Medical Self-Defense, Organ Markets, and the Poor

Josh Wright —  13 November 2006

Eugene Volokh has posted a series discussing his new article (forthcoming in Harvard L. Rev.) “Medical Self-Defense, Prohibited Experimental Therapies, and Payment for Organs,” which I point out because the article claims that bans on organ payments violate patients’ medical self-defense rights. As readers of TOTM know, organ markets are a topic of substantial interest around here. Eugene dedicates a separate post to refuting the oft-repeated mantra that the ban on compensation is necessary to prevent the wealthy from buying up all of the organs. I remain unconvinced by claims that organ markets will harm the poor for reasons addressed in greater detail in this post. Eugene’s article admirably contributes to a substantial literature refuting the claim that organ markets will make the poor worse off (see, e.g., Cohen, Epstein, Boudreaux, Becker links in this post).

While it is very difficult to say anything new about the benefits of organ markets — there are only so many ways of saying that supply curves slope upwards — the comments to Eugene’s posts and discussions of this issue elsewhere lead me to believe that there are a few points worthy of repetition with respect to the assertion that the wealthy will buy up all of the available organs at the expense of the poor.
The first is a simple one. The market price of kidneys would not depend only upon the willingness to pay of the rich. This is not how prices are formed. As Gary Becker put it in this post, “market forces rather than rich persons would determine the price of organs, in the same way that rich people do not presently set the price of maid services.”

The second point is a tired one, but one that bears repeating as often as necessary: the problems of organ shortages and poverty are different problems. There are a number of policies one might prefer as a method to reduce poverty.  A ban on compensation for organs is not one of them. We might also agree that some form of state subsidy of organ transplant costs for the poor is a good idea.  Again, this issue is distinct from whether the transactions should be allowed.  The relevant policy inquiry with respect to poverty is whether lifting the ban on compensation for organs will make the poor better or worse off? Even assuming arguendo that the organs will come primarily from those living below the poverty line, the argument that a ban on kidney transactions will make the poor better off when we restrict their choice set necessarily assumes that these individualsare simply unable to economize the relative costs and benefits of the choice. As I have written previously:

I fail to understand how depriving those with low incomes of a choice they currently do not have shows a greater concern for the poor than giving them an option not previously in their choice set. This objection masks, and not very effectively, an assumption that the poor either cannot or will not economize on the potential costs and benefits in the language about justice.

2 responses to Medical Self-Defense, Organ Markets, and the Poor

  1. 

    Presumably, you mean price ceiling rather than price floor. And yes, some sort of price floor or even a quota on organs from poor people would be better than the current system which prohibits transactions in total. But the problem with a price floor in this market, like any, is that it would not reduce the organ shortage as much as a system in which the market price to be determined by supply and demand.

    I do not purport to know what the market price would be. This is the value of market prices rather than a centralized allocation of resources. Becker and Elias have some interesting work estimating reservation prices using estimates from the literature on the value of life, changes in quality of life, etc.

    The social costs associated with the kidney shortage are very real. Many of those waiting for organs are very ill, and will die before a transplant organ is available. Perhaps, being concerned with the distribution of gains from trade, you should also be asking about how those losses will be distributed in the regulated market facing the price ceiling?

    In addition, the “untrammeled” market has the advantage of knocking out the black market in organs and reducing the advantages of wealth in obtaining access to organs under most proposed systems actually under discussion. I would have thought you would be in favor of such a move, or at least incorporate this benefit into your analysis.

  2. 

    I don’t think the issue is necessarily whether “organ markets will make the poor worse off.” I think the issue arises out of a fair distribution of the gains from trade. Perhaps it is the case that in an untrammeled market where an organ seller can gain $1000 and live off that for two years, and the buyer can gain the kidney and live for whatever the expected span of gained life is, both are better off. But if the price of comparable life-saving treatments is ten times that amount, and all buyers can pay ten times that amount (a not unreasonable assumption given the numbers Volokh is using), I don’t see the problem with a price floor.