Why You Should Be Able to Sell Your Kidney
By James Mackintosh
Javier Milei won the Argentine presidency with a promise to rip up the state, dynamite the central bank and ditch the peso for the dollar. All are controversial, but none so controversial as his belief that there should be a legal market in human organs.
The yuck factor led him to play down his views as the election neared, but trading in organs is one of the most interesting libertarian ideas— and regarded with horror by critics, who see it as the purest form of dystopian capitalism. There are two compelling reasons to allow people to sell their organs, while the counterarguments tend to overlook the basic question of economics: What is the alternative? The cases for and against putting a price on kidneys go to the heart of the debate about capitalism.
For: Freedom
I own my body, so if I want to sell part of it, that’s up to me. I have the right to injure or kill myself—at least in most developed countries—and I have the right to donate a kidney for altruistic reasons. Why can’t I sell a kidney? This is also the political argument for capitalism, espoused by Friedrich Hayek and Milton Friedman: Government direction of the economy crushes individual freedom, and political freedom becomes impossible. The default position for individualists should be that a mutually agreed exchange is fair.
For: It works better
We celebrate altruistic donations of kidneys to save lives, and many countries use “nudge” tactics to encourage after-death organ donations by requiring opt-outs, rather than opt-ins. Yet the U.S. waiting list for a kidney is three to five years, and in the U.K. is two to three years. There’s no match between demand and supply because the supply is restricted by artificially keeping the price at zero. Raise the price, and the supply will rise. Exactly this has happened in the world’s only legal market for kidneys, in Iran, where there’s no waiting list and kidneys sold for about $4,000.
For: Legalize, regulate
Even if morally repulsive, if a black market in kidneys is going to exist anyway, maybe it’s better to have it regulated and done properly. The case against is that it’s inhumane to remove someone’s kidney for money. Beyond the ickiness, this breaks up into several aspects:
Against: Bad incentives
If there’s an open-market price for kidneys, it would encourage their theft from unwilling or uninformed donors, a particularly nasty crime. This, of course, is the reason to regulate; there’s a free market in donated cadavers in the U.S., but no one makes the case that people are killed so the murderers can sell the body parts, because of the penalties for murder. These incentives are arguably worse in the black market for kidneys; a Nigerian senator imprisoned in the U.K. this year for attempting to buy a kidney from a poor victim promised a price equivalent to thousands of dollars, while providing little information about the health effects. Even for donations, incentives can be unpleasant, with family members subject to extreme moral pressure to donate.
Against: Abuse of power
In a free market, the trade would almost certainly be kidneys from poor people being sold to rich people. This is abhorrent to many, an example of social inequality invading the body. Yet the same goes for almost everything in life, including health. Life expectancy for the richest 20% of men in the U.S. is 12 years longer than for the poorest 20%, while the rich can afford better healthcare. We try to mitigate some of that via Medicare, and there’s nothing to stop Medicare buying and distributing kidneys too, so the trade would be from poor people to other poor people, via the government.
Back in Argentina, Milei will have much more to worry about than markets in human organs. The rest of us should try not to be repulsed by the idea, and give it serious thought.
Javier Milei supports a legal market in human organs. NATACHA PISARENKO/ ASSOCIATED PRESS