Economists speak of "repugnant markets" -- areas of commerce that the public finds morally objectionable, at least for certain periods. Life insurance, for example, was widely disdained until the mid-1800s but has since become a global industry. Conversely, indentured servitude and child labor, once common and accepted practices, now seem beyond the pale.
Today the sale of human organs is generally viewed with repugnance. The National Organ Transplant Act of 1984 banned it in the United States. However, a new study by a Johns Hopkins University researcher shows that people might abandon their moral objections to organ selling -- and to other transactions in repugnant markets ─ when presented with information about the potential advantages of such sales.
"Some people's ideas of what's moral and acceptable may be changed by evidence, once the costs associated with these moral positions are taken into account," says Johns Hopkins Carey Business School Assistant Professor Mario Macis. "People may find the sale of organs less offensive after they have considered data about factors such as waiting lists, those who die while waiting for a transplant, and the savings in long-term medical care that can result from transplants."
The paper has a two-fold purpose that combines health care and economics, Macis says. First, it calls attention to the desperate shortage of organs for transplant: More than 120,000 people in the United States are on waiting lists for organs (mainly kidneys), while each year only 29,000 of the procedures are performed, and 10,000 people die or become too ill for a transplant. Second, the study asserts that individuals' deeply held moral beliefs can be affected by rational calculations of cost benefits.
Macis and his co-authors ─ fellow economists Julio Elias of Universidad del CEMA in Buenos Aires and Nicola Lacetera of the University of Toronto ─ presented their findings this past January in Boston at the annual meeting of the American Economic Association. The paper, "Sacred Values? The Effect of Information on Attitudes toward Payments for Human Organs," is to be published this May in the American Economic Review: Papers and Proceedings.
For their study, the researchers conducted an online survey of about 3,400 U.S. residents. Members of a control group were asked whether they would approve of payments for organs. Just under 52 percent said yes. The same question was posed to members of an additional, or treatment, group, but first they were asked to read a 500-word text about the social and economic consequences of the U.S. organ shortage. Of this group, more than 71 percent said they would approve of organ sales ─ an increase of almost 20 percentage points over the control group's positive response.
"This told us that some people's moral beliefs can be changed by evidence. Their attitudes don't necessarily reflect immutable values," says Macis.
In the paper, the authors point to other researchers who have laid out some of the benefits of a payment system: Compensation of $15,000 to $30,000 per transaction would likely induce enough sales to bridge the current gap between the low supply of organs and the high demand for them. Additionally, a kidney transplant saves a patient about $250,000 in dialysis treatments that would otherwise be necessary.
"The vast majority of organs are donated by the recipients' family members," explains Macis. "But matches aren't always possible, and the supply, as we've seen, is grossly inadequate. Having a system of payments for organs from unrelated people could dramatically increase the supply."
How would such a market be organized? Macis, who earned his doctorate in economics from the University of Chicago, advises against private deals or negotiated prices. "The obvious way would be through a government agency, with firm regulations about price and other aspects of the transaction," he says. "A wide-open market with buyers and sellers exchanging kidneys for cash is not how it should work."
The research team plans at least two follow-up studies, Macis says. One would examine the effect that emotion and poignancy -- as in, say, a video about a waiting transplant candidate or an impoverished person hoping to raise cash by selling a kidney -- might have on those who find the sales objectionable. Another study would dig more deeply into why nearly 30 percent of the treatment group in the first study continued to oppose the sales after reading the information about the impact of the organ shortage.
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