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Peter Jaworski Ph.D.
Peter Jaworski Ph.D.
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New Book Examines the Moral Economy

A Persuasive Argument to Monetize Donations of Blood, Plasma, Kidneys

In Iran, but nowhere else in the world, it is legal to sell one of your kidneys. Closer to home, you can sell your eggs or sperm for fertility treatment. You also can sell your blood or plasma here in the United States, but not in Canada. Late last year, the Ontario government passed legislation to prohibit paying and receiving payment for blood and plasma.

The thought of markets in special things like blood, plasma, eggs, sperm or kidneys turns many people’s stomachs. For some, the idea of exchanging something profane, like money, for something sacred, like blood, is repugnant or noxious. In my book “Markets without Limits,” written with my Georgetown McDonough colleague Associate Professor of Ethics Jason Brennan, we argue that anything you may permissibly give away for free, you may permissibly sell. Markets and money do not introduce moral wrongness where none was present. This is as true of shoes and widgets as it is of special things like blood and kidneys (and sex, but we won’t talk about that here).

In “Markets Without Limits” we consider how sometimes, people are simply repulsed by the idea of mixing the sacred with the profane. Other times, however, the worry is different. For example, the Ontario government cited worries about the quality and quantity of blood as primary reasons motivating their decision to prohibit blood and plasma markets. Canada had a hepatitis-C outbreak on account of blood transfusions, mostly from compensated blood donations from prisoners in the United States. When we incentivize through payment, they reasoned, we encourage people with “lower quality” blood to donate. However, advancements in screening people and their blood have made this concern almost entirely moot.

But they also expressed worries about lowering the quantity of donated blood. Here, they relied on work by social psychologists, especially self-determination theorists, which argues that, sometimes, when we pay people for doing something, they will do less of it. In a variety of contexts, when we offer an external incentive -- like money, but also praise or grades -- it can result in undermining our sense of autonomy, and thereby lead to less of the desired behavior. Now known as the undermining effect, this phenomenon also has been called the over justification effect or the crowding effect.

Ontario made use of it in justifying the legislation, but so do many others, including, perhaps most famously, political theorist Michael Sandel in his recent book “What Money Can’t Buy.” But this simply ignores that there are different ways of designing a compensation system and different ways of having a market in sacred or special things. If we had a sign that read, “If you donate blood, we’ll give you $25!” then it might undermine autonomous motivation. Instead of doing that, however, why not offer to make a contribution to the charity of the blood donor’s choice? Instead of paying with cash, how about a gift card or a tax credit or a day off work?

Economists have experimented with precisely these kinds of markets and, thus far, have found that donations increase with offers of compensation—the higher the monetary value of the reward offered, the more people who will donate blood. The undermining effect is not a reason to avoid having a market in sacred things, it is a reason to be careful about how we design markets in sacred things. After all, when it comes to kidneys, blood, and plasma, lives are at stake. And what is more sacred than life itself?

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About the Author
Peter Jaworski Ph.D.

Peter Jaworski, Ph.D., is a professor at Georgetown University's McDonough School of Business.

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