The kidney market debate: a retrospective on Becker and Elías

Should body parts be bought and sold? In an important paper, Becker and Elías (2007) argue that markets should be used to allocate human kidneys, and they introduce a modified supply and demand model for analyzing how paying for organs could save many tens of thousands of lives. Setting up markets where moral norms against markets were previously operative, however, can unleash unintended and undesirable ethical quandaries. This chapter argues that the narrow economic lens needs to be supplemented with an understanding of the broader ethical landscape, which includes a pluralistic three-dimensional analysis of virtue, duty, and outcome-based ethics. What Becker and Elías propose ultimately turns out not to be a market at all, but a highly regulated and paternalistic authority that guards against low pay, seller irrationality, and seller preference reversals. Becker and Elías do not worry about motivational crowding out, a key concern of many ethicists. The strongest critique of their analysis is the omission of any discussion of incentives for the influx of organ sellers from desperately poor nations. What might move the kidney debate forward, therefore, is for economists to see compensation as part of a larger ethical ecosystem. Economists can do a better job of analyzing controversial public policy issues by using elements drawn from virtue ethics, deontology, and consequentialism.