Sunday, 18 December 2016

Time to stop the abominable illegality of kidney markets



Do you like the ambiguous title? No, I don’t think illegal kidney markets are intrinsically abominable. Insofar as they are abominable in various respects it is entirely a further consequence of the abominality of making them illegal. The abominable politicians who passed the law and sustain the law are to blame for thousands of deaths every year.
A fundamental argument for a market in kidneys is that they’re my kidneys and it’s up to me what I do with them, so keep your nose out of it. I would also direct you to an earlier argument of mine based on the ultimatum game, in which I show that if it is true that the offers in that game should be fair, then failing to pay donors for kidneys is unfair. http://blog.practicalethics.ox.ac.uk/2010/10/kidneys-and-the-ultimatum-game/ But perhaps you’d prefer an argument based on better consequences. Let me give you one:

Economists Gary Becker and Julio Elias have come up with an estimate for the price and supply of kidneys in a free market that strengthens such a case here. Figures about UK are from here.

To simplify the figures somewhat, at the moment for 6 people needing a kidney transplant only 1 kidneys is available. Because people die while waiting the average waiting time is roughly 5 years. Furthermore, living on dialysis while waiting for a kidney is itself a very impoverished life involving not only the suffering of undergoing dialysis but also little energy to live normally. The middle aged live only 8 years on dialysis but 23 years with a new kidney. So the people who die before a transplant lose 15 years of  life and a further 8 years of the losses of being on dialysis, whilst those who get a transplant lose 5 years of the losses of being on dialysis. Just to get a lower bound of these losses, say dialysis life is a loss of £10,000 goodness per year and dying is a loss of £20,000 per year. Those who die before a transplant lose £380,000 whilst those who get dialysis and then a transplant lose £50,000. Then we need to add in the costs of dialysis, which is roughly £26,000 per year. Adding in the costs of dialysis gives us £588,000 and £180,000 respectively. Roughly one will die and five wait for 5 years. This gives us the expected loss of each person needing a kidney to be £248,000.

Now that is a bit too simple to estimate the minimum value of a kidney in a market since we have treated the value of the 25 donated kidneys at £0. But I’m going to ignore that because this suffices as it stands. All I am aiming at is a lower bound. We can clearly say that the value of giving each of those people a kidney transplant tomorrow is AT LEAST  £248,000 each. Granted £128,000 for the cost of the transplant itself (a generous estimate), we could pay a donor £119,999 for a kidney and still come out ahead. And just so we are clear that my figures are very much a lower bound, taking the more complicated UK NHS cost-benefit analysis from here, and assuming 10 years average life after a transplant, we could pay £257,999 and still come out ahead. To my mind that settles the matter: we should be willing (if we have the money) to pay up to that much for a kidney.

But it gets even better! Becker and Elias have, by the use of economic methods based on evidence from Iran (where there is a legal market), Singapore and Australia (where some expenses are paid), estimated that the free market price of a kidney would be up to  £20,000. At this price more kidneys would be available than needed, essentially eliminating the need for people to wait. At this price, the consumer surplus on buying a kidney is at least £100,000 per person. Furthermore, most of this surplus we are already spending on dialysis. Just to see how that scales up to the UK, we have ‘over 37,800 patients with end-stage renal failure’. So the surplus for those in the UK alone would be roughly £4 billion (and £9 billion on the NHS figures) most of which we are already spending on dialysis.

And what do we have instead: donations, exhortations, exchanges and that most ridiculous and dishonest guise for theft: implied consent, giving us one kidneys when we need six. Are we nuts? Yes! And worse than nuts. We ban all this good and think ourselves morally superior for abominating the black market in kidneys. This, THIS, not a market in kidneys, is the abomination.

Originally at http://blog.practicalethics.ox.ac.uk

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