Freedom, Markets, and Well-being Fall 2017

Kidney Markets


Satz considers three arguments against markets for kidneys (Satz 2008). She says that only the first one is an argument against kidney sales even in the best circumstances. The others present considerations that could, in theory, be addressed through regulation.

The three arguments are:

  1. Kidney markets undesirably restrict the options available to people: when it is possible to sell a kidney, lenders will demand kidneys as collateral for loans. She thinks that “people should not have to pay a cost for refusing to sell their body parts” on the grounds that “a person’s relationship to their body is so important that it should enjoy a special protection against the effects of market forces” (Satz 2008, 278).

  2. Inequality: kidneys are sold by poor people to rich people; the exchanges looks exploitative.

  3. Weak agency: the people selling the kidneys do not appreciate the consequences of doing so. Sometimes, they are forced to sell their kidneys by their husbands.

Our Discussion

Prof. Brown led off our discussion with a handout of updated facts about the gap between the need for kidney transplants and the supply of donated kidneys. It’s big and so people die for lack of a transplant. That is what motivates interest in markets for transplantable organs: generally speaking, when you offer to pay for something, you tend to find people willing to supply it.

Prof. Brown shares Satz’s interest in the first argument, about how markets in organ transplants would change the choices available to others. The technical term for this is “pecuniary externality” and, according to Prof. Brown, it’s something that economists are interested in. She noted that pecuniary externalities are not exactly the same as the other cases of externalities that economists study. A plain externality is a cost that is external to the price system. For example, since there are no property rights in clean air, there is no price to pay for polluting the air. Pecuniary externalities involve costs taht are external to the market but not external to the price system.

Shakira noted an important ambiguity that runs through the discussion. We know there are black markets for kidney transplants. Assuming that we cannot eliminate them, the practical question facing us is not “should there be markets for kidney transplants?” but rather “should there be legal markets for kidney transplants rather than black markets?” As Shakira pointed out, it’s quite possible that legal markets would be better than black markets even if you think there should be no markets at all.

Satz makes a similar point about countries like India where it may well be impossible to stamp out the black market at reasonable cost (Satz 2008, 278). On the other hand, if India cannot stop the black market, is it obvious that it could effectively regulate a legal market?

Nathaniel wasn’t crazy about the formulation of the first point. It’s not a conflict between individual choices and the choices available to the society at large. As he sees it, it’s a conflict between some individuals having the option they want and other individuals not wanting to have this option. That said, Nathaniel thought the first point was a good one.

Matthew thought that the first point covertly gets its force from the second one. The first point is that many people do not want the option of selling an organ because it will mean that they cannot secure a loan without putting their body parts up as collateral. As Matthew sees it, this is compelling only if they can secure credit only under the most burdensome terms. Only desperately poor people will find themselves being asked to put up their kidneys as collateral; those who have a steady stream of income will not have to worry about it. But that is just the second point: that the markets involve the exploitation of the poor by the rich.


Satz, Debra. 2008. “The Moral Limits of Markets: The Case of Human Kidneys.” Proceedings of the Aristotelian Society 108: 269–88.