Should We Be Able to Buy and Sell Organs?

This commentary, by Donald J. Boudreaux, chairman of the Department of Economics at George Mason University, suggests setting up a market in human organs for transplantation. To promote his proposal, Boudreaux applies a false reductionism to the reasons for opposing organ markets, writing: "There are surprisingly few good economic reasons offered in defense of the U.S.-wide prohibition on the purchase and sale of transplantable body organs. By far the most common argument against a freer market for transplantable organs is an aesthetic one: Commerce in body organs seems icky."

Libertarians always seem to judge matters of morality in economic terms, which in my view should usually be way down the list when analyzing ethical issues such as this. Moreover, subjective "ickyness" has very little to do with it. Indeed, prohibiting organ markets is important to maintaining an ethical health care system.

First, permitting organ buying and selling would further the ongoing commoditization of human life. We already see destitute people from countries like India or Turkey selling one kidney so that their child can go to school or have surgery. Right now such transactions are "black market." Formally sanctioning markets in organs would open the door to a neo colonialism in which the "natural resource" mined by the rich would not be timber or copper ore, but body parts of the poor.

A second, and clearly related issue, has to do with the unfairness of a market system in organs: In such a system, only poor people would sell, and rich people buy.

Third, the current triage system would implode. Right now people are willing to stay in line to receive organs because it seems to be run fairly. In other words, who receives an organ is based on need and compatibility of the tissues, not personal resources or power (Mickey Mantle notwithstanding to the contrary). Changing the system to include markets would undermine the current approach badly. In short, if markets came to prevail, it could open the door to a free for all.

Fourth, if a seriously ill person could be seen as more valuable dead than alive. This fact could easily influence the care decisions made about potential donors.

Professor Boudreaux makes a classic libertarian argument. But libertarianism can easily slouch into social Darwinism. In my view, creating an organ market would push us in the exactly wrong direction.