Pssst, Wanna Buy a Kidney?

It’s become a truism of the digital age that one can purchase almost anything online. But there are still many goods and services that cannot be legally bought and sold. Dealing in these so-called “repugnant” markets, such as prostitution and illicit drugs, is often prohibited for moral reasons. Yet there are some banned goods for which a market mechanism could actually help solve societal problems.

Case in point: human kidneys. While the demand for kidney transplants among individuals with acute renal failure far outstrips the supply of donated organs, lawmakers and many citizens still balk at the suggestion that the shortage could be alleviated if individuals were allowed to sell their kidneys.

The repugnance about trade in human material isn’t limited to kidneys, notes Nicola Lacetera, a professor of strategic management at U of T Mississauga and co-author of a recent international study on repugnant markets. In most countries, for example, people cannot be paid for giving their blood or plasma. But, Lacetera adds, the repugnance isn’t so strong that it prevents the use, in Canada, of plasma imported from the U.S., where payment is legal.

Lacetera’s study concluded that if consumers receive specific information about the benefits of establishing a price on “repugnant” items, they are more likely to support the existence of those markets. He and his study co-authors conducted two experiments involving surveys, which asked U.S. residents specifically about prostitution and kidneys.

“We wondered what would happen if we gave people more information about how these payments would work,” Lacetera says. “Or asked people how they could overcome [their] aversion.” Researchers have estimated that if the price for a transplanted kidney is in the $30,000 to $50,000 range, the price would appeal to enough qualified donors to drastically reduce the shortage of suitable organs. When respondents were provided with the additional information, and the result, their distaste for the idea ebbed. “The baseline support goes up when there’s additional information.” Still, 30 per cent of respondents remained opposed. (In the case of prostitution, some respondents, especially women, became even more adamant with their objections after receiving additional information about the benefits of a regulated sex trade.)

Lacetera also debunks the notion that there’s currently no economic activity associated with kidney donations. Even if there’s no price tag on the organ itself, the medical procedures associated with a transplant produce earnings for surgeons and other health professionals. “They’re all compensated for performing a transplant and that’s considered OK.” He points up a discomfiting contradiction in current practice: “If some of that money goes to the donor, then it’s not OK anymore. One might even argue that not paying donors is even less ethical than paying them.”

It might be possible to further shift public attitudes if regulators took steps to design the market in such a way as to directly confront qualms about coercion, medical safety and perverse incentives – specifically, the prospect of very poor individuals either offering up, or being pushed to donate, their organs simply to survive.

“But the moral opposition may still persist even if these issues are addressed,” he admits. “Economics can help us understand the trade-offs people make between their understanding of the value of a transaction and their moral beliefs. But we also need insights from a broad range of disciplines, including ethics and psychology, to fully understand the nature of these beliefs.”