Sweet, wasn't expecting so many responses.
jules.lt wrote:Putting organs on the open market increases the mortality in poor people because of the increased number of surgical operations and decreased number of functional kidneys in poor people.
That that poor will be disproportionately affected in a negative way applies to a myriad of other markets, but our initial response isn't to outright ban them. Rather, we impose regulatory and oversight mechanisms designed to surgically root out the less desirable behaviors that mar what can otherwise be a perfectly legitimate, voluntary system. If our concern is poor people being exploited, we can just as easily set a salary floor - a minimum income - for organ donors. We could similarly impose other restrictions: you must have a college degree; you must be currently employed, or employed for a certain period of time; and so on and so forth.
It is also worth noting that, due to their poverty, people in lower socioeconomic classes are not in very good health, whether due to lack of medical access or simply indulging in drug and alcohol abuse which is more prevalent within poorer circles. While this is generally lamentable, in terms of organ donation, this already trends towards disqualification for organ donation. There is a standard set by medical practitioners and by those who are seeking organs which requires the donors to meet minimum health criteria. This, too, functions as a more natural hurdle towards the poor becoming organ farms for the wealthy.
As for the concern over the wealthy dominating the demand market, the question here is acquisition, not allocation. We can impose a good many ways to distribute these organs. We could, for example, let the state purchase the organs at a given price, and then distribute under any other kind of criteria. Some examples: market, lottery, egalitarian -- just to name a few. (See:
Lloyd Cohen's body of work.)
There is also the issue of black markets. The poor, unfortunately, receive the short end of the deal in virtually every arena in which they participate, and black markets are no joke. Far better to legalize organ donation and let individual donors of every stripe receive the medical and safety regulations, as well as compensation, for their organs than let them
definitely be exploited in the underbelly markets.
I realize this raises a follow-up question, so allow me to attempt and address it now: if behavior in black markets is purportedly so corrosive, why should we legalize it? Perhaps it would be better to continue creating incentives against engaging in this behavior.
The distinction here is that it is the illegality that deters "good" people (for lack of a better word) from engaging in this kind of transaction. Most people do not want to break the law, and these are the kinds of people who have the ethical framework that makes them desirable and safer with which to work. Market liberalization encourages these honest and conscientious agents to enter the market and work within the legal framework. Moreover, the
visible repeated interaction with these businessmen and women creates the incentive to engage in good business practices. I am not saying that this creates a market in which angels operate, merely that it encourages
typically honest middlemen and brokers to work in a market that is otherwise left to rogues - the sort who would deign to work underground on exploitative terms - and likewise results in visible behavior that is subject to sanction if one behaves as a deviant.
As for my own opinion, there is a point I don't think I've seen brought up yet. Currently, organ acquisition largely operates under the
rule of capture, meaning that whatever hospital harvests the organs gains dominion (property rights) over them. However, they cannot sell these organs to other institutions, so the only real way for hospitals to benefit from this acquisition is to transplant these organs themselves. It sounds good in that it creates professional opportunities for those involved, but it also creates the incentive for hospitals to
hoard organs rather than share them with those who have more need for them. Taking a more liberal approach to the organ market would more closely align this need with supply.
