Virginia Postrel is Mad

No one is more familiar with the ethics of organ donation than Virginia Postrel so when she says that the National Kidney Foundation is behaving reprehensibly you can be damn sure she is right.

The National Kidney Foundation
is behaving reprehensibly, especially given its mandate. When I first
got interested in organ donations, I naively thought that the
foundation would be in the business of doing everything possible to
encourage kidney donations. I was terribly wrong. The group vehemently,
and successfully, opposed a bill that would have allowed tests of incentives for organ donors. (CEO John Davis brags
here, scroll to second item.)

So determined is the NKF that kidney donors should never, ever, in any
way be compensated for their organs–no matter how many kidney patients
current policy kills–that the organization is now trying to stamp out public discussion of the idea. When they heard that AEI is planning a conference
on the subject for June 12, they wrote a letter to AEI president Chris
DeMuth suggesting that the conference shouldn’t be held. The letter
from NKF chief Davis (PDF available here) opens:

The officers and staff of the National Kidney Foundation (NKF) were
surprised to learn that AEI has scheduled a forum entitled "Buy or Die:
Market Mechanisms to Reduce the National Organ Shortage" that will be
held on June 12, 2006. …we believe that the concept of financial
incentives has been adequately debated for 15 years, begining with the
National Kidney Foundation’s 1991 workshop on "Controversies in Organ
Donation," and culminating in the definitive Institute of Medicine
(IOM) report that was issued late in April 2006. We don’t see how an AEI forum would contribute substantively to debate on this issue. [Emphasis added.]

In other words, "We’d like to maintain our monopoly on the policy debate, so please shut up."

…For more background on the policy debate, see previous posts here, here, and here. Marginal Revolution blogger and GMU economist Alex Tabarok takes a detailed look at incentives here.


The ‘kidney for sale’ debate enters territory that people are uncomfortable with. Most people view the body/life/health as a sacred matter much like religion is. Debate the existence of God and see how far you get. We haven’t evolved sufficiently.

I am pleased that this discussion will occur. For years I have maintained that there should be markets in blood and organs. Few were willing to discuss the possibilities and many seem angered by the idea.

I'm not sure what to think about the inequality indignation (in fact, it perplexes me in many other areas of policy as well; maybe because I am a white middle class kid living in California?) but can you not just look at things the same way you do sweatshops? Why stop these people from giving the only thing they have to contribute because the result is not up to your personal standards? Would you stop a quadraplegic from working at $5 an hour?

People's instinctive reaction to the selling of bodily components seems to be based on concern for the seller. I don't know whether this is a health issue or an instinctive revulsion to selling body parts, but I don't understand it. Where is concern for the seller in other transactions? If I want to sell my house, is the government going to make sure I have somewhere else to live first? Moreover, presumably any legal sale of organs from a live donor would include a serious informed consent stipulation, which should take care the health issue - after all, people are allowed to compromise their own health by smoking and eating too much McDonalds - and the revulsion to selling body parts is illogical since (a) selling sperm and even eggs is permitted, and (b) *giving* organs is allowed.

This reminds me of prostitution. I, like many people, earn my living by selling a portion of my mental output. Others earn their living by selling a skill or talent they possess, such as the ability to create music or tell stories. Some people earn their living by selling what their body can do: run fast, or hit home runs, or look good on television. The only thing that makes selling sex different from selling public speaking appearances is that many people feel that they personally would hate doing it. Well, I would hate mucking out horse's stalls all day, but that doesn't make it unethical for someone else who either likes it better or has fewer choices than I to make their living at it.

Paul Dietz,

A good question. Some people don’t view body/life/health as a sacred matter and are willing to put a price on such things, which disturbs a large part of the population and thus you have government intervention.

Moreover, gov’t is tasked (rightly or wrongly) with protecting human life – another reason for it’s intervention.

Over half of the 92,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.

There is a simple solution to the organ shortage -- give organs first to people who have agreed to donate their own organs when they die.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. About 60% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. They do this through a form of directed donation that is legal in all 50 states and under federal law. Anyone can join for free at or by calling 1-888-ORGAN88. LifeSharers has 4,510 members, including over 400 minor children enrolled by their parents.

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