In a previous post, I argued that public opinion was a slippery concept, not well measured by opinion polls. One of my examples was kidney markets:
Rather than being a stable parameter, public opinion is very fragile. Polls might show that most people believe X, but as soon as the issue rises to prominence and more information comes out, their views might shift radically. I often talk to people about the importance of allowing a market for kidneys. The first reaction is often negative, as people wonder if this approach would be biased against the poor. Some even fear the theft of kidneys from unwilling donors. It only takes me two minutes to convince them otherwise. The theft of kidneys occurs when there is a black market created by shortages. A market would actually help the poor because it would be cheaper for the US government to pay for kidney transplants for the poor than to continue supporting those with kidney disease under Medicaid. We’d save lives and money. Once you simply point out the facts, public opinion shifts quickly.
Of course that’s just a personal anecdote. So how about a rigorous study from Johns Hopkins University:
- Americans’ attitudes toward paying kidney donors are polarized. Forty-six percent of respondents said they favor compensating donors whether or not it markedly increased the supply of available organs. Of those who opposed compensation, 21 percent said they did so regardless of the impact on organ supply. “They were against it, even if it meant satisfying the total demand for organs,” says Macis. “They have a ‘sacred value,’ an absolute moral imperative that opposes compensation, while the 46 percent favor it because they see an element of fairness in compensating donors for an act that demands a lot from them.
- About a fifth, 18 percent, said they would change from opposing to supporting compensation if it meant a significant boost in the supply of organs. “This is consistent with utilitarian preferences,” Macis says. “They’re willing to make that trade-off, from no to yes, if they see it can do a lot of good for people awaiting transplants. Thus, a majority would favor compensation for kidney donors if it resulted in enough additional lives saved”
Exactly what I expected. I’ve also argued that society will become more utilitarian as it becomes better educated.
BTW, compensating donors does not just create a “significant boost” in kidney transplants, it completely eliminates a kidney shortage that kills up to 43,000 Americans every single year. If you think kidney sales should not be allowed, how confident are you of your view? Are you willing to explain why I’m wrong about compensating kidney donors to those 43,000 people who will otherwise die? I’m not saying the other side of the debate is definitely wrong, but with so much at stake there’s a huge hurdle to overcome if you stand on a non-utilitarian principle such as “no cash for body parts”.
PS. Over at MoneyIllusion I have a post praising the Trump administration’s decision to compensate kidney donors for lost wages and certain other expenses. The best single decision of this administration. As with pot legalization, society is gradually moving in a utilitarian direction.
HT: Frank McCormick
READER COMMENTS
Alan Goldhammer
Jul 12 2019 at 12:32pm
I wonder how much of public opinion on this issue is shaped by the kidney harvesting urban legend. Perhaps people feel that with a price on kidneys this will happen more often than it does (zero right now).
Brett
Jul 12 2019 at 12:40pm
That was my primary concern. How do you make sure that illegally sourced kidneys aren’t entering the supply?
Dustin
Jul 12 2019 at 1:23pm
@Brett,
Just don’t make it legal to buy kidneys from people who walk into the doc’s office with one on ice. It really isn’t difficult to ensure that the donor is doing so of their own volition with a chain of custody that originates from a qualified medical practitioner.
Scott Sumner
Jul 12 2019 at 1:18pm
Of course the truth is the exact opposite, Black markets are caused by price controls, which create shortages. No shortage, no black market.
nobody.really
Jul 12 2019 at 2:32pm
1: I favor markets in body parts.
2: That said, offering a price for something that was once free does not necessarily increase the supply. Consider the daycare provider who berates parents who arrive late to pick up their kids. So she adopts a system of assessing fees on these parents by the minute. Net result: Parents arrived LATER. Once a fee was established, it seemed to normalize behavior that had previously been governed (albeit imperfectly) by norms. (Similarly, try this experiment: As the control group, try picking up girls in bars for sex without any offer of money, and record your success rate. As the experimental group, try picking up girls in bars for sex while offering them $5, and record your success rate. I suspect the offer of increased financial compensation may not trigger the increase in supply that classical economic theory might predict.)
In short, creating a norm of paying for kidneys might destroy the current voluntary supply of kidneys. How big/important is that supply relative to the potential supply in a commercial market? Don’t know.
3: Again, the lure of increased financial compensation may not trigger a net surge in kidneys supplied, ‘cuz there may be other dynamics at work. But ironically, the act of paying for kidneys might actually trigger some of those other dynamics and release the supply of kidneys.
First, the simply act of NORMALIZING kidney donations might trigger an increase. If people stopped regarding donations as some kind of risky, superhuman gift, and rather established it as a norm upon graduating high school (for example), we’d get a lot more. After all, people do a lot more recycling today than ever before, even though most people get no compensation for doing so.
Second, and perhaps more important, if we could create a LIQUID MARKET IN KIDNEYS—that is, a reasonable assurance that if you have $X in the bank you will be able to buy a replacement kidney—then I expect a LOT more people would be willing to part with their current spare. I’m much more willing to part with some rare collectible when I know that I can always buy another one on eBay.
robc
Jul 12 2019 at 2:44pm
IIRC, the day care example in #2 has been debunked, or at least, the study with those results is questionable at best.
nobody.really
Jul 16 2019 at 2:14pm
Maybe–but a 2016 (student-written) Harvard econ blog post continues to cite the study. If someone has a cite debunking or qualifying Gneezy and Rustichini’s 2000 daycare study, please share.
mattb
Jul 12 2019 at 3:48pm
Regarding the daycare provider study, my take away from this study is that the price being charged for being late was too low. My son’s daycare charged $20 per minute if you arrived late. You can be sure that I was never late to pick him up. If the price were $1 per minute, I wouldn’t have cared as much.
Scott Sumner
Jul 12 2019 at 7:16pm
Nobody, Even if voluntary donations were to fall to zero, a kidney market would completely eliminate the shortage.
nobody.really
Jul 14 2019 at 7:32pm
Is Sumner predicting that the market price for kidneys would effectively fall to zero, so that price would never pose an obstacle to obtaining a kidney?
Or is he merely saying that there would be a market-clearing price for (various types of) kidneys, and thus by the standards of classical economics we could say that there would be no “shortage,” in the same sense as there is no shortage of Rembrandts?
The first statement, if supported, might greatly enhance the public’s enthusiasm for deregulating the trade in kidneys. The second–not so much.
Cliff
Jul 15 2019 at 12:43pm
Total cost of a kidney transplant would certainly be less than it is today
Jason S.
Jul 12 2019 at 4:49pm
It’s an example of society moving in a more libertarian, not necessarily utilitarian direction. If society were moving in a more utilitarian direction, we’d see more people favoring a strong moral duty of everyone with two healthy kidneys to donate one. (Under utilitarianism, everyone has a moral duty to maximize the utility of sentient beings at all times.)
Steve Robinson
Jul 12 2019 at 5:13pm
Consider the market for blood/plasma.
The US often pays donors, most other countries don’t. They often have shortages and have to buy from US
news story from 2018–
Canada suffers a shortage of domestically produced blood plasma and has to import more than 80 per cent of the plasma needed to produce PDMPs from paid donors in the United States.
Lorenzo from Oz
Jul 12 2019 at 9:51pm
Not on kidneys as such, but this piece reinforces your point about the problems of analysing opinion polls.
Nick
Jul 12 2019 at 9:52pm
If it’s socially acceptable for pro-legalized-abortion advocates to argue with ‘my body, my rules’, why should not an advocate of kidney markets argue with the slogan ‘my kidney, what I do with it is none of your business’? Why should a proponent of kidney markets be burdened with the additional “utilitarian” justifications?
I call this selective libertarianism.
Really? Deontological ethics for me, not thee? (Just making a statement Dr. Sumner, not accusing you of engaging in it.)
Scott Sumner
Jul 13 2019 at 10:48am
Nick, Yes, there is a double standard there. In my case, I’m utilitarian on all public policy issues.
Phil H
Jul 13 2019 at 12:23am
“As with pot legalization, society is gradually moving in a utilitarian direction.”
Interesting. I don’t think I want “society” to become more utilitarian, but I think I do want policy to be more utilitarian. I may be confused on this point! Either way, so long as it’s safe, I agree that compensation should be allowed for kidney donation. Safety should be a precondition: I wouldn’t agree that it’s fair to let individuals make their own judgment of medical safety.
BC
Jul 13 2019 at 5:45am
It’s fascinating how some people’s moral intuitions lead them to conclude that it’s immoral to allow someone to flip burgers for less than $15/hr yet also immoral to allow someone to give up a kidney for anything more than $0. It seems obvious to me that giving up a kidney is a far greater burden and sacrifice than flipping burgers for an hour.
Seppo
Jul 14 2019 at 6:23am
If kidneys had an established market, would we expect for people unable to pay their debts to sell a kidney before allowing them into personal bankruptcy?
Would we start seeing people placing kidney futures as a collateral to get better mortgage terms?
I favour the market approach, but there will be things that make people cringe. In a away that would equalise society, because everyone is born with something of value.
TMC
Jul 14 2019 at 1:52pm
“About a fifth, 18 percent, said they would change from opposing to supporting compensation if it meant a significant boost in the supply of organs”
I’d rather surveys flesh out a better response with an example along with the question they ask. It’s telling when people respond that climate change, or some other cause, is very important to them, then the support craters when they are asked to pay $5 a month to mitigate. I’d expect, as you say, more utilitarian results from these surveys if this were the case.
Fred
Jul 14 2019 at 2:24pm
Iran allows payment for kidney donation. How is that working?
nobody.really
Jul 15 2019 at 11:59am
Ok, Free-Marketeers, who REALLY supports a free market in kidneys?
Recall that Dr. Hannibal Lecter had a taste for human livers with fava beans and a nice Chianti. Should he be allowed to outbid dialysis patients to procure a little something to complement his Merlot?
Roll-call vote….
Mark Z
Jul 15 2019 at 3:21pm
I think how far you need to reach to come up with a hypothetical challenges to defend your position says more about your position than the free market position.
nobody.really
Jul 15 2019 at 3:47pm
*Sigh.*
Merlot haters gonna hate….
Ricardo
Jul 16 2019 at 11:25am
Perhaps we should start calling the other side “kidney hoarders” and refer to their practice as “kidney greed.”
Comments are closed.