A step in the right direction

The Trump administration recently announced a change in policy regarding organ donations. Henceforth, donors will be compensated for lost wages and some other expenses. There are some other organizational changes in organ transplant management that should also boost transplants. This is probably the best thing the Trump administration has done since taking office, and it will likely save many lives.

But it’s just a start. The government needs to compensate organ donors at a level sufficient to eliminate the shortage of transplant kidneys and livers. This would save tens of thousands of American lives each year, and would also save billions of dollars in tax money. Learn from Iran!

It’s appalling that no previous administration did what the Trump administration did this week. And a future generation of Americans will be appalled that we did not go even further in deregulating organ transplant markets. Still, it’s a very nice first step.

PS.  Steve Hanke agrees:

President Trump’s actions go near the edge of what current law allows. As I wrote in a December 2018 Forbes column, the federal government should go further. It should allow compensation to donors in addition to the payment of lost wages and expenses. Reasonable levels of compensation should be enough to eliminate the shortages of kidneys and livers entirely. This would require action by the Congress to reform the National Organ Transplant Act.

HT:  Frank McCormick



20 Responses to “A step in the right direction”

  1. Gravatar of Michael Rulle Michael Rulle
    12. July 2019 at 03:39

    I am unfamiliar with this issue, so I am glad you educated your readers. I had tended to view organ selling as a desperate act by the seller—to the extent I thought of it at all. The numbers speak for themselves, however, and I agree this was a good thing.

  2. Gravatar of rayward rayward
    12. July 2019 at 05:45

    Of course, America doesn’t allow the sale of body parts. Is Sumner suggesting we should? I applaud Trump for the effort, but reimbursement for lost wages alone is unlikely to increase the harvest of organs. Dead people are a better source for harvesting organs. And an advantage is that one need not compensate a dead person for her organs. What can be done to increase organ donations by dead people? What if the default in hospitals was to harvest the organs of dead people, the default overridden only if the departed left a written statement indicating she wanted to keep her organs in case she needed them later.

  3. Gravatar of ssumner ssumner
    12. July 2019 at 07:25

    Rayward, Wrong on every count. Of course we should allow the sale of kidneys, not doing so is mass murder. And of course the Trump administration’s move will save lots of lives.

    The public agrees with me, BTW.

  4. Gravatar of Charles Fox Charles Fox
    12. July 2019 at 08:20

    The link regarding Iran’s market estimates the kidney price in the US would be about $25,000. I wonder how much lower the price would be if prospective donors thought it would be relatively easy/inexpensive to receive a donation should their remaining kidney fail.

    @rayward, do you think it is immoral for people to sell their time?

  5. Gravatar of rayward rayward
    12. July 2019 at 09:09

    Okay, Sumner prefers that current law be changed and allow the sale of body parts, kidneys he mentions, but what about other body parts. Eyes? Feet? Testicles? They sell blood, don’t they (to paraphrase the tile of a movie). But what does society do with a bunch of people who have sold their body parts? Again, my point was that reimbursement of wages won’t result in much of an increase in organ harvests, but a change in the protocol at hospitals would (i.e., if the default were that the departed’s organs are to be harvested unless the departed had expressed a preference to keep them just in case she needs them later).

  6. Gravatar of Randomize Randomize
    12. July 2019 at 10:27

    Some dystopian outcome could be possible with unregulated selling of organs from otherwise healthy people but to not compensate estates for dead organ donors is simply wrong on every level. How many families would have the resources to keep on going after the death of a bread-winning parent if the deceased’s body could be harvested for cash?

  7. Gravatar of Rick Rick
    12. July 2019 at 11:43

    “Henceforth, donors will be compensated for lost wages and some other expenses.”

    Will be compensated by whom? The executive order says the following:

    “The regulation should expand the definition of allowable costs that can be reimbursed under the Reimbursement of Travel and Subsistence Expenses Incurred Toward Living Organ Donation program, raise the limit on the income of donors eligible for reimbursement under the program, allow reimbursement for lost-wage expenses, and provide for reimbursement of child-care and elder-care expenses.”

    My reading of the federal guidelines (https://www.federalregister.gov/documents/2009/06/19/E9-14425/reimbursement-of-travel-and-subsistence-expenses-toward-living-organ-donation-eligibility-guidelines) leads me to believe that this will be a simple expansion of federal dollars to cover these expenses rather than a requirement that insurance cover such incidental costs.

    The distinction, I think, is crucial. If insurance were required to pick up the tab, then insurance premiums would rise by a comparable amount and the benefit of greater organ donor supply would be paid for by the insurance customers–who, I suspect, would be most likely to benefit from the greater number of organs. In contrast, the federal taxes required to fund this expansion may be very broadly distributed.

    Who receives the benefit of increased access to organ donations? While the distribution of organs to patients on a transplant list looks like quite a just system, it doesn’t seem to me that it is a very easy thing to get on a transplant list in the first place; each hospital in an organ procurement network seems to give doctors wide latitude in deciding which patients are acceptable for a transplant. How much does one’s ability to pay matter? Income? Education? Personal connections to the interviewing physician(s)? Do we think doctors are blind to these things?

    This looks more like another instance of Director’s Law in action to me.

    Of course, the best solution would be to allow people (or their estates) to be compensated for the organs themselves at market rates so that the waiting list would disappear entirely. That might not do much (in the short run) to expand the access of the poor to organ transplants (as the cost might still be quite high), but at least they could be compensated for an organ if they so desired (and, of course, in the long run, costs would likely come down, so that future generations of the poor would benefit). As it stands, it looks like we are just expecting them to foot the bill for someone else’s organ transplant. We don’t need another regressive tax.

  8. Gravatar of Christian List Christian List
    12. July 2019 at 13:15

    And a future generation of Americans wants to be appealed that they did not even go further in deregulating organ transplant markets.

    Count me in as a skeptic. Of course you are right, it is essential for moral and economic reasons that one is allowed to sell one’s own kidney. But why didn’t it happen already?

    From the economic perspective there are many things that would make a lot of sense, yet they just don’t happen. Why is that?

    In recent years, the opposing (socialist?) perspective seems to come into fashion again. Pseudo-economics and pseudo-moral are spreading across Europe and the US, propagating anti-economic ideas. Think of MMT, tariffs, anti-free trade agendas, minimum wages, all kinds of subsidies, rent controls, zoning, and so on. And those ideas seem to be quite successful.

    How popular is the idea that you should be allowed to sell your own kidney? From what I read: The idea is not popular at all. You seem to be more optimistic, that’s nice, but I think you are unrealistic.

    What will happen first? NGDP targeting or the legalization of organ sales? I assume we are fortunate if we are still alive before one or even both things happen. The USSR alone lasted for about 70 years. So I guess people can be extremely stubborn.

    But great post anyhow. Your last post about China was great, too. Other posts about China sounded too apologetic, but this last one was (finally) really good.

  9. Gravatar of Jeff Jeff
    12. July 2019 at 13:35

    It is now possible to do liver transplants from living donors as well. Only part of the liver is transplanted, and the part that remains regenerates to full function within 4 to 6 weeks and eventually gains back almost all of its original size as well. So there’s really no reason not to allow donors to sell part of their liver as well.

  10. Gravatar of Christian List Christian List
    12. July 2019 at 13:38

    I have had many discussions about this topic. With parents, friends, partners, strangers, patients. For some reason, it is extremely difficult to convince most people. This happens to me on quite some economic topics. There seems to be a “scissor in the head”, a program or hardware that can not be easily reprogrammed, maybe?

    Quite some people are exactly as cynical (and irrelevant to the actual topic) as the two commenters with R here. There is no way through.

    On the other hand, I sometimes have the impression that only surprisingly few people really shape public opinion. (Even less seem to think things through deeply.)

    The other 70-90% just follow the herd and parrot whatever the current opinion and morals are? So I guess there is still hope? You just need to convince a few percent, the rest will follow? (This argument cuts both ways of course.)

  11. Gravatar of Michael Sandifer Michael Sandifer
    12. July 2019 at 15:57

    This is an econ 101 level post, meaning I think nearly all 101 students learn that a free market in human organs would increase the supply of available organs for transplant. I don’t think it’s controversial at all among economists.

    But, how does one promote this idea beyond economists and the dilettantes like me?

    There needs to be a campaign to get it on the political agenda.

  12. Gravatar of Christian List Christian List
    12. July 2019 at 17:07


    Good point. Liver transplants are even more important than kidneys. Without kidneys you can live, there is still dialysis. So the issue of kidney transplantations is mostly about quality of life and cost savings.

    But without a liver, you die. In the US alone, about 17,000 people are on the transplant list for a liver each year. But there are only 5,000 livers per year and only about 5% of them come from living donors.

    Living donor liver transplantations are possible since 1989 but the numbers aren’t really increasing in a relevant way since those 30 years. Just 250 LDLTs each year in a country like the US seems quite low.

  13. Gravatar of Benjamin Cole Benjamin Cole
    13. July 2019 at 01:54

    As a libertarian, I advoctare the legalization of lethal cage-fighting. Winner to harvest loser body parts.

    Mr Fox above suggests kidneys worth $50k. Add on liver, possibly heart. Might get a few bucks more from a rendering plant. Winner gets fraction of gate, no need to pay losers.

    This new art form could supply needs.

  14. Gravatar of Patrick R. Sullivan Patrick R. Sullivan
    13. July 2019 at 06:05

    A good explication of what is at issue here is Nobel laureate Al Roth’s Who Gets What;


  15. Gravatar of ssumner ssumner
    13. July 2019 at 06:37

    Rayward, If you don’t know anything about a subject, why even comment?

    Randomize, You said:

    “Some dystopian outcome could be possible with unregulated selling”

    They regulate the sales.

    Rick, Why would insurance premiums rise? It’s far cheaper to compensate donors than treat kidney disease.

    And the poor would benefit the most, since they are most disadvantaged by the current system. It’s far cheaper for Medicaid to compensate donors than to treat kidney disease.

    Christian, You said:

    “The idea is not popular at all.”



    You said:

    “Other posts about China sounded too apologetic, but this last one was (finally) really good.”

    That’s only because you don’t know how to read. I’ve never apologized for China’s human rights. You don’t want accurate posts, you just want posts that make you “feel good” by bashing China. I don’t cater to people like you.

    Patrick, Yes, he’s excellent.

  16. Gravatar of Rick Rick
    13. July 2019 at 06:59

    You’re right, of course. I should’ve accounted for the improvement over the status quo.

  17. Gravatar of Public opinion regarding cash for kidneys – Econlib Public opinion regarding cash for kidneys - Econlib
    14. July 2019 at 05:26

    […] Over at MoneyIllusion I have a post praising the Trump administration’s decision to compensate kidney donors for […]

  18. Gravatar of Christian List Christian List
    14. July 2019 at 15:04


    Not wrong at all. The idea is not popular. I know these studies. They are methodically and ethically questionable. They no longer just collect opinions. They try to influence opinions.

    A major objective of these studies seems to be to provide policy makers with tactics and methods so that the public decides in the desired direction. In other words: It’s bollocks.

    Are you willing to explain why I’m wrong about compensating kidney donors to those 43,000 people who will otherwise die? 

    First, I’d question how you get those numbers. Many people seem to believe that you die when your kidneys stop working. But you survive with the help of dialysis. Kidney transplants are mainly about quality of life and cost savings. It’s not so much a question of life and death.

    It is important to stick to the facts. Kidney patients are often extremely ill. They often have several serious problems. Kidney transplants are not a miracle cure. I give an example: When people on the kidney transplant list die, you should look closely at why they actually died. To simply count them as victims of a wrong transplant policy who would have supposedly survived through another policy is not legitimate in my view.

    You don’t want accurate posts, you just want posts that make you “feel good” by bashing China.

    These are childish imaginations in your head that just tell something about you, but nothing about me.

  19. Gravatar of ssumner ssumner
    15. July 2019 at 08:53

    Christian, You’ve replaced Ray Lopez as my main source of comic relief. On the very same day as you posted this:

    “These are childish imaginations in your head that just tell something about you, but nothing about me.”

    You also asked me for more posts bashing China:

    “So tell the whole story or don’t tell it at all. Your half-truths won’t get us anywhere. It’s just embarrassingly apologetic. The dictatorial Mainland China is preying on democratic Taiwan like a rabid tiger. Almost every month they announce another threat. You forgot to mention that little part, didn’t you?”

    I guess self-awareness is not your strong suit.

  20. Gravatar of Christian List Christian List
    15. July 2019 at 14:04

    The problem is not only the “bashing” part, I would simply say “criticism” to it, but be that as it may, you can choose the partisan terms that you like. (It’s not bashing at all.)

    Your Trump criticism is refreshingly open, you could do the same with China, but there you have bite inhibition. Why is that?

    The other problem is the motivations that you assume and that you can’t possible know. I don’t feel good at all, I feel very bad. The feeling is really miserable, and I would give a lot if China behaved differently, so that my miserable feeling could change as well. I have absolutely nothing against China per se. A free, liberal China would certainly be great and an inspiration to humanity. Right now it’s more of a shame spot, and I’m not gonna stop saying this part of the truth openly. You can keep saying the other part. We complement each other perfectly.

    You’ve replaced Ray Lopez as my main source of comic relief. 

    Now I really had to laugh. Ray could be very funny, you often had to laugh. So I take this as praise. But I’m not as funny as Ray. We Germans are not very funny. But from now on I’ll try my best. I hope that doesn’t seem like a threat, it sounds a little like it. Germans and humor, oh no, please not.

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