Are we murderers for not donating our organs? [repost]

Zell Kravinsky risked his life to donate his healthy kidney to a complete stranger. Would you do the same?

Kravinsky is a radical altruist. He believes in giving away as much as possible to others, including his nearly $45 million fortune and his own body parts. Most people would consider donating a kidney as going above and beyond, but Kravinsky told the New Yorker in 2004 that he considers anyone who doesn’t donate their extra kidney a murderer.

We probably don’t, as individuals, have a moral responsibility to donate our organs, but maybe we do have a societal responsibility to find a system by which we can match kidney donors and recipients so that no one has to die just because there isn’t a transplant available. In 2012, there were 95,000 Americans on the wait list for a life-saving kidney, according to economists Gary Becker and Julio Elias. The average wait time for a kidney in 2012 was over four years.

Becker and Elias are proponents of creating a formal, legal market for organs to eliminate long wait times and better match recipients with donors. Right now, it is illegal to sell your organs in most of the world, including in the U.S.

The main risks of monetary compensation for organ donations are the coercion of unwilling donors, the potentially unequal distribution of donors — poor people would be more likely to become donors, and the moral question of whether or not it is okay to sell body parts, even if they are our own.

Purely moral arguments aside for a moment, there are ways to alleviate the risks of a market for organs. Waiting periods between registration and donation, psychiatric evaluation ahead of registration as an organ donor, and strict identification requirements or even background checks can all combat coercion in the market for organs, while saving the lives of the many Americans who die on an organ waitlist. Becker and Elias also point to the fact that people in lower income brackets are disproportionately affected by long waitlists: the wealthy can fly abroad to obtain a healthy organ or manipulate the current waitlist system in their favor, while poorer Americans face longer wait times. While donors may be disproportionately poor, which raises concerns of implicit economic coercion, the lower income brackets also benefit disproportionately from the policy.

Even more powerful than a legal market alone would be a combination of a legal market for organs and an implied consent law, which would mean people would have to opt out of being an organ donor, rather than the U.S. standard of opting into being a donor. A 2006 study by economists Alberto Abadie and Sebastien Gay found that implied consent laws have a positive impact on organ donations. Under a combination of these two initiatives, essentially all organ donor needs might be met, and a person’s will might come to include provisions for their organs to be harvested and family members to be compensated.

While Kravinsky donated his kidney for free, he once offered a journalist $10,000 to donate a kidney to a stranger, according to Philadelphia Magazine. But the journalist backed out of the deal he struck with Kravinsky after his wife and friends convinced him not to go through with it. They convinced him that the risk of surgery, though relatively minor, was not worth saving a life. But if a safe, legal market for organ sales is established, perhaps the establishment of a market price for organ donation and a normalization of the procedure will allow Americans to save lives and make money, without requiring Kravinsky’s extreme, and perhaps aggressive, sort of altruism.

Originally written for my Economics of Sin senior seminar, spring 2017; previously published at the Unofficial Economist on Medium.

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Hannah Blackburn

Hannah Blackburn is an associate at IDinsight in Nairobi, Kenya. IDinsight is a non-profit organization that uses a variety of data-driven research methods to help decision makers in the development field maximize their social impact.

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