Should there be a legal market for the transplant of kidneys from live donors? If so, what form should this market take? If not, how should the shortage of kidneys for transplant be addressed?
First I am going to argue that that a upholding the right to self-ownership should be a justification in allowing for an unregulated legal market for the transplant of kidneys from live donors.
Second I will explain how the negative externality that would occur due to the existence of a new market for live kidneys, would create a decrease in the welfare of society through behavioural effects in other similar markets. I will counter this argument by explaining that there would be an overall net gain in utility received by a variety of agents in society (This analysis would be done in isolation/exclusion of a right-based justification).
Finally I will explain the framework of what form this market should take. Even though I may have indicated it should be a free market from the first paragraph, I will argue how immoral circumstances that could occur from the commodification of the kidney on an unregulated market, would create a strong justification to have certain regulations enforced by the government.
The prevention of any legal market for the transplantation of live kidneys undermines the right of self-ownership. Rights can be defined by a universally held entitlement that all humans hold and by which they can exercise certain claims on other agents in upholding these entitlements. I want to focus on Negative rights which are usually compromised of the following: if agent A holds a negative right (to not be prevented in wilfully taking part in market transactions involving goods under their own self ownership) it prevents an agent ‘B’ (Government) from carrying out a certain action ‘Y’ (Legal prevention of monetary transactions for goods under self-ownership) which would otherwise interfere with individual A. Such a right would centre its justification on moral and freedom based reasoning that an individual should be able to participate in any market transaction of a good that he/she owns and any such prevention to do so would violate an individuals’ right.
This is as ownership of a good entails the owner to have power over access to its exclusive use and the ability to freely pass ownership to another agent. Therefore to block the existence of such a market would unfairly limit the freedom of an individual who wishes to exercise ownership powers (assuming individuals are the rightful owners of their own bodies) and therefore weigh unfairly against individuals who have a preference for the existence of a kidney market. This shows that upholding these rights is important when considering the effective freedom available to all individuals and values their autonomy in respect to their desired preferences.
A negative externality is a cost faced by a third party agent due to an economic transaction. In this case the increased participation of individuals willing to supply a kidney in exchange for a monetary gain would dilute the value that society places on the contribution that altruistic behaviour makes in society (an altruist believes in selfless behaviour and incorporates the welfare of others positively as a function of their own utility).
This is as preventing the exclusivity of having only altruistic donors for a certain organ, would cause society to perceive a downward bias on the true positive effect created by altruistic behaviour. This occurs due to the distortion created by the large benefits of having a market for kidneys, which clouds the true value of virtuous selfless behaviour that drives the supply of altruistic donations.
This would therefore cause a decrease in the number of altruistically driven donations for the organ market in general. This is as individuals that participate in altruistic behaviour take into the consideration the value that other agents place on such behaviour. This is in order to decide whether acting altruistically would not only satisfy their altruistic preference but also bear an increase in satisfying other personal preferences that are not altruistically related. Such as the way others view them as virtuous and vital additions to the benefit of society.
The presence of a market provides the opportunity for a donor and recipient to take part in a transaction that better improves the utility of both individuals (by capturing dead weight loss) assuming they both place heterogeneous values on the kidney (e.g. the donor values his kidney at £1000, yet receives £1200 and the recipient values the transplant of the kidney at £1500 yet only pays £1200). Such an exchange would lead to a Pareto improvement in terms of utility, which is defined as the movement towards an alternative state in which no one is made worse-off and at least one person is made better off; if such a state does exist. The absence of a market in this case would lead to a dead weight loss, due to the lost producer and consumer surplus (Difference between value of the good and price paid/received for it) which would have been captured were the market exchange of the good permitted.
In the U.K. kidneys are viewed as market inalienable, in other words the good cannot be transferred between agents that involves an exchange of resources and can only be provided as a gift (gift alienable).
I believe the shortage of kidneys available in the U.K. (6,500 people are on the waiting list for a kidney transplant) is due to the fact that the supply of kidneys is restricted to those individuals that wish to exhibit altruistic behaviour. The altruistic behaviour in this sense would be the act of donating a kidney for the purpose of improving the welfare of the recipient.
I believe that the introduction of a legal market would increase the number of individuals willing to exchange a live kidney, this is as the benefits (satisfaction of both monetary gain participating in altruistic behaviour) of donating a kidney to an individual would outweigh the costs associated with the exchange of a kidney for more individuals than was previously occurring when the good was marked as only gift alienable. The relevant costs include the value of time lost, the cost of bearing pain during the procedure and finally the value placed on the marginal loss of optimal health due to having one kidney (all in monetary terms).
The consequence of an increase in the supply of live kidneys available for transplant would lead to a direct decrease in deaths and patients with kidney related illnesses. Due to the intrinsic and instrumental value placed on life, a decrease in deaths would be of the greatest benefit to society in a utilitarian sense.
When viewing the market for kidneys in isolation in terms of net utility gain (excluding the right-based argument), the decrease in utility attributed to the loss in donations from exclusively altruistically motivated behaviour, is not sufficient in preventing a market in live kidneys due to the larger increase in benefits created by the existence of the market.
The need for a regulated market will be exhibited by the moral concerns that would be raised in the presence of a free market. Morality has an importance in this market due to the innately positive (power that the kidney has in maintaining the life of an individual), special (due to the importance of its function in the human body) and sacred (as it is naturally occurring and not man-made) nature of the kidney. These characteristics provide a basis by which the demand and supply of kidneys should not be exclusively decided by characteristics that are independent of any moral significance.
Equitable concerns, involves an unfair and skewed distribution of the recipients who receive available kidneys for transplant due to the level of heterogeneous purchasing power attributed to each individual in a free market. Those who have a high purchasing power would first dominate the demand for live kidneys, as they are able to offer higher monetary gains as a method of being the first to receive a kidney from a willing donor. The free market would therefore disregard the true need of receiving a kidney in terms of health related factors. This would be morally unjust due to the fact that some individuals may face a greater need to receive a kidney but do not obtain one due to financial inequalities that are created by factors that are out of their own control (such as a natural disaster causing all of an individuals financial resources to be destroyed).
I propose that the government should control which recipients receive the available kidneys that are being offered for transplant. This is as a single agency would be better able to order the levels of need of a kidney transplant exhibited by individuals due to a more transparent method of monitoring the need of a kidney transplant. This would be done by using a single set of conditions; such as the level of the severity of the kidney related illness faced in terms of pain, estimated time till kidney failure, time spent on the waiting list and ability to lead a normal life.
Immoral circumstances would occur through the exploitation of vulnerable individuals who are more susceptible to participate within the supply of such a market due to financial constraints.
In other words it would be morally unfair to have an unregulated supply of live kidneys. This is as individuals who are in a position of poverty due to no fault of their own would be more predisposed to accepting a monetary payment for their kidney which is incredibly lower than the monetary value that what they would normally accept, had they not been in poverty. This therefore creates the basis for having a regulated supply, due to the fact that individuals can be placed in a status of poverty due to reasons that occur independent of their own choices, that causes them to accept a considerably lower monetary payment in exchange for such a highly valued good.
To prevent this the purchase of all kidneys should be conducted by the government at a fixed price level to ensure that those faced with severe financial constraints receive at least a significantly improved outcome compared to a free market. This would also safeguard fluctuations in cost that may unfairly out-price individuals from purchasing a kidney, those that are still unable to purchase the kidney at the decided fixed cost would be able to receive a subsidy from the government. This subsidy would be financed and based on efficiency gains. Currently the average cost of dialysis is £30,800 per patient per year and the indicative cost of a kidney transplant is £17,000 per patient per transplant. The saved costs from having an increase in kidney transplants and decrease in dialysis treatments would create a positive externality in freeing up resources to be spent on other publicly provided goods, as well as subsidizing those that cannot afford kidney transplants, therefore creating an overall positive gain in terms of utility for society.
Due to the right-based justification, I believe that a market for the transplant of live kidneys should exist. The degree to which this right of self-ownership is sustained may be lower than that required by the absoluteness of rights. This is due to the regulation that has to be put in place to prevent the immoral mechanisms and consequences that drive and occur from demand and supply of such a good. This large moral weight attributed to the commodification of the kidney case arises due to the unique characteristics that such a good holds. I believe it is therefore important to create a balance (trade-off) between sustaining the right of self-ownership and maintaining a high regard towards morality by having a regulated market for the transplant of kidneys from live donors.