Cash For Kidneys, Part 3

[This is a followup to Part 1, and Part 2.]

Charles B. Fruit, the Chairman of the National Kidney Foundation recently got a couple of letters published declaring his opposition to paying for kidneys. Both of them are worth reading, if only to see how pathetic the arguments are.

The first note was printed in the Wall Street Journal:

Rather than retreating from Mr. Epstein’s dismissal, the National Kidney Foundation and I stand proudly, not only to endorse last month’s Institute of Medicine report on organ donation, but to count ourselves among the millions of other “high-minded moralists” who oppose treating life-saving organs as commodities. There is a reason why Congress, through the National Organ Transplant Act of 1984, wisely prohibited any “valuable consideration” — including financial transaction — to acquire, receive or transfer organs. Families decide to donate the organs of a loved one for altruistic reasons. Payment is an affront to those who have already donated,

Stop right there! This is probably the stupidest argument against organ markets ever.

First of all, a usage note: An affront is a deliberate offense. Clearly, nobody is trying to intentionally offend organ donors.

Second, this “affront” sounds an awful lot like envy. If hospitals started paying for organs, I can see where people who had recently given them away for free would be angry. But if it were me, I wouldn’t be angry that people were being paid, I’d be angry that I’d been ripped off!

The best reason for allowing payments for organs is to increase the number of donated organs, therefore saving lives. There may be good and moral reasons why that is not a trade-off we should make, but keeping people from being offended isn’t one of them.

Besides, why should we care if those who have already donated are offended? It’s not like they can take the organs back.

and evidence from a national poll indicates it may prove similarly offensive to future donors as well. The National Survey of Organ Donation (Wells, 2005) found that 10.8% of those polled would be less likely to grant consent for the organs of a deceased family member to be used for transplant if they were offered payment. And 68.2% said they would be neither more nor less likely to grant consent.

Those numbers add up to 79%. What about the other 21%? What did they have to say? The only remaining option seems to be “more likely.” I can’t find the National Survey of Organ Donation online, so I can’t check.

If we give Fruit the benefit of the doubt and assume the omitted numbers don’t invalidate his evidence, then this is a much better argument than the first one. If paying people would actually reduce the organ supply, then of course we shouldn’t pay people.

But I don’t believe it for a moment.

If paying people to donate organs makes them less likely to donate organs, it would be a shocking exception to the usual economic rules. In every other human activity, paying people makes them more likely to do what you’re paying them to do.

Just because something is altruistic doesn’t mean you can count on people doing it for free. We pay firefighters, don’t we? Sure, there are also volunteer firefighters, but most of those are in small towns. That’s the equivalent of kidney donors who give to their sick friends. In a large city, you have to pay people if you want them to bear that amount of hardship for strangers.

What about all those people who answered the poll and said payment would make no difference? They’re lying. Nobody wants to admit they’d sell their family members’ organs. It does sound unseemly, after all, especially with people like Charles Fruit going around badmouthing the idea. Of course they didn’t want to admit it. After all, this was just a poll. If you want to find out what people will really do, you have to put some money on the table.

Few people take on difficult tasks solely for the internal feel-good reward. Priests are following a religious calling, yet the churches have to pay. Soldiers are patriots defending their country, yet the country has to pay. Doctors are paid to heal the sick, yet the sick have to pay. Organ donors heal the sick too, so why shouldn’t they get paid?

Overall, Mr. Epstein calls for “a sensible, above-board, functional organ market” where “price should be determined by supply and demand.” We moralists can only pray that his proposed market mechanism for the transaction of hearts, lungs, kidneys and other life-saving human organs would work a little better than it does for the nation’s consumers of gasoline.

More stupidity. The national gasoline markets work very well, especially when idiot politicians leave them alone. Sure, people are complaining about the price of gasoline, but what they’re not complaining about is a shortage of gasoline. The gas may cost more, but there’s still plenty of it.

Here’s a thought experiment for you: Go fill your car with gas right now. Even if you are reading this in the middle of the night, you could probably have your tank full within half an hour. For some people, it might be twice as long; for me, it’s ten minutes.

The median wait for a kidney is three years. That’s long enough to build an entire gas station. I think this is a clear win for market efficiency.

The second letter, published in the New York Times, repeats the polling data from the first one, and then goes on to conclude:

A wholesale sellout to the law of supply and demand is not the answer.

The “law of supply and demand” is a scientific law, like the “law of gravity.” Unlike manmade laws, which are prescriptions for desired behavior, scientific laws are descriptions of observed behavior. The law of supply and demand is a description of what happens, not of what we’d like to happen.

The science of economics is softer than the science of physics, but not so soft that we can ignore its laws just because we want to. The supply of transplantable kidneys is subject to economic laws whether we want them to be or not, and right now the law of supply and demand is killing people who need kidneys.

In the United States, about 20,000 people need a kidney transplant every year. About 7,000 kidneys can be taken from people who donate their organs when they die, so only 13,000 kidneys have to come from living donors. In other words, the demand for kidneys is 13,000 per year.

Every year in this country, four million people turn 18. Nearly all of those people have two kidneys but really need only one to survive and live a normal life. That means we have a potential supply of four million spare kidneys every year. To meet the demand for 13,000 kidneys, we only need a little more than 3 in every thousand people to donate a kidney.

However, because organs cannot be sold, the price of a kidney is effectively set at zero dollars. At that price, only slightly more than 2 people per thousand decide to donate kidneys. That means the supply is only about 9,000 kidneys per year. The other four thousand people who need kidneys can’t get them. So they die.

Maybe we should sell out to the law of supply and demand just a little, because right now it’s kicking our ass.