Almost 3,000 Americans die prematurely every year because they cannot get a kidney transplants, and more than 40,000 others suffer while waiting for such medical procedures (Territo & Matteson, 2011). However, even if all the patients on the waiting list could get a kidney transplant, each year 22,000 patients still join the waiting list. This health care problem is not due to lack of medical knowledge and technology or inadequate supplies of medical personnel and relevant equipment (Territo & Matteson, 2011). The main reason for this problem is the shortage of kidneys. The demand for transplantable kidneys exceeds the supply (Leider & Roth, 2010). If kidneys were a purchased commodity, the gap between supply and demand would mean the price was too low (Leider & Roth, 2010). However, in every country except for Iran, a market for purchasing organs are considered to be ‘repugnant’ and these markets are broadly prohibited. We use ‘repugnant’ in its economic sense- in a repugnant transaction the participants are willing to transact but third parties disapprove and wish to prevent the transaction (Leider & Roth, 2010). Based on the model of supply and demand of transplantable kidneys, the aim of this paper is to discuss the economic debate about whether the market for kidneys should be legalised.
First, it provides a model of supply and demand to discuss the consequences of a ban or partial ban on kidney sale. Second, it provides arguments whether the market for kidneys should be prohibited. Finally, the paper evaluates the arguments whether the market for kidneys should be legalised.
Demand and supply
In the late 1970s a person advertised in a newspaper that he was willing to buy a kidney in good condition for $3,000, this ad scared many people, but encouraged thousands of other people to sell their kidney. Since then, reports abound of a black market for kidneys from living donors that has emerged and flourished among the poor in India and Southeast Asia, with surgery scars evident on the backs of donors, all because the donated kidneys are fetching $6,000 and often far more, a market outcome that has been decried everywhere by pundits, politicians, and medical professionals (McKenzie & Tullock, 2012). The 1984 law banning organ sales functions as a price ceiling, a price control, or limit imposed by the government, and creates a shortage in its wake, leading to what economists call a “deadweight loss.”
Deadweight loss can be stated as the loss of total welfare or the social surplus due to reasons like taxes or subsidies, price ceilings or floors, externalities and monopoly pricing (Times, w.d).
However, if the price of a kidney increases, more people are hesitating to hand over one of their kidneys and sell it for a great price. In short, there is likely to be some quantity of kidneys made available when the price is zero; this quantity, depicted by Q1 in Fig. 1 reflects people’s altruism (McKenzie & Tullock, 2012). As the graph illustrates, there will be a larger quantity for buyers when the price of a kidney increases. The demand for kidneys is a function of several factors, including the size of medical schools and their need for kidneys in research and instruction and the number of people who experience kidney failure (McKenzie & Tullock, 2012). Food and drinking behaviour is connected to kidney failure.
Next to that, the demand for kidneys is linked to techniques which are known for transplanting organs. As the techniques in this area are perfected, the doctors’ willingness to operate will rise, increasing the demand for transplantable kidneys (McKenzie & Tullock, 2012).
Figure 1. Supply and Demand of Transplantable Kidneys. Reprinted from The New World of Economics: A Remake of a Classic for New Generations of Economics Students (p. 95), by R. B. Mckenzie, G. Tullock, 2012, Heidelberg, Springer.
The demand curve in Fig. 1 looks notably inelastic, however it still presents a negative slope like all other demand curves. As the price of a kidney rises, some people may be willing to stay with the then cheaper dialysis machine; others may be excluded from the market because of insufficient funds to buy at the higher prices (McKenzie & Tullock, 2012).
If a free market in kidneys is possible, the price of a kidney would rise toward the intersection of supply and demand. These days there is only one other alternative, which is dialysis. This dialysis has a total cost of $30.000 at the end of the year. Besides, it is very time-consuming, travelling to the hospital and the time spent on the machine. Indeed, when the costs are totaled, one can see that many kidney patients may be willing to pay a handsome market price for a kidney not because it is an attractive or morally acceptable solution, but because it is cheaper than the next best alternative (McKenzie & Tullock, 2012).
Arguments against the legalisation of kidney selling
Since kidney selling could help all the 22,000 people on the waiting list, not only the ones in front of the line, while kidneys are currently allocated on the basis who have been waiting the longest, rather than who need it the most. There are many reasons why kidney selling should be illegal. Some say that the system exploits poor people since only financially needy people would agree to sell a kidney and many sellers receive little or no follow-up care after their surgery (Devettere, 2016). Some say that the consequences are low-quality kidneys, while most sellers do not have the best health conditions. Some say that the practice of kidney selling would undermine an allocation system based on medical criteria since the purchased kidneys would go to the well insured and the rich (Devettere, 2016). Some say that kidney selling will reduce altruism. Altruism is the willingness to do something that brings benefits to someone else. Allowing kidney sales is not incompatible with altruism because anyone wanting to donate a kidney without payment could (Munson, 2009). Unpaid donations become less likely by the opportunity of kidney selling, which will lead to a decreasing amount of altruism in the world.
Nevertheless, there are even stronger arguments against legalizing the market for kidneys. First, there is legitimate concern about truly voluntary informed consent (Devettere, 2016). People who are willing to sell a kidney are under great pressure, which lead to not truly voluntary circumstances. Especially poor people, there are great concerns if they really get all the information, and are able to understand all the information. Some say that only the most vulnerable will be coerced into selling kidneys. Second, it is difficult to see how a social system that allowed living people to sell kidneys would be compatible with an ethics of promoting the good of society (Devettere, 2016). The sellers are only people who need money. If there was a commercial about this topic, the organ system was reliant on social class where people are needy because of financial problems, this is close to building a society, which is for the people and not for someone’s benefit. Thus, virtue ethics- an ethics of creating good social and political systems-would likely not find a system of selling organs legally a wise choice (Devettere, 2016). A good society does not encourage slavery or prostitution via commercial systems, even if people have freedom to choose slavery or prostitution as a way of living.
Slavery, prostitution, and paying people for organs are arguably not beneficial practices for societies because whatever they might achieve is outweighed by the bad features inherent in the systemic commercialization of slavery, of prostitution, and of organ harvesting from needy people (Devettere, 2016).
Arguments why the market for kidneys should be legalised
In contrast, to prohibit the trade of kidney selling, there are also many arguments why kidney selling should be legalized. First, every individual has his or her legal rights to do whatever you want with your body. As individual, you can strengthen your body by exercising and diet, otherwise you can destroy your body by using an overdose drug or through lack of care. According to, David Holcberg of the Ayn Rand centre, it is matter of self-determination: ‘The right to buy an organ is part of your right to life. The right to life is the right to take all actions a rational being requires to sustain his life. This right becomes meaningless when the law forbids you to buy a kidney that would preserve your life (Farndon, 2009). ‘
Second, the argument about the financial position. Some people are not able to buy a kidney, because of their limited financial resources. However, the introduction of a market for kidneys may reduce, but need not preclude, altruistic donations of kidneys (McKenzie & Tullock, 2012). The donated kidneys can be offered to people who have limited financial resources. These financial problems can be solved just like many other health-related problems, this can be done through charity or by aid of the government. The market system has one redeeming feature, and that is the government and charitable groups will have more kidneys which they can buy and give to the poor (McKenzie & Tullock, 2012).
Furthermore, doctors will have a greater variety of kidneys to choose from; and the greater the variety can mean that doctors can more closely match the kidney to the recipient, reducing the possibility of rejection. The number of kidneys from live donors will increase. Since experience indicates that the rejection rate is lower with kidneys from live donors than from cadavers, further reductions in the rejection rate can be achieved (McKenzie & Tullock, 2012).
Conclusion
To summarize, the demand for transplantable kidneys exceeds the supply, since selling kidneys are illegal. Although kidney selling is illegal, many people are hesitating to hand over one of their kidneys, when the price of selling a kidney increases. The demand curve is based on several factors; the size of medical schools, the medical schools need for kidneys in research, the number of people who experienced kidney failure and the techniques which are known for transplanting organs. If a free market in kidneys is possible, the price of a kidney would rise toward the intersection of supply and demand. However, today there is only one possible alternative, which is dialysis. This alternative cost a huge amount of money and is time-consuming.
Even though a market in kidneys seems a good idea, there are many arguments why the market for kidneys should not be legalised. First of all, the argument that only needy people sell their kidneys and receive only a little or no follow-up care after surgery. Next to that, only the rich people will benefit and the consequences of a market will lead to low-quality kidneys. Furthermore, kidney selling will reduce altruism.
Besides these arguments, there are even stronger arguments. First, the legitimate concern about truly voluntary informed consent. People, especially the poor, are under great pressure and some people may not understand all the information which has been given. Second, a social system that allowed living people to sell kidneys would not be compatible with an ethics of promoting the good of society.
Arguably, there are also many arguments why the market for kidney selling should be legalised. First, every person has his or her own individual rights. Second, financial problems can be solved, by charity or the aid of the government. Third, the doctors have a greater variety to choose from; more variety means that the possibility of rejection will decrease.
The economic debate on the market of kidneys is clearly still not finished. By the view of the opponents selling a body part is always wrong. The 18th century philosopher Immanuel Kant always said that people are supposed to act in a way that shows humanity and dignity. Disregard less of our wealth, talents or something else, people always worth more than any price. On the other hand, by the view of the proponent, legalizing the market for kidneys will decrease the number of people who cannot receive transplants and provide better medical care. It would reduce the gap between supply and demand and even in long-run cut out the shortage of kidneys.