All Commentary
Saturday, August 1, 1987

A Free Market in Kidneys?

Dr. Block is Senior Economist at The Fraser Institute, Vancouver, Canada.

According to recent reports, the black market value of a kidney which can be transplanted is some $13,000—which translates to roughly seven times its weight in gold. This is a dramatic figure, and behind it lies a tale of untold human suffering.

There are thousands of people who desperately need kidney transplants. Paradoxically, there are other thousands of people who die each year, taking healthy kidneys to the grave, who have had no financial incentive to bequeath these organs to those in need. Why, it may be asked, cannot potential donors be given a pecuniary reward for doing the right thing? That is, what precludes a businessman from purchasing the future rights to kidneys from potential donors, and then selling these kidneys to those who need transplants?

The problem is, it is illegal to harness marketplace incentives in order to encourage kidney donors. In the United States, the National Organ Transplantation Act (1984) prohibits the sale of organs for transplantation.

Instead, we resort to all sorts of inefficient stratagems. Celebrities exhort us, in the event we suffer an untimely death, to make a posthumous gift of these organs. Medical schools coach their students on the best techniques for approaching next of kin; the difficulty is that they must ask permission at the precise time when it is least likely to be given—upon the sudden loss of a loved one.

These tactics have been to little avail. While potential recipients languish on painful dialysis machines, the public hasn’t signed cards in sufficient numbers giving permission for automatic posthumous donor status. Things have come to such a pass that in Canada there are plans being bruited about which would allow the government to seize the kidneys of accident victims unless they have signed cards denying such permission.

The free enterprise system, were it allowed to operate, might save the lives of thousands of kidney disease patients. A legalized marketplace would offer strong financial incentives for donors. Would you sign a card donating your kidney after death for $13,000, right now, in hard cash? There are very few people who would turn up their noses at such an offer. And if sufficient supplies were still not forthcoming at this level, prices would rise even farther until all demand was satisfied. Given free enterprise incentives, there would be no shortage of kidneys.

This, after all, is the same process we rely on to provide the other necessities of life: food, clothing, and shelter. We do not wait for voluntary donations of these vitally important goods and services.

There is no doubt that those presently responsible for preventing a free market in kidneys act with the noblest of motives. To them, legalizing the purchase and sale of human organs would be degrading. Far better, from their viewpoint, that people donate their bodily parts for free so that thousands of kidney disease sufferers might live normal lives. However, no matter how benevolent the intentions of the prohibitionists, it cannot be denied that the effect of their actions has been to render it less likely that those in need will be served.

it is time to put aside our archaic and prejudicial opposition to the marketplace, so that we can relieve the suffering and, in many cases, lift the death sentence we have inadvertently placed on our fellow citizens.

  • Walter Edward Block is an American economist and anarcho-capitalist theorist who holds the Harold E. Wirth Eminent Scholar Endowed Chair in Economics at the J. A. Butt School of Business at Loyola University New Orleans. He is a member of the FEE Faculty Network.