By: Eunice Chon (Harvard University) | February 26, 2025
Economists are concerned about the chronic kidney shortage, and many support opening a market for organs (Mankiw). The projections look good; a reduction in costs for patients, previously waiting several years for a transplant and more kidneys available (Sumner, Mankiw). According to the principle of utility, compensating donors for their kidneys, leading to an efficient allocation of organs, is moral. But when examining this issue on the grounds of equality and dignity, inequities that ultimately introduce coercion in the most vulnerable populations and the issue of turning body parts into commodities greatly undermine the morality selling kidneys. Thus, the negative consequences from incentivizing supply and the consideration of kidneys as means to an end rather than ends in themselves prevents the organ market from being a moral exchange.
Opening a market allows inequities to factor into kidney donations, placing disadvantaged communities at higher risk for coercion. Inequality is a greater concern than overall utility because inequality compromises access to justice and basic services, preventing upward mobility for populations that need it most. For instance, “the impoverished or low-income would be more likely to donate organs for money, as $45,000 means much more to a poor person” (Sumner). This higher marginal benefit incentivizes poorer people to make decisions that others would not make, likely due to the health risks of donating. Such negative spillovers transcend our borders, for opening a market domestically would exacerbate overseas organ-trafficking markets rooted in coercion, which is intolerable. An example would be kidneyvilles in India, where husbands pressure their wives to sell their kidneys, and one camp outside Chennai held “80 women with foot-long scars across their abdomens” (Carney). Compensating the poor will not be an economic equalizer because these donors would not expect to receive a kidney should they need a transplant: “the human tissue always moves up — and never down — the social hierarchy” (Carney). The government’s price ceiling on kidneys regulates supply but also prevents wealth from influencing transplant waiting lists. Once a market opens, one could reasonably speculate that the rich will find ways to move up transplant lists with their willingness to pay, preventing poor people from accessing kidneys. Unfortunately, monetizing kidneys will result in a plethora of negative consequences that worsen inequities – not improve them.
Another concept of morality compromised is the principle of dignity, for it is unethical to turn the human body into a commodity (Sumner). Even if public opinion on what’s purchasable changes, it would not justify how the flesh is “regarded merely as means . . . [rather than] be esteemed as an end.” An extreme illustration would be surrogacy “baby factories” in India, where “women were housed under lock and key” as “virtual slaves under the doctor’s perpetual surveillance” (Carney). Criticisms of undue restrictions on bodily autonomy and privacy introduce a Libertarian argument, though other Libertarians may view the organ market as an opportunity to profit based on choices for their own bodies. But the issue goes beyond individual agency, for a price tag on what is priceless violates the categorical imperative. Kant defines dignity as an intrinsic “unconditional incomparable worth,” for “whatever has a value can be replaced by something else which is equivalent.” Kant’s argument provides a solid moral basis requiring some nuance to defining the boundaries of dignity. What makes selling kidneys an infringement of dignity compared to profiting from hair, plasma, breast milk, sperm, or even photographs of the body, is not irreplaceability, but rather irreproducibility, an inability to regain the status quo preceding the intervention. The human body as an end, or bottom line, emphasizes the finiteness of the flesh,[1] and undermining an intrinsic dignity of an individual and the kidney by assigning a value is unacceptable for disrespecting each priceless, irreproducible, bespoke body.
Diverging from individual rights and dignity, utilitarians compellingly argue: an organ market will save lives and end the kidney shortage. The price ceiling of zero causes a shortage, encouraging prospects of a competitive market, in which price is determined by supply and demand (Mankiw). Taxpayers save thousands of lives and $12 billion a year, and “the net benefit from saving thousands of lives each year and reducing the suffering of 100,000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3″ (Sumner). Libertarian market fundamentalists believe that the market will function well by itself, and if there is inequality, governmental policies are responsible. However, correctionary policies would regulate their “free market,” making this argument inconsistent and unrealistic- considering American history of systemic oppression. Price set by supply and demand is implausible when price can become unreliable as the global market, including black markets abroad, gains share of the supply. Inequality will escalate, for which a free market has no solution. Underemphasized in these utilitarian arguments is the individual as an end with rights and dignity that should not be compromised. Mankiw calls the second kidney “an extra organ that we don’t really need,” but just because a person can live without one does not mean that it should solely become a means to an end, commodity, or lesser in dignity compared to the heart or brain. The human body is not an exchangeable good, and ultimately, leaving organs in the hands of something as arbitrary as price in a capitalistic system that is far from perfect is immoral.
A common objection to utilitarianism is the lack of acknowledgement of uncompromisable, inherent rights. The question of fairness complicates this argument with disagreements over what those rights are. Many consider health, particularly access to healthcare, a right, which implies that people have a right to a new kidney should they require one. The principles of utility are compelling, and this paper does not object to the frustration of a kidney shortage. However, right to healthcare does not include the entitlement to someone else’s kidney. Thus, issues of inequities and individual dignity faced in an organ market trump the concern of the shortage itself. The kidney shortage is concerning, and there is no denying that more people donating will increase utility. However, making a kidney a commodity infringes on both consequential and categorical moralities because monetary compensation for kidney donors would exacerbate inequalities riddled in our domestic and global capitalistic system and diminish the dignity of each body by placing a price tag on an irreproducible organ.
Works Cited
Carney, Scott. “Opinion | If You’re Willing to Buy a Kidney, You’re Willing to Exploit the Poor.” The Washington Post, WP Company, 28 Oct. 2021, https://www.washingtonpost.com/news/in-theory/wp/2016/01/04/if-youre-willing-to-buy-a-kidney-youre-willing-to-exploit-the-poor/.
Kant, Immanuel. “Transition from Popular Moral Philosophy to the Metaphysic of Morals.” Groundwork for the Metaphysics of Morals, 1785.
Mankiw, Greg. “The Kidney Shortage.” Greg Mankiw’s Blog, 15 May 2006, http://gregmankiw.blogspot.com/2006/05/kidney-shortage.html.
Sumner, Scott. “Opinion | The Moral Case for Paying Kidney Donors.” The Washington Post, WP Company, 28 Oct. 2021, https://www.washingtonpost.com/news/in-theory/wp/2015/12/30/the-moral-case-for-paying-kidney-donors/.
[1] Finiteness, as in kidneys not being considered an infinite input to be extracted, such as the environment.