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:
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).
Inequality: kidneys are sold by poor people to rich people; the exchanges looks exploitative.
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.
Peter N. was impressed by the difference between two cases:
If there isn’t a legal market, there will be a black market.
It’s possible to squash both the legal and black markets.
In the Indian case, for example, the black market exists despite the fact that it’s illegal to sell kidneys. So this might be a case where a regulated market is preferable. In the US, by contrast, we think it’s possible to get rid of the black market, if we wish to do so. Peter T., however, noted that there are far fewer problems with kidney markets in countries like the US; so it’s not obvious that we would want to get rid of it, even if we could.
Jeremy noted that it was unlikely that kidney sales would crowd out donations of kidneys based on what is called “intrinsic motivation” for the simple reason that not many people donate kidneys out of the goodness of their hearts. Professor Brown explained some of the research behind the idea that putting a price on something could crowd out intrinsic motivation. This seems to have been the case with blood donations, picking up kids on time from day care, and work that is paid at an insultingly low rate.
I asked why we shouldn’t use markets to address the shortfall in transplantable kidneys. It’s a lot of death and suffering, after all. And while you might not like it as a way of transferring resources from the rich to the poor, it does do that. Otherwise, the poor wouldn’t willingly sell their kidneys.
Professor Brown gave a paternalistic reason: the people selling don’t understand the costs of doing so. The Goyal article seemed to bear this out as it reports that people were paid less than they were promised and 80% of them said they would not do it again.
Kamyab liked the agency argument. He was impressed by the suggestion that husbands coerce their wives to sell their kidneys. If so, the exchange isn’t a voluntary one with winners on both sides and no losers. (It isn’t a Pareto improvement, if you want to be fancy.)
Remy had a very interesting suggestion. Instead of paying cash for kidneys, pay with something else, like health care. That can’t be diverted to someone else, it addresses some of the undesirable side effects of selling a kidney, and it’s something that is almost certainly needed anyway. Nice idea.
Crystal had egalitarian concerns. She likes the idea of a list. Those most in need get the kidney rather than those who are best able to pay. It’s a lot like Williams’s point about the proper distribution of health care. I suppose that an advocate of markets might try to address her point by showing that a market would increase the supply of kidney transplants so much that everyone on the list is taken care of at least as well as they would be without the market. But I don’t know if it would work that way. You could also imagine a market for donations but not for transplants. Have a central agency buy the kidneys and distribute them according to need. That might increase the supply of kidneys without making wealth a condition of getting the transplant.
Satz, Debra. 2008. “The Moral Limits of Markets: The Case of Human Kidneys.” Proceedings of the Aristotelian Society 108: 269–88.