Is There a Moral Way to Fix America's Kidney Shortage?

For those who need a transplant, the wait for an organ in America is growing longer: As Nobel economist Gary Becker lays out in a recent op-ed for The Wall Street Journal, 95,000 Americans were on the waiting list for new kidneys in 2012, but only 16,500 kidney transplants occurred that year. Today, there are over 78,000 candidates waiting for an organ transplant.

The exchange of kidneys represents what economists call a repugnant market: It could be made more efficient if people were allowed to pay for them, but there are ethical concerns about introducing money into the equation. As demand far outstrips supply—the average wait for a kidney has climbed to 4.5 years—there’s an increasing call for establishing a regulated organ market.

A new NBER paper explores whether information—such as the depressing numbers above—affects people's attitudes toward an organ market. The researchers were interested to look at how morals about markets play out, and to measure how people respond to new information about a charged issue.

First, they surveyed a control group on their attitudes about a regulated organ market—52 percent expressed a positive opinion. Next, a treatment group was required to read about the dire situation in the kidney transplant system in America. They were then asked to respond to various statements, including one about supporting a regulated organ market for live donors and families of deceased organ donors. Support for "regulated monetary payments for organ donors" for that group was 72 percent, significantly higher than the control group.

Overall, they found that liberals and moderates were more sensitive to new information than conservatives. Perhaps unsurprisingly, those self-reporting lower income than the national median and those with a religious affiliation were both less in favor of payments for organs. And while the hope is that an official marketplace for organ would reduce organ theft, another huge concern is that allowing such transactions would expose cash-strapped individuals to exploitation.

Solutions in recent years to the kidney shortage problem have included a matching system devised by Al Roth, who won a Nobel in economics for market design. In Roth's system, those who wanted to give a kidney to a loved one but couldn't because their blood types don't match, could be paired with another couple with the same problem. This program, the New England Program for Kidney Exchange, increased the number of matches. Another method is being pioneered in Israel to increase supply: You move up in the transplant waiting list if you've signed a donor card, or if a family member has donated an organ before.

In both cases: No money changes hands, not as many problems. But as the organ-shortage problem persists, money seems to not only be the easy and extremely hard-to-swallow option—but also a last resort.