Cash For Kidneys
It's my feeling that you should be able to do what you want with your body -- whether it's getting high or selling off a piece of it.
Not allowing people to sell their organs, even if they want to do it, causes a shortage in transplantable organs. Sally Satel writes about this at AEI:
[A] theoretical objection to compensating donors is the notion that it will "commodify" the body and thus dehumanize the rest of us, let alone the person who gives his kidney in exchange for "valuable consideration." Yet with proper respect for donors and informed consent, it strikes me that careful engagement in financial arrangements is far less distasteful than allowing people to suffer and die.
Jason Brennan posts at Bleeding Heart Libertarians about how many people believe "for profit" kidney sales are wrong, out of the notion that people who save lives should not be profiting from it.
But, wait -- as Brennan asks: "Does it imply that competent and skilled surgeons (firefighters, nurses, police officers, EMTs, etc.) who are just in it for the money, or who are significantly motivated by personal gain, ought not take the job?"
And he gives a variation on Singer's "drowning child" thought experiment:
Three toddlers are drowning in three different pools. In the first case, a person says, "I value the toddler's life for it's own sake, and I am willing to save the child without getting a reward." In the second case, a person says, "I am willing to save the child only if I make a small profit. $10 will do it." In the third case, a person says, "I am not willing to save the child myself-I can't be bothered to do so, because I don't care enough about other people. However, I think the idea of saving a child for profit is evil. So, in addition to not saving the child myself, I'm also going to make sure that person 2 doesn't save the child for $10 either."
The first person is the most noble. The second person isn't noble, but at least he's willing to help people for money. The third person, it seems to me, is vile and rotten. He uses moral language, but he is himself a morally contemptible figure. He refuses to help a child himself, and also, at the same time, stops less than fully virtuous people like person 2 from saving children.
Many opponents of kidney sales strike me as being like person three.
He notes that he's given a talk on Markets without Limits to perhaps 2,700 people, and none of them had said they'd be willing to donate a kidney -- while expressing outrage that people might be paid for doing so, rather than simply doing it to help.
Perhaps donating a kidney out of altruistic motivation is nobler than selling a kidney for profit. But, even if we grant that, it still seems that a person who is willing to save a life for money is (all other things equal) better than a person who is not willing to save a life, either for money or out of the goodness of her heart. "I won't save a life that way, and no amount of money could get me to do it" seems to me an admission of deep moral depravity. "I won't help, even for money," is a badge of dishonor.
Of course, there are other objections to kidney sales besides the one I'm considering here. People think kidney sales involve exploitation, the misallocation of resources, coercion, etc. But, as Peter and I show in our book, these are at worst contingent problems that could easily be regulated away in a legalized kidney market.
Interestingly, the person I know who did donate a kidney -- Virginia Postrel (who's written about this) -- is libertarian and the former editor of Reason. She gave her kidney to American Enterprise Institute scholar Sally Satel, whose piece on kidney donations I linked above.
And obviously, as Sally notes, there would need to be safeguards:
Donor protection is the linchpin of any compensation model. Standard guidelines for physical and psychological screening, donor education, and informed consent could be formulated by a medical organization, such as the American Society of Transplant Surgeons, or another entity designated by the federal Department of Health and Human Services. A "waiting period" of three to six months could be built in to ensure the prospective donor has ample time to think it through. Monitoring donor health post-transplant is important as well. One idea is to provide lifetime health insurance, through Medicare or a private insurer for the donor. He would receive annual physicals, routine medical screening, and long-term follow-up in addition to standard health coverage. A federally sponsored registry of donors could help us study long-term outcomes for donors and vendors and take steps to remedy physical or psychological difficulties that arise.
Oh, and in case you were thinking of making the argument that the cash market for kidneys hurts the, uh, free market, here's Sally again:
While private contracts may seem unfair because only those with means will be able to purchase directly, poor people who need kidneys would be no worse off--and, very likely, considerably better off--than under the current system. First, a stranger interested in selling a kidney is unlikely to give it away for free to the next person on the list (only 88 donors last year made such anonymous gifts); thus, few poor people would be deprived of kidneys they would otherwise have gotten voluntarily. Second, anyone who gets a kidney by contract is removed from the waiting list, and everyone behind him benefits by moving up. Third, private charities could offer to help subsidize the cost for a needy patient or pay outright.