"someone lives and someone dies"

[Metsfanmax]

But the reason I linked the article is that very special considerations apply when it comes to organs. If we open up the global market, it means that there will be a lot more people in developing nations who are willing to donate organs in the hope of making money. Many of these people will be ill-informed about the health risks of such donations, and probably many more could be coerced into participating in less than savory areas. If this did occur, it would occur on a much larger scale than it does now, where the illegality of it results in simply less organ trafficking.

And more people in developing countries would have more income which they can put toward more valuable uses. It's up to them and marketers (educational, hospitals, governments) to convince people that plan A is better than plan B. As long as the market isn't driven underground, it's the better choice.

Market failures and abuses are always created when the choices that people make are too complicated for them to understand. Capitalism works perfectly when we can assume that all humans are rational actors that understand the benefits and costs associated with any economic choice. And in many cases this is a fairly good assumption. I understand the benefits and costs associated with buying a box of strawberries; I know about how much happiness it would bring me, and I know how much I need to consume to stay healthy. But the rational actor theory breaks down, as I'm sure you are aware, when the choices cannot properly be evaluated. Such is the case with a complicated medical decision like whether to donate a kidney. It is easy to envision a scenario in which poor people cannot get sound medical advice on whether they should be donating kidneys, and unsavory marketers take advantage of that to get people to donate who would not otherwise do so, given access to medical consultation. It is not enough that a marketer can convince a poor person to make a choice that will make them significantly less poor. There has to be not only a strong legal structure, but reasonable access to medical care, in place to ensure that the poor are not being taken advantage of in a way that leaves them significantly worse off as a result of the market. Poor areas are the places where these will be least likely to exist, and income from an organ donation market isn't going to be the magic bullet that lifts these areas out of poverty.

The question of organ donations from cadavers is much different. Instead of opening up the market there, I would advocate for an opt-out organ donation system for all citizens upon death.

Why? Let people earn money for their organs. You want to help poor people? Here's an easy solution: let people sell the organs of their dead bodies.

You want dead people to earn money for their organs? How does that even work?

[patrickaa317]

Why? Let people earn money for their organs. You want to help poor people? Here's an easy solution: let people sell the organs of their dead bodies.

You want dead people to earn money for their organs? How does that even work?

Sign a contract that they will keep them in good condition, they can collect payment in advance, then upon death that company gets the rights to them. Granted the company would be taking a chance that the person does not pass away in a situation that damages to the organs they have paid for.

Not saying I agree with this but that is a way to allow people to earn money before they are dead. I'd agree to sell my liver to the highest bidder, though I don't know how much someone would want it...

[BigBallinStalin]

But the reason I linked the article is that very special considerations apply when it comes to organs. If we open up the global market, it means that there will be a lot more people in developing nations who are willing to donate organs in the hope of making money. Many of these people will be ill-informed about the health risks of such donations, and probably many more could be coerced into participating in less than savory areas. If this did occur, it would occur on a much larger scale than it does now, where the illegality of it results in simply less organ trafficking.

And more people in developing countries would have more income which they can put toward more valuable uses. It's up to them and marketers (educational, hospitals, governments) to convince people that plan A is better than plan B. As long as the market isn't driven underground, it's the better choice.

Market failures and abuses are always created when the choices that people make are too complicated for them to understand. Capitalism works perfectly when we can assume that all humans are rational actors that understand the benefits and costs associated with any economic choice. And in many cases this is a fairly good assumption. I understand the benefits and costs associated with buying a box of strawberries; I know about how much happiness it would bring me, and I know how much I need to consume to stay healthy. But the rational actor theory breaks down, as I'm sure you are aware, when the choices cannot properly be evaluated. Such is the case with a complicated medical decision like whether to donate a kidney. It is easy to envision a scenario in which poor people cannot get sound medical advice on whether they should be donating kidneys, and unsavory marketers take advantage of that to get people to donate who would not otherwise do so, given access to medical consultation. It is not enough that a marketer can convince a poor person to make a choice that will make them significantly less poor. There has to be not only a strong legal structure, but reasonable access to medical care, in place to ensure that the poor are not being taken advantage of in a way that leaves them significantly worse off as a result of the market. Poor areas are the places where these will be least likely to exist, and income from an organ donation market isn't going to be the magic bullet that lifts these areas out of poverty.

It's about relative benefits and costs. The centrally planned system with its queues and no price mechanism is inferior to any plan allowing for the open markets of organs.

The question of organ donations from cadavers is much different. Instead of opening up the market there, I would advocate for an opt-out organ donation system for all citizens upon death.

Why? Let people earn money for their organs. You want to help poor people? Here's an easy solution: let people sell the organs of their dead bodies.

You want dead people to earn money for their organs? How does that even work?

You know how a Will works, right?

[jonesthecurl]

Why? Let people earn money for their organs. You want to help poor people? Here's an easy solution: let people sell the organs of their dead bodies.

You want dead people to earn money for their organs? How does that even work?

Sign a contract that they will keep them in good condition, they can collect payment in advance, then upon death that company gets the rights to them. Granted the company would be taking a chance that the person does not pass away in a situation that damages to the organs they have paid for.

Not saying I agree with this but that is a way to allow people to earn money before they are dead. I'd agree to sell my liver to the highest bidder, though I don't know how much someone would want it...

Is life worth living? That depends on the liver.

[Metsfanmax]

But the reason I linked the article is that very special considerations apply when it comes to organs. If we open up the global market, it means that there will be a lot more people in developing nations who are willing to donate organs in the hope of making money. Many of these people will be ill-informed about the health risks of such donations, and probably many more could be coerced into participating in less than savory areas. If this did occur, it would occur on a much larger scale than it does now, where the illegality of it results in simply less organ trafficking.

And more people in developing countries would have more income which they can put toward more valuable uses. It's up to them and marketers (educational, hospitals, governments) to convince people that plan A is better than plan B. As long as the market isn't driven underground, it's the better choice.

Market failures and abuses are always created when the choices that people make are too complicated for them to understand. Capitalism works perfectly when we can assume that all humans are rational actors that understand the benefits and costs associated with any economic choice. And in many cases this is a fairly good assumption. I understand the benefits and costs associated with buying a box of strawberries; I know about how much happiness it would bring me, and I know how much I need to consume to stay healthy. But the rational actor theory breaks down, as I'm sure you are aware, when the choices cannot properly be evaluated. Such is the case with a complicated medical decision like whether to donate a kidney. It is easy to envision a scenario in which poor people cannot get sound medical advice on whether they should be donating kidneys, and unsavory marketers take advantage of that to get people to donate who would not otherwise do so, given access to medical consultation. It is not enough that a marketer can convince a poor person to make a choice that will make them significantly less poor. There has to be not only a strong legal structure, but reasonable access to medical care, in place to ensure that the poor are not being taken advantage of in a way that leaves them significantly worse off as a result of the market. Poor areas are the places where these will be least likely to exist, and income from an organ donation market isn't going to be the magic bullet that lifts these areas out of poverty.

It's about relative benefits and costs. The centrally planned system with its queues and no price mechanism is inferior to any plan allowing for the open markets of organs.

I would have thought that you would not stoop to one sentence assertions with no justifications. I made an argument for why the centrally planned system might well be better for society as a whole. You respond "no, markets are always better." There's no way to conduct a discussion in that manner.

[BigBallinStalin]

So you know how a Will works, right?

I can't really address your points if you refuse to think about voluntary contracts, which you know are a crucial part of markets.

[Metsfanmax]

So you know how a Will works, right?

I can't really address your points if you refuse to think about voluntary contracts, which you know are a crucial part of markets.

The part about organ donation on death is an entirely separate question, and one that we can get to, but I wanted to do one thing at a time; first, I was focusing on organ donations from living individuals.

We have previously discussed this is another thread, but I do not see how a person ought to be able to make a contract that is to be enforced after the person no longer exists. I can acknowledge the existence of wills and other legal contractual mechanisms that I find silly, and even understand how they work, without having to agree with the reasoning behind them.

[BigBallinStalin]

Oh, another thing. Are you assuming symmetrical behavior? It seems that you describe x-amount of participants in the market as stupid and unable to learn from trial-and-error, yet you assume Great Things about the central planners of government who can magically overcome all these problems. You're using a Market Failure + Nirvana Fallacy argument.

If we get into it, I wouldn't be surprised to find you having unreal expectations about the political process. Holding unreal expectations of the political process while comparing them to a hypothetical image of the market* doesn't help your case.

*(an image of failure--and only of failure--since "obviously" the market couldn't correct the problem, yet government magically could).

[BigBallinStalin]

So you know how a Will works, right?

I can't really address your points if you refuse to think about voluntary contracts, which you know are a crucial part of markets.

The part about organ donation on death is an entirely separate question, and one that we can get to, but I wanted to do one thing at a time; first, I was focusing on organ donations from living individuals.

Actually, it's relevant. With market activities, you have the option to voluntarily agree. With government, you don't. Do you see some of the problems with that? What are your underlying assumptions when you jump to the Government solution?

[Metsfanmax]

Oh, another thing. Are you assuming symmetrical behavior? It seems that you describe x-amount of participants in the market as stupid and unable to learn from trial-and-error, yet you assume Great Things about the central planners of government who can magically overcome all these problems. You're using a Market Failure + Nirvana Fallacy argument.

BBS, I really expect better from you than to strawman me into defending central planning as the only way to do anything.

I didn't say that people are either stupid or unable to learn from trial-and-error. I said that they could well be uninformed, which is of course not the same thing as stupid (and the lack of information could well be due to a campaign of disinformation). It is also absurd to suggest that people should learn from trial and error when we are talking about donating a kidney. It's not like they'd give the other one up even if they could.

The argument being made isn't that government is perfect, or even that great. The argument is that the probable increase in efficiency of organ transfer that would be created by opening up the market, is not necessarily a net good thing for society. In fact, the point I made is that this very increase in efficiency would be at the expense of the worst off members of society, who could very well be taken advantage of in a way that leaves them worse off than when they started.

So you know how a Will works, right?

I can't really address your points if you refuse to think about voluntary contracts, which you know are a crucial part of markets.

The part about organ donation on death is an entirely separate question, and one that we can get to, but I wanted to do one thing at a time; first, I was focusing on organ donations from living individuals.

Actually, it's relevant. With market activities, you have the option to voluntarily agree. With government, you don't. Do you see some of the problems with that? What are your underlying assumptions when you jump to the Government solution?

What part of my plan involved a situation where people have no option to agree? In any situation I advocate, people should have the ability to determine whether or not they want to be an organ donor. I never once advocated that the option to be a donor should be removed. In this case, the restriction is not on whether you can be an organ donor, but on whether you can get paid for it, and who controls the transfer of the organs.

[Woodruff]

Ok, you've convinced me. I am willing to donate my appendix for $25,000.

(But not the manuscript itself...)

[BigBallinStalin]

Actually, it's relevant. With market activities, you have the option to voluntarily agree. With government, you don't. Do you see some of the problems with that? What are your underlying assumptions when you jump to the Government solution?

What part of my plan involved a situation where people have no option to agree? In any situation I advocate, people should have the ability to determine whether or not they want to be an organ donor. I never once advocated that the option to be a donor should be removed. In this case, the restriction is not on whether you can be an organ donor, but on whether you can get paid for it, and who controls the transfer of the organs.

You can't legally sell organs although of course there probably is some exemption for a select few for very specific reasons. The prohibition denies voluntary contracts on the sales of organs, and I'm sure you'll agree that it does. That's what I'm talking about: the status quo.

It's fine if you wish to have some "give your organs for free when you die" program so long as it's voluntary. And since people can opt out, then I'm also completely fine if they wish to sell their organs upon their death or while they live. However, when I was arguing for a market approach, you reject it with your market failure argument, so I'll perceive that as support of the status quo or at the very least support of the prohibition against the market--which is the government-enforced, involuntary approach. (which of course gets people killed, shortens life expectancies, and denies the poor an avenue of income).

If you don't reject the government prohibition, then you inadvertently support it.

[BigBallinStalin]

Oh, another thing. Are you assuming symmetrical behavior? It seems that you describe x-amount of participants in the market as stupid and unable to learn from trial-and-error, yet you assume Great Things about the central planners of government who can magically overcome all these problems. You're using a Market Failure + Nirvana Fallacy argument.

BBS, I really expect better from you than to strawman me into defending central planning as the only way to do anything.

I didn't say that people are either stupid or unable to learn from trial-and-error. I said that they could well be uninformed, which is of course not the same thing as stupid (and the lack of information could well be due to a campaign of disinformation). It is also absurd to suggest that people should learn from trial and error when we are talking about donating a kidney. It's not like they'd give the other one up even if they could.

So, whenever you're using the Market Failure argument, the necessary question is: compared to what? Because currently, we have the government approach (government prohibition, which would not be removed as a consequence of your position).

Trial-and-error is more sophisticated than that. You learn from other people's profitable endeavors and mistakes, and such information becomes profitable to release to others as well. Allowing avenues of discovery to occur through a market enables greater gains of trade--regarding organs, information, innovation, etc. You don't get similar outcomes with government, or with your non-market approach because you'll lack the market process and all that comes with it (e.g. overcoming the knowledge and incentive problems).

The argument being made isn't that government is perfect, or even that great. The argument is that the probable increase in efficiency of organ transfer that would be created by opening up the market, is not necessarily a net good thing for society. In fact, the point I made is that this very increase in efficiency would be at the expense of the worst off members of society, who could very well be taken advantage of in a way that leaves them worse off than when they started.

How so? I read your response, but it fails to demonstrate the worst-off would worsen--especially if they can get money for organs. Hell, they could even sell fetus/feti or whatever part is necessary for gathering stem cells, thus advancing that research by lowering the price of production. Talk about a long-term net benefit.

And as you deny the avenues of discovery, trial-and-error, innovation, etc. by prohibiting markets in organs, then you fail to gain all those benefits. You'll lead yourself to some other non-market approach which will hit similar outcomes as the status quo (because it fails to correct for knowledge and incentive problems, which are systemic with government planning).* *(if you reject the government planning part, but still reject a market in organs, then de facto, you'll support the government planning).

Some people get taken advantage of through nefarious marketing, but that's not the only thing occurring. Your response was "all cost, no benefit," which isn't a proper cost-benefit analysis. You're concerned about people being uninformed yet deny them the route which corrects being uninformed (no price signals).

"Market failures and abuses are always created when the choices that people make are too complicated for them to understand. "

Failure and abuses occur whenever choices are too complicated. This happens with governments, your plan, and markets, but the question remains: which system or mix of systems is best at handling this? The market process regarding organs.

"Capitalism works perfectly when we can assume that all humans are rational actors that understand the benefits and costs associated with any economic choice."

Sometimes, and that word "capitalism" needs to go. For example, there is the problem of uncertainty. Which system controls best for that?

"But the rational actor theory breaks down, as I'm sure you are aware, when the choices cannot properly be evaluated. Such is the case with a complicated medical decision like whether to donate a kidney."

The rational choice theory I adhere to is Misesian. Basically, people select the means which best attains their goals--to the best of their knowledge. With my framework, I'm not assuming perfect knowledge/information. Neoclassical economics does. (To be clear).

Given that there are constraints on gathering information on the margin, what system best handles this problem? Which delivers prices which more accurately reflect the value of information? Which enables entrepreneurs to profit from exchanging such information? The market process.

Without prices on organs, how do researchers and developers know which organ is highest in demand? You have queues, but that's not demand. This is a knowledge problem which isn't resolved through government prohibition of the organs market, nor can it be resolved through your non-market approach of voluntary donation.

"t is easy to envision a scenario in which poor people cannot get sound medical advice on whether they should be donating kidneys, and unsavory marketers take advantage of that to get people to donate who would not otherwise do so, given access to medical consultation. "

Do people on Medicaid and Medicare get sound medical advice? Do their doctors face the proper incentives which induce them to give the correct advice? Do they operate within a competitive environment, so that if they screw up, they lose their customers? I doubt it.

RE: marketers, fraud is a legal issue which should be punished by law. With the opening of markets, prices go down, and the black market shrivels, thereby freeing up government resources to deal with more important issues (e.g. fraud in the open market).

"There has to be not only a strong legal structure, but reasonable access to medical care, in place to ensure that the poor are not being taken advantage of in a way that leaves them significantly worse off as a result of the market."

This goes back to health care and health insurance, which is not the point at the moment. Also, "worse off as a result of the market." Again, Compared to what? Obviously, the mixed system with health insurance and health care is a crock. The government provision isn't convincingly great, nor is it viable in the long-run (e.g. look at those democracies running deficits, hitting their poor with inflation over decades, creating crap labor markets, shortages of services due to government-provided healthcare--e.g. Canada and most of Europe, etc.). Inefficiency worsens the poor, and you'll get plenty of it with more government control/ownership.

"Poor areas are the places where these will be least likely to exist, and income from an organ donation market isn't going to be the magic bullet that lifts these areas out of poverty."

It's no magic bullet, but it will certainly help. It would guide humanity in the right direction toward greater life expectancies, more income for the poor, lowered prices for research due to an increased supply, thus better long-term benefits; less deaths; less hospital bills for time wasted at the hospital while waiting for the right organ; more options for others to help their loved ones (easier to gather money than 1/6 of a kidney); more efficient categorization, dissemination, and transplantation of organs since there would be more exchanges occurring (add all those benefits, which offset the costs); economies of scale, etc.

An open market for organs would be better than the alternatives (government prohibition, which would come with your plan--even if you wish for it to be voluntary).

[Metsfanmax]

You can't legally sell organs although of course there probably is some exemption for a select few for very specific reasons. The prohibition denies voluntary contracts on the sales of organs, and I'm sure you'll agree that it does. That's what I'm talking about: the status quo.

It's fine if you wish to have some "give your organs for free when you die" program so long as it's voluntary. And since people can opt out, then I'm also completely fine if they wish to sell their organs upon their death or while they live. However, when I was arguing for a market approach, you reject it with your market failure argument, so I'll perceive that as support of the status quo or at the very least support of the prohibition against the market--which is the government-enforced, involuntary approach. (which of course gets people killed, shortens life expectancies, and denies the poor an avenue of income).

If you don't reject the government prohibition, then you inadvertently support it.

(I'm going to respond to this post only, and not get into the details of your second post quite yet, because I think a lot of it isn't directly applicable to what I say here. But I did read the post, and some of what is here is in response to it, and we can get back to its specifics if we need.)

You have framed this as a choice between two extremes: 1) have the government control who can donate kidneys and who can receive them, without the ability for people to enter into voluntary contracts or 2) let the market do its work in the proper allocation of kidneys from donors to receivers. It seems that you and I may start from different places in approaching a question like this. For me, the most important question to answer first is, what exactly is our goal here? There are two possible things to talk about when discussing an organ donation market. The first is the well-being of the recipients: only a small fraction (around a quarter) of those who need a kidney each year actually obtain one. So one possible goal is to increase the number of organs transplanted to sick patients. A second possible goal is to increase the economic well-being of those who choose to donate. The key issue here is that these two goals are not necessarily compatible. As mentioned, it is easy to envision a scenario in which we can successfully dramatically increase the rate of transplantations, but at the expense of uninformed members of society who would later regret their choices. Alternatively, though less likely, one could imagine a situation where we can pay large sums to those who would donate kidneys, but have this occur in a country with a healthcare infrastructure that cannot cope with the amount of organ donations. An obvious approach would be to look for a system that increases the well-being of both donors and recipients, but there is no guarantee that such a system exists in practice.

A key thing to keep in mind when discussing this issue is, as you correctly observe, what happens if we choose the status quo hypothesis. A lack of action is itself an action, as organ markets are illegal in almost every country in the world. As a result, there is a significant black market for organ trafficking. This helps us frame the debate, as it suggests that organs will be donated no matter what we do. As a result, legalizing and regulating the practice could well result in better outcomes for the poor; the Time article I linked suggests that there really are predators out there, looking to take advantage of the poor and uninformed. But this seems far from clear. Legalizing a practice and regulating it doesn't always mean that society will be better off as a result. I need only refer to cigarette smoking as an obvious example of what happens when the medical risks of a choice are unclear, and in particular are not immediate (since people do not generally do a good job of weighing future costs and benefits appropriately). A study about ten years ago of a few hundred Indians who sold a kidney on the black market demonstrated that most of them did so to help get out of debt, but a few years later 75% of them were still in debt and regretted having made the choice. Importantly, this is true regardless of whether or not the system is regulated or not.

If we just focus on the effects on the donors, perhaps a reasonable compromise is to have a government-regulated market instead of a free market for organ donations. This combines some of the most attractive aspects of both: it allows people to get paid for donating their organ, but hopefully mitigates the impacts that occur when shady businesses try to take advantage of people. This could be achieved with careful unbiased advice from physicians (and in particular, not the ones who are involved in the transplant itself). One country that has experimented with this is, oddly enough, Iran. They have been able to significantly shorten waiting lists for kidneys by implementing a system where the government gives a fixed donation to anyone who donates, and the donor and recipient can work out some additional price that is mututally agreeable. As with any real system, this is not impervious to market forces. But are the people who donate better off as a result? I just don't think we have enough research to answer the question. We need more studies like the Indian black market study linked above, if we really want to know. Perhaps a fundamental difference between you and I is that for any particular policy question, I am going to give much more weight to the specific empirical studies done rather than try to start from a theory-based approach (this is my scientist nature talking). I don't know how to effectively bridge that gap, because you probably give much more weight to the empirical evidence of market forces solving very general types of efficiency problems.

Moving away from the donor side, to the recipient side. I advocate an opt-out system of cadaveric organ donations. This would create a very large supply of organs for those who need them. All citizens would be signed up at implementation of the law, and should be able to easily opt-out if they would choose not to donate their organs at time of death. I would not then support the ability for people to engage in a contract to sell their organs at time of death (even aside from my previous points about wills, etc.), because I see this as just a free handout to people. If we want to give people handouts, we can come up with a better reason than that. The fact is, that people have no good reasons to care about what happens to their bodies after they exist, and allowing them to get paid for that, when the obvious solution is just to use their organs anyway, seems absurd to me. Now, I do want to respect freedom of choice (and politically, an involuntary donation system would be unfeasible), hence the opt-out part. But the effect could be huge. Countries with opt-out or presumed consent laws see much higher "organ donor card" signature rates than opt-in countries like the US; for example, of seven opt-out countries in Europe, the lowest rate of people registered to become organ donors on death is about 90%. While there are issues associated with this (for example, cadaveric donations are significantly more expensive than living donations), the pool becomes much larger, and this has the potential to swamp other effects.

But the bottom line here is that there is probably not a one size fits all policy. How much weight we put on the medical aspect of saving lives, versus the economic aspect of helping the poor, versus whether we prefer donations from living or deceased donors, will affect how we view this situation. We obviously want to consider the well-being of the sick patients first, but we cannot ignore the impacts this has on the rest of society.