What’s the price of a kidney? How much would you need to be paid, in order to give one up? Or, if you were in need of a kidney, how much would you be willing to spend on it?
For many people, these are uncomfortable—even unconscionable—questions to ask. The idea of monetizing a human organ seems strange and intuitively wrong. And that uneasiness comes from a well-intended place, one that says it's impossible to put a price on life.
And yet I’m going to suggest that we do ourselves a disservice in refusing to consider questions of this nature. I recently read an article by Sally Satel, on the issue of organ donation, and the broken donor system in the United States. Satel notes that the organ shortage is so dire that 101,00 people are currently waiting for donor kidneys, and 12 people die each day having never received one.
A new bill, proposed by Congressman Matt Cartwright, seeks to change the failing state of the donor system. The Cartwright measure would allow researchers to collect data on what happens when we actually decide to reward people for heroic acts of generosity (namely, giving up an organ)—something that is illegal at the moment.
Opposition to the bill comes from both sides of the political spectrum. People on the left tend to reject the idea of compensating donors, often on the grounds that such a policy would exploit the poor, whose lives are of course just as worthy as those of the wealthy. The religious right also object, arguing that we simply can't place a value on life, no matter whose it is.
Both concerns stem in part from something psychologists call a taboo trade-off: the revulsion we feel at attempting to monetize things that, normatively speaking, we typically think of as being invaluable. Studies show that people of many different political stripes feel greater moral outrage at the thought of monetizing organs and body parts, as opposed to things like paying a doctor for medical care (incidentally, in an age of political polarization, this seems to be one of the few issues where the left and the religious right end up as strange bedfellows).
But in clinging to the purity of our positions—that we can’t put a price on certain things—we may inadvertently create more harm than good. For example, in some ways, the current organ donation system actually privileges the wealthy at the expense of the poor; finding a volunteer donor becomes somewhat easier when one has the benefit of a vast and powerful social network. And indeed, Satel writes that currently the poor, "are less likely to be referred for transplant, more likely to die on dialysis, and less likely to receive an organ from the national pool even when they are referred."
There is also the plain fact that voluntary donors represent the best that society has to offer. These are people who take time away from work and their families, and who give up their organs via painful (and yes, sometimes risky) operations, all to benefit someone else. They should be recognized and rewarded for their profound generosity.
The Cartwright measure would pilot a responsible compensation program. The key here is responsible; the bill includes several safe-guards to protect against abuses of the system. For example, recipients would not compensate donors directly (which would grant the wealthy better access to organs than the poor). Rather, the government would provide donors with things like income tax credit and tuition vouchers (Satel notes that funding for the initiative might come from the money that the government would save in no longer having to pay for patients' dialysis). Potential donors would also be screened for signs of emotional or financial distress—either of which may be associated with impulsivity. And the process itself would be drawn out, perhaps with a waiting period, in order to give potential donors time to make thoughtful, informed decisions.
Of course, we can’t say for certain how the Cartwright bill would play out, because we’ve never tried something of this nature. We’re stuck in a cyclical quagmire where our moral intuitions (putting a price on an organ just feels wrong) prevent us from collecting any data on the benefits or risks of such a policy—and the lack of data allows our moral intuitions to continue to prevail. We're feeling around in the dark.
But what is clear is that the current system is badly failing us, and people die every day waiting for organ transplants. The Cartwright measure proposes a prudent alternative to the status quo that would at the very least provide us with data, which we can use to make informed policy decisions. We owe it to people on the transplant list, and to people who might end up on the list in the future, to overcome the sanctity and purity of our ideological positions and to do what we can to better the system.
Satel. S. (2016). A College Tuition Payment for Your Spare Kidney?
Tetlock, P. E., Kristel, O. V., Elson, S. B., Green, M. C., & Lerner, J. S. (2000). The psychology of the unthinkable: taboo trade-offs, forbidden base rates, and heretical counterfactuals. Journal of Personality and Social Psychology, 78(5), 853.