in the regulation of physicians, hospitals, drugs, medical
devices, and surgical and other medical procedures.