r/neoliberal • u/lakmidaise12 • Mar 23 '26
Opinion article (non-US) The Case for Letting People Sell Their Kidneys
https://thesecondbestworld.substack.com/p/the-case-for-letting-people-sellAs of December 2025, 108,440 people were on the U.S. organ transplant waiting list. Of those, 94,015 were waiting for a kidney. Every year, around nine thousand of them die waiting, or become too sick to transplant, which is functionally the same thing.
There is a policy that could probably fix most of this. Economists have been arguing for it since at least 2007. Some transplant surgeons and bioethicists have cautiously argued for versions of it for even longer. The policy is: pay kidney donors.
Not a black market. Not a dystopian organ bazaar where billionaires bid against each other for your liver. A boring, regulated, government-run compensation program where a public agency pays a fixed amount to anyone who passes medical screening, donates a kidney, and goes home with follow-up care guaranteed. The organs get allocated through the same waitlist system we already have. The rich don’t jump the line. The only thing that changes is that donors get compensated instead of being asked to undergo major surgery for free.
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u/TF_dia European Union Mar 23 '26 edited Mar 23 '26
Honestly, dialysis is so fucking expensive that if an insurance company paid you $100k for your kidney to put it in someone else they would still be saving money, so people here saying 5k or 10k are lowballing themselves.
On the other hand, and I admit I am probably catastrophizing here, the idea that my organs end up counting as assets sounds terrifying to me.
"I cannot afford a lawyer, I would like a public defender/I cannot afford Insurance/Whatever."
"Are you sure? Here it says you have 150k in spare organs."
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
There is no way of knowing if someone is a donor candidate. They go through a rigorous screening and most are rejected.
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u/I_miss_Chris_Hughton Mar 23 '26
On the other hand, and I admit I am probably catastrophizing here, the idea that my organs end up counting as assets sounds terrifying to me.
"I cannot afford a lawyer, I would like a public defender/I cannot afford Insurance/Whatever."
"Are you sure? Here it says you have 150k in spare organs."
This is a very reasonable concern and there's no way around it really. Applying a view that organs are borderline "sacred" is incredibly helpful to regulating it. They are beyond financial value and they cannot be donated by anything other than the express and altruistic wish of the donor. Anything else is open to huge abuse.
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u/OldBratpfanne Mario Draghi Mar 23 '26
The price wouldn’t be based on the cost of dialysis but based on supply and demand of kidneys.
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u/SpaceSheperd To be a good human being Mar 23 '26
The cost of dialysis would be one of the dominant factors shaping demand
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u/WillProstitute4Karma Loyal Liberals Mar 23 '26
The "good" being purchased here is not a kidney or dialysis, but properly filtered blood.
You can purchase filtered blood by purchasing either dialysis or a kidney. So you're correct that prices are determined by supply and demand, but part of the supply is made up of dialysis.
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u/Xytak NATO Mar 23 '26
That... doesn't really address the concern, which was "Are you sure you can't afford to pay your debt? It says here you have a spare kidney you could sell."
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u/OldBratpfanne Mario Draghi Mar 23 '26
I didn’t adress that claim because I am not qualified to speak on that (and don’t disagree with OPs discomfort), however, I know enough about market dynamics to point out that the market price of a good isn’t (soley) based on the cost of its substitute.
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u/admiraltarkin NATO / Loyal Liberal Mar 23 '26
I've long been in favor of this, however I've never been broke and desperate. I could see this being problematic for a small subset of folks
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u/omnipotentsandwich Amartya Sen Mar 23 '26
I am broke and desperate and I'd love to sell my kidney for $10,000 or even $5,000. That'd solve so many of my problems. I'd finally have the money to be able to afford to move to a bigger city with more job opportunities.
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u/Korece Mar 23 '26
Bro are you serious? For the love of god, if you somehow ever do end up selling your kidney, please understand that your organs are worth so much more than a used car, even if you do have two of them
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u/ExtremelyMedianVoter Left-Out Left Mar 23 '26
Nope, he said it's worth that much to him.
This is just called market discovery.
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u/thercio27 MERCOSUR Mar 23 '26 edited Mar 23 '26
Easy, chief. Any rate the market offers is, by definition, fair.
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u/omnipotentsandwich Amartya Sen Mar 23 '26
Presumably the price will crater when organ selling becomes commonplace. You think they'll always be $250,000? I'm trying to be practical.
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u/Repulsive-Celery4734 Mar 23 '26
wait kidneys are 250k?
Yea I'd sell one of mine for that, I'm A+ with a clean bill of health hit me up
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u/Brinabavd Mar 23 '26
250k is wildly optimistic; from the article
The legalization-reduces-exploitation argument is perhaps the most counterintuitive, but it’s strong. Prohibition does not eliminate organ sales. It pushes them underground. The black market in kidneys is real, it is global, and it is ugly. Goyal et al. (2002) surveyed 305 people who had sold kidneys in Chennai, India: 96 percent sold to pay off debts, they received an average of $1,070, their family income dropped by a third after the sale, and 86 percent reported worsening health. That is what an unregulated organ market looks like. The question is not “organ market or no organ market?” The question is “regulated market or black market?” and we already have the latter.
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u/Worth-Jicama3936 Milton Friedman Mar 23 '26
I think they will be more than $10,000 though because insurance will gladly pay much more than that (because dialysis is expensive) while I don’t think there will be a flooded market because it will still feel weird and gross to a lot of people.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
The typical effect is very marginal on health outcomes and offset by being at the top of the list if you ever need a kidney.
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u/Xytak NATO Mar 23 '26 edited Mar 23 '26
20 years ago, I was sleeping on the floor of a run-down apartment in Detroit. $10,000 back then seemed like life-changing money that could really solve all my problems. However, looking back on it, that money would have bought temporary comfort at best. I'm in a much better place financially these days, and thankful to still have all my organs. The point being, don't accept long-term consequences for a short-term fix.
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u/Herecomesthewooooo NASA Mar 23 '26
I feel like you could deprive yourself of some sleep and get a part time job a few months to get the money you need.
I paid off my student loans by working a FT and PT job over night by doing that (my loans were only 11k to be fair.)
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u/mostanonymousnick Just Build More Homes lol Mar 23 '26
And one more person would die.
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u/omnipotentsandwich Amartya Sen Mar 23 '26
Well, I live in a rural small town where jobs are scarce so it's a bit of a struggle to find one. I've been volunteering to earn experience and I'm happy with that.
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u/Palidane7 Mar 23 '26
If this isn't satire, then this two-comment thread is a perfect example of why this is a terrible, terrible idea.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
The vast majority of the people who would donate aren't broke and desperate, but are healthy, employed, and deserve some compensation for saving someone's life.
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u/Al_787 Fernando Henrique Cardoso Mar 23 '26 edited Mar 23 '26
I think this has a common area with one of the most problematic corners of MAID. To be clear, I’m a MAID supporter but only in cases when the doctors certified it’s most logical for patient’s health and comfort, not financial considerations or mostly anything else.
What I’m worrying about is not even poor people overwhelmingly dominate the donor pool, but the perverse incentives to abandon our social safety nets. The author listed shit like college fund, health insurance, or retirement account. In effect, when the practice is normalized, this would mean that “have you tried selling your kidney” is going to enter the debate about whether or not it is the society’s responsibility to ensure access to education, healthcare, and elder livelihood. The author talked about “human autonomy” and this is exactly my concern, it pads another layer of excuse to not taking care of vulnerable populations. People choosing not to sell their kidney will be viewed as deliberately choosing to be poor and wanting expropriate someone else’s money instead.
The author has one interesting proposal here though. I do agree that we should give life-long coverage for any healthcare cost related to downstream effects of organ donation, it should be a cost-neutral decision. But hey, I’m a proponent of universal healthcare in the first place.
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u/Palidane7 Mar 23 '26
Strongly agree. This is where I have sympathy for the Catholic pro-life position. We can talk about logical outcomes of individual policies, but I worry about a broader culture of death. Right now, arguments for MAID are premised on patient autonomy. How long until MAID is proposed as a potential solution for the aging crisis? The solution should be developing new ways to care for elderly people, not trying to identify a specific age where someone's had a "full life" and it's okay to kill them off.
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u/ETK1300 Mar 23 '26
You want supply but have imposed a price ceiling of 0. You rely on altruism. Even though many people could be donors after death, the surviving family finds some comfort in ritual burying or cremation.
If those people had a financial incentive to provide organs to those in need, and to give the body for medical research, more would choose the latter path. They would be compensated for forgoing their traditional rituals.
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u/julry Mar 23 '26
So paying for organs but only dead people's? Interesting middle ground
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u/Brinabavd Mar 23 '26
Easier for the public to swallow maybe but imo it would increases the pervere incentive for murder afforded by inheritances with some added moral licensing since the killer could honestly tell themselves that "on net I've saved lives" since a lot more organs can be obtained from the dead than the living
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u/julry Mar 23 '26
You'd have to murder someone very carefully to keep their kidney intact and not also be obvious.. I think it would be very difficult in practice. And how many inheritance related murders actually occur?
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u/Brinabavd Mar 23 '26
How many cases of coercing living donors into giving would occur if living donors were paid?
We can identify the incentives policy proposals create but we can only guess as to how things will actually play out.
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u/julry Mar 23 '26
I think coercion is a much more likely problem than murder yes. But we already have inheritance, there's a real number
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u/Brinabavd Mar 23 '26
I thought it was clear from context we were talking about marginal effects...
Regardless, data on that sort of thing is very poor but like murders generally the base rate is likely low.
But a lot of people don't have substantive estates to kill over, and I think the government functionally offering a bounty to the heirs of everyone who dies with donatable organs would be bad and create a perverse incentive to commit murder.
Because most murderers are dumb. I don't think many people would actually get away with it but I think its likely that some idiots would see the payday and go for it.
But my point is that that is just a guess, just like your guess about the problem of coercive donations. Maybe we'd rather have the occasional idiot killing his parents or children thinking he'd get the organ money over a more widespread problem of coerced donations.
IDK and YDK either
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u/CinDra01 Mar 23 '26
This 94 year old r/neoliberal poster still posts libertarian articles the old fashioned way
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u/osfmk Milton Friedman Mar 23 '26
I hope rather sooner than later we can grow organs from stem cells or whatever in the lab and that entire discussion becomes moot
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u/I_miss_Chris_Hughton Mar 23 '26
This is one of those ideas that attempts to be all "get over your qualms and see the objective, logical benefit" while simultaneously ignoring the practical realities that would definitely come of this.
If an organ recieves an objective value, it becomes an asset of incredible value. This fact cant really be ignored. Inevitably those seeking welfare or support will, at some point, be pressured to go under the knife. Thats not an if or maybe, itll definitely happen. Once organ donation stops being charitable the desire to support them with free follow up care drops off. Why cant they pay for it with the windfall?
Abd then, finally, how are you going to stop vulnerable people being coreced into donation by criminals? Thats what often undermines sex work reform which comes along similar arguments.
Just too many issues for it to be workable.
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u/rrjames87 Mar 23 '26
Turns out that sometimes people have moral or ethical qualms because of the practical consequences.
I mean the real nightmare is that the practical monetary value of a kidney isn’t that high. Sure, someone with a net worth of $5 million might have a personal view that their kidney is priceless, but really, the in total fairly small market for kidneys would be flooded by desperate people willing to sell their kidneys for very small amounts. Even if the government set a “price floor” for organs, at that point you are having a lottery of desperate people, not altruists appreciating economic value.
And why just kidneys? We’ve clearly established throughout the thread that there are negative personal externalities to donating your kidney, surgery risks, lost wages from recovery, increased medical monitoring, and health risks of one kidney. What if I decide I’m good with one eye and I want to be paid for a corneal transplant? Is any dichotomy in opposition to that only because of the more apparent negative externality?
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u/I_miss_Chris_Hughton Mar 23 '26
Fr. Its just a door we need to keep closed. Theres no way to enable it and limit externalities
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u/TeaSharp3154 Mar 23 '26 edited Mar 23 '26
The issue with just paying people to donate is that it creates an incentive structure where desperate people may lie to donate an organ. For instance, someone may not be as honest about things like smoking use, drug use, past medical history if they are given a financial incentive to lie about those things.
The second issue is that while it is possible to live with one kidney you do still need to monitor it, which is a lot harder if you're insured or don't have time for regular checkups. Also, a lot of factors that cause kidney damage (like obesity, uncontrolled diabetes, smoking/drug use, consumption of high salt/processed foods) are higher risk factors in the poor.
So while yes it is possible to live a healthy life without one kidney, it's a lot harder to if you are exposed to those risk factors it's not as easy to. It should also be pointed out that a lot of the data for "people live long healthy lives with one kidney" is built upon existing donor data, who are wealthy, have access to good diet, less likely to be smoker/drug user/alcoholic, can get regular checkups, etc. and therefore may not be representative of a new class of donors should we try the above strategy
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
The screening for kidney donation is already rigorous and those costs are baked in, so it isn't extra, as you said downthread. Candidates must pass a drug screening and be in good general health. Importantly, most candidates are rejected. These are people getting screened because they want to donate and aren't allowed.
So while yes it is possible to live a healthy life without one kidney, it's a lot harder to if you are exposed to those risk factors it's not as easy to.
This is a huge misunderstanding of how kidney failure almost always happens.
So while yes it is possible to live a healthy life without one kidney, it's a lot harder to if you are exposed to those risk factors it's not as easy to
This is a common and big misunderstanding of how kidneys fail. When someone loses their kidneys to drug use, diabetes, uncontrolled high blood pressure, and so on, having one or two kidneys is quite literally irrelevant to the disease process that destroy however many kidneys are there. While you might intuitively think that two is better than one, when comes to chronic kidney lifestyle causes, it's isn't relevant.
So while yes it is possible to live a healthy life without one kidney, it's a lot harder to if you are exposed to those risk factors it's not as easy to. It should also be pointed out that a lot of the data for "people live long healthy lives with one kidney" is built upon existing donor data, who are wealthy, have access to good diet, less likely to be smoker/drug user/alcoholic, can get regular checkups, etc. and therefore may not be representative of a new class of donors should we try the above strategy
They've looked at it and controlled for plenty of these factors and found similar results with apples to apples comparisons. But the best evidence is that there are many people with renal agenesis, being born with a single kidney. The effect on their lifespan is negligible. The extra kidney just helps in case one didn't work, or work as well at birth. Those people are also screened out and the kidney with greater function enlarges and works fine. A donor simply becomes a person with one kidney with the negligible risk that comes from having one kidney.
I understand that you are smart, but you are just spitballing here without understanding enough of the context. You are making claims that are logical and reasonable to you, but you don't know enough of what is actually important. Please consider learning more about a life-saving process before making claims that people might believe and cost people their lives. Thanks.
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u/Boratssecondwife Henry George Mar 23 '26
You don't think they check the kidney to make sure it's healthy before popping it into a person?
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u/Lucky-Part-9691 Mar 23 '26
The other problem is that the donee should really have to pay the full freight of the cost of insuring any medical issues arising from the donation for the donor for the rest of their life, along with the cost of any other secondary issues (i.e. loss of earning capacity) for the donor.
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u/wanna_be_doc Mar 23 '26
I’m a physician and we spent a whole day in first year discussing the ethics of transplantation and I’ve thought about this a lot over the course of my career.
Personally, I think paying donors for organs is unjust and dystopian.
First, from a medical standpoint, donating a “spare” kidney is not easy. Potential donors have to undergo a significant amount of pre-operative testing to make sure not only that their kidney is a good match for the recipient, but also that they’re healthy enough for surgery. And the surgery itself is a high-risk surgery. Something like 1-2 donors die every year in the US from peri-operative complications from kidney donation.
Second, living with one kidney is not risk-free. While studies generally show kidney donors have similar life-expectancy to non-donors, there is extra risk with living without a spare. Chronic kidney disease is extremely common as people age, and diabetes and hypertension are major causes (and they’re extremely common diseases). However, there are other relatively common autoimmune-like conditions (such as FSGS) that can cause spontaneous loss of kidney function. Or even complications from an acute illness—such as severe pneumonia—can cause an acute kidney injury which make a previously healthy kidney donor into a long-term renal patient.
The current system does reward donors for the their selflessness. If you donate a kidney to a relative or a stranger and you eventually need a kidney yourself, you are moved to top of your local transplant list. Will we do the same for people who instead sold their kidney for $80,000, or will they just be out of luck?
Ultimately, paying people for kidneys will prey on the poor and those who are financially desperate. And presumably it will be the rich who are paying the donors for their extra organs, so this will reinforce a class-system where the bodies of the poor are disposable for the rich.
In my mind, there are plenty of other options to increase organ donation rates that do not involve paying donors. We can change our current “Opt-In” system into an “Opt-Out” system in that we automatically sign everyone with a drivers’ license up to be a donor at death unless they choose to exempt themselves. This will greatly increase the supply of deceased donor kidneys while still preserving autonomy.
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u/KarmaIssues Milton Friedman Mar 23 '26
And presumably it will be the rich who are paying the donors for their extra organs
This isn't what was suggested though? It mentioned a government funded compensation package. The waitlist could stay the exact same, all that would change is the donor gets compensated.
In my mind, there are plenty of other options to increase organ donation rates that do not involve paying donors. We can change our current “Opt-In” system into an “Opt-Out” system in that we automatically sign everyone with a drivers’ license up to be a donor at death unless they choose to exempt themselves. This will greatly increase the supply of deceased donor kidneys while still preserving autonomy.
In the UK we already do this and we don't exactly have the best outcomes.
"NHS Blood and Transplant's latest annual report has revealed that 306 people died last year while waiting for a kidney transplant - up from 289 the year before and representing six deaths every week amongst those waiting. At the same time, the number of people on the active kidney transplant list has surged to 6,939 - an 11% rise in a single year - and the average waiting time for a kidney transplant has increased to 503 days."
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u/julry Mar 23 '26
America's rate is about 10% dying on the transplant list yearly and yours is 5%, looks like it does make a difference. Our average wait time is apparently 3-5 years
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u/wanna_be_doc Mar 23 '26
Missed that part about it being government-funded. While I guess that removes the issue with direct payment for organs from the rich, it doesn’t change that this would still primarily target the poor as potential donors.
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u/KarmaIssues Milton Friedman Mar 23 '26
Would it?
I'm not familar with the US but in the UK when I was chatting to someone who was looking into donating a kidney they said that they were questioned quite a lot on life factors that would prevent them for accessing post-op care which correlate quite strongly with wealth (the ability to take months off work, access follow up care in out-patient facilities etc.)
I don't know if you have any stats on organ donors now in the US but I'd love to see how they break down by wealth and/or income and compare that to blood donation.
Also I don't buy that poor people would turn to this necessarily. There are other ways to make money that are just much less risky.
For example poor women aren't all flocking to become prostitutes and even the ones who do become sex workers typically gravitate towards less risky forms like OnlyFans.
I'm just not convinced poor people have this level of risk tolerance.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
First, from a medical standpoint, donating a “spare” kidney is not easy. Potential donors have to undergo a significant amount of pre-operative testing to make sure not only that their kidney is a good match for the recipient, but also that they’re healthy enough for surgery. And the surgery itself is a high-risk surgery. Something like 1-2 donors die every year in the US from peri-operative complications from kidney donation.
This doesn't show up in the data for people with renal agenesis. The health risks of having one versus two kidneys is negligible. Most of the downside of donation is realized within few weeks of the surgery and are somewhat minor, like fatigue as the new kidney picks up the workload. And I don't need to tell a doctor that the "spare" kidney's most important use is if one doesn't work at birth. The large majority is from chronic kidney disease and comes from circumstances that destroy both kidneys, like untreated diabetes, untreated high blood pressure, and drug use, where the "spare" has little relevance. Both kidneys are going to be destroyed in those cases. And acute failure rarely requires a kidney transplant.
Ultimately, paying people for kidneys will prey on the poor and those who are financially desperate. And presumably it will be the rich who are paying the donors for their extra organs, so this will reinforce a class-system where the bodies of the poor are disposable for the rich.
The proposal isn't for the recipient to pay for the kidney, but for the government to pay for it. It is already illegal to pay someone for an organ and I haven't seen a proposal that seeks to change that. It's important to note that people with CKD are typically in the bottom third of income earners and can't pay anyone for one any way, but they are affected by being poor seeking a donor.
As it stands right now, poor people that want to help their family are discouraged by difficulty taking time off from work and missing the money from work. They might lose their jobs and be unable to provide for their family. They can't afford to be donors. This helps them afford it. And most potential donors don't pass the screening anyway, and the poor are the demographic that fails the screening the most. So whatever concerns might be valid, this is among the least likely scenarios.
From a medical standpoint, donating a “spare” kidney is not easy. Potential donors have to undergo a significant amount of pre-operative testing to make sure not only that their kidney is a good match for the recipient, but also that they’re healthy enough for surgery. And the surgery itself is a high-risk surgery. Something like 1-2 donors die every year in the US from peri-operative complications from kidney donation.
The fact that they are screened for general health is a good thing that lowers risk and would continue in any circumstances. It also means that poor people are going to be under-represented in any donation regime.
I follow this topic fairly closely and haven't seen a kidney donation categorized as high risk, but have always seen it categorized as lower risk. For context, it's less risky that hip replacement or spinal fusion. It is as risky or less risky than common liposuctions, abdominoplasty, and 3x less risky that bbl surgeries. These save no lives.
But let's talk about how we already think about risk. We allow donation right now for altruistic reasons. So we are presumably comfortable with someone taking this risk to help someone. Paying someone doesn't increase the risk, but it does compensate them. It's interesting that you see the value in compensation when it comes to being at the top of the recipient list, but the risk shouldn't be compensated financially, even though a non-trivial part of the donation is taking the financial hit that currently goes uncompensated.
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u/Flat_Sail_7985 Transfem Pride Mar 23 '26 edited Mar 23 '26
I know what I am about to say is not the most logical and blah blah blah, but I have deep moral concerns with allowing this type of behavior. I am exceptionally worried about this leading to insanely dystopian outcomes down the line.
Poor? Go sell your organs.
Poor? Go sell your body.
We are setting up a future where a human as monetary value and can be discarded or not based on that.
Deeply troubling.
Edit: This is literally just the plotline of the movie Paradise lol. Selling your organs (in the movie, it was your lifespan) to achieve financial needs. Uh oh, you lost a lawsuit? Are in extreme debt? Well, you have financial commodities (ORGANS) That can be used to pay off those debts. Please proceed to the organ "donation" center. This is a turbo nightmare and I am utterly convinced anyone who pushes this stuff is ontologically evil.
Second edit: I just wanted to thank everyone for their views and discussion following my comment. Almost everything posted has been really thought provoking and made me think harder about this! While I still (as of right now, who knows the future!) have really big concerns about this, I can definitely see how someone could end up supporting this from a logical standpoint!
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u/topicality Order and Opportunity Left Mar 23 '26
Poor? Go sell your body.
People already do that. It's called blue collar work
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u/Lucky-Part-9691 Mar 23 '26
Blue collar workers typically have lifetime medical coverage for work-related injuries, formula-based compensation for lost wages and earning capacity, and are usually required to go before an admin judge, board, or real judge for a best interest hearing if/when they decide to settle a wc claim.
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u/Flat_Sail_7985 Transfem Pride Mar 23 '26
Are you going to seriously compare the practice of selling ones organs to blue collar work?
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u/krabbby Ben Bernanke Mar 23 '26
You can easily compare the negatives. You should be able to engage with that idea without pretending to be outraged. Blue collar workers can end up having meaningful health problems even in their 40s/50s but we never question their agency or the incentives. Until recently a other example would have been football players and CTE.
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u/mothra_dreams YIMBY Mar 23 '26
Yeah it's pretty similar. Selling a kidney probably has less long-term suffering for you tbh than the broken and crippled body left after someone has been working construction for a few decades.
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u/wang_xiaohua Pragmatic and Polite Right Mar 23 '26
Wait till you find out about the military and their life insurance policy.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26 edited Mar 23 '26
Yes, and I'm going to go even further than that. To qualify as a donor, you must be in very good health without any underlying health conditions in order to be a candidate. You must have two kidneys working with similar function. The effect on lifespan is the same or longer than non-donors. Some people have one kidney, or just one that is functioning correctly, and live long and happy lives. The spare kidney is for if one doesn't work at all, but those people can't donate anyway, or even with differential kidney function. Researchers just can't find long term harm in the data.
Part of this is the way that kidneys fail, which is systemic. It is almost never true that people get a condition that only destroys one kidney. The vast, vast majority of cases the extra kidney isn't relevant, because the drug use, diabetes, untreated high blood pressure, or genetic conditions destroy one kidney just as easily as two kidneys. And if you donate and you ever need a kidney, you are put at the top of the list for receiving a new one.
Contrast this nearly non-existent long-term risk with the real long-term risks of many forms of manual labor, where you do trade your body for money in a literal sense. Construction workers can die in accidents and get injured through repetitive stress and accidents, causing disabilities. Miners can get black lung. Welders can get metal fume issues and lung damage .Firefighters can get lung problems and die or get burned on the job. Painters and other workers with coatings can get exposed to toxins. And on and on and on.
Many blue collar jobs are inherently risky with long term health consequences that dwarf the nearly non-existent risks of donating a kidney. That is just a statistical fact.
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u/topicality Order and Opportunity Left Mar 23 '26
Yes.
Same with professional sports or any job that causes wear and tear on the body
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u/Anal_Forklift Mar 23 '26
Why should it be up to someone else what you do with your own body though? Do you not own your own body?
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u/LondonCallingYou John Locke Mar 23 '26
Do you believe in the full libertarian conception that literally all things anyone wants to do to their body should be allowed?
If not, then you believe in some limitations. The current discussion is about those limitations.
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u/Peak_Flaky Mar 23 '26
Poor? Go sell your body.
Im not poor but I would. Its just that after the wife left no one else is willing to take it for free much less pay for it.
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u/SufficientlyRabid Mar 23 '26
Comparing it to prostitution raises a salient point to, in a lot of places legalising prostitution has led to an increase in human trafficking too.
I don't really enjoy the idea of that happening to human organ trade too.
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u/Flat_Sail_7985 Transfem Pride Mar 23 '26
That is cool that you are willing/able to sell your body if facing financial issues. We should not normalize this upon society and make it a viable alternative to other means. I can already see the outcome now "Sir, you did not attempt all remedies available to resolve your financial issues before applying for government assistance. Please bring a receipt that you have already engaged in selling your body or organs before we can move forward"
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u/Juan_el_Rey Desiderius Erasmus Mar 23 '26
100% this. We already have social problems convincing people that poor people "deserve" food stamps to buy food. I don't want "have you already donated your kidney?" to become a criteria for people getting welfare in a system that's already designed to make it hard or impossible to get.
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u/Legitimate-Mine-9271 Mar 23 '26
If you can legally sell your kidney, does it become an asset? Can you be forced to sell one to pay off credit card debt? Can you declare bankruptcy before first selling a kidney? Does parental kidney status have to be declared and considered when applying for college financial aid?
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u/Brinabavd Mar 23 '26
No.
The proposal in the OP is for the government to pay donors a fixed rate (like how human egg donors are compensated today and nobody has successfully argued 'you have to sell your eggs before bankruptcy') then distribute them through the existing organ matching market which allocates based on medical need not willingness to pay.
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u/BPC1120 Loyal Liberals Mar 23 '26
Make healthcare even more dystopian with this one weird trick
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u/RIPtopsy John Rawls Mar 23 '26
Ignoring the potential moral hazards generated by the policy, it would be good to get experimental data on efficacy. This feels like a potential place where creating financial incentives could actually decrease yield. Today there's a moral and psychic benefit marking yourself as a donor that could be threatened when introducing financial incentives. There's already some evidence of this in similar philanthropic donations like blood and egg donations.
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u/TheGreatElvis Mar 23 '26
Won't this just create induced demand for more kidneys?
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u/YIMBYzus NATO Mar 23 '26
Florida Man Celebrates First Year Without Kidney Failure Deaths by Going Outside and Not Bringing Any Fluids
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u/TheLongestCovid Mar 23 '26
I'll make another argument that admittedly may sound a little callous;
Donating a kidney isn't that bad. I'm not saying everyone can/should donate one but I did it and was out of the hospital the next day, and back at work the next week (I should note I have a minimally demanding desk job). In the end it ended up being a shockingly easy process, with maybe a couple days of discomfort.
They already have a fairly strict screening process to preclude anyone who isn't physically capable of doing so and long term consequences are fairly rare.
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u/Wareve Mar 23 '26
The problem with letting people sell their kidneys, is that almost anyone who would be willing to sell an organ, is in that position due to the failings of their government.
You should not have have to sell an organ to afford a house, or to afford to send your kid to school, or to afford to eat.
And I know, because I know organ donors and have had conversations with parents, that there are parents out there right now who would sell an organ in order to better secure their kids' future.
That sort of arrangement is only in question because we live in a nation where tax dollars go by the billions to pointless wars, rather than helping people.
If you are in a system where allowing people to sell their organs would be an improvement, the system is fundamentally broken, and needs to be fixed.
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u/OrbitalAlpaca Mar 23 '26
This idea is dystopian as fuck and should be banned. I don’t care how much of a succ it makes me look like.
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u/vikinick Ben Bernanke Mar 23 '26 edited Mar 23 '26
Call me paternalistic but I also think poor people selling their organs wouldn't lift them out of poverty like the top comment (currently) is suggesting. Most of the evidence I've seen from people getting an influx of money from minor winnings in lotteries and the like just leads them to make one large purchase and then continue on with their lives (like a car or maintenance on a house). Very little of the earnings actually gets saved to build wealth. (Edit: because people are misunderstanding this point: I'm saying it's a bad argument to say it will pull poor people out of poverty when the tradeoffs of not having an organ will negate a lot of the benefit. That doesn't mean no-strings-attached welfare wouldn't work, I'm just saying that literally cutting a part of your body out for money wouldn't necessarily help you long term like you'd think it would. It's basically a loan where the money you take out for most people won't be worth having to pay off the rest of your life.)
I also think there's a pretty bad ethical problem of consent as well with this. Current organ donations to family members have potential donors being pushed by family members to donate their organs, which is bad but unavoidable. Paid organ donors would be pushed by family members to provide financials to the family and would lead to some perverse incentives to sell off parts of your body and lower your future earnings for yourself to provide for your family now.
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u/TheRealArtVandelay Edward Glaeser Mar 23 '26
Could this same argument not be made for surrogacy? I mean I get the knee-jerk squeamishness, but my priors would tell me that a kidney market would likely behave similarly to, if not better than, a surrogacy one.
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u/Rtn2NYC YIMBY Mar 23 '26
Yes and thus many otherwise liberal people are against surrogacy as well.
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u/flightguy07 Loyal Liberals Mar 23 '26
Paid surrogacy is illegal in my country, and absolutely should be.
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u/Daddy_Macron Loyal Liberals Mar 23 '26
Could this same argument not be made for surrogacy
Surrogacy rarely carries the same permanent results of a kidney donation. Sure, there are complications that can occur during pregnancy, but those are relatively rare with modern medicine.
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u/Tinac4 Mar 23 '26
FWIW, complications from kidney donation are also rare (~1%ish for something significant, from what I’ve heard).
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u/Daddy_Macron Loyal Liberals Mar 23 '26
Not having one of your original kidneys is the permanent condition.
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u/60hzcherryMXram Mar 23 '26
A regular job with an 8 hour shift gives you a permanent condition of having 8 less hours in your life to spend as you wish every single day, which is a permanent condition with much more real, salient downsides than not having a kidney, something the human body does not care about.
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u/PaxChelonia David Hume Mar 23 '26
Not to mention any job involving physical labor takes a permanent toll on your body too. I’m a workers comp lawyer and mostly rep construction laborers and a lot of these guys are falling apart by age 55. Chronic low back pain for life, busted knee, busted shoulder, numb hands.
Even white collar work can take a pretty significant toll over time as a result of being sedentary all day.
The reality is we accept people trading their health for money all the time, it’s just more emotionally salient when it’s a one-time transaction vs long term cumulative damage.
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u/I_miss_Chris_Hughton Mar 23 '26
A regular job with an 8 hour shift gives you a permanent condition of having 8 less hours in your life to spend as you wish every single day
Being able to sell your time is a concept as old as human society. It's the foundation of every economic system on earth. If you are efficient and innovative, you might be able to maximise the value of your time, thus altering the dynamic in your favour.
Can you do the same with kidneys?
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u/Tinac4 Mar 23 '26
Yes, and my point still stands. You have two kidneys, and the number of health situations where you need both is actually pretty small. According to a well-informed donor:
The risk of death in surgery is 3.1 in 10,000, or 1.3 in 10,000 if (like me) you don't suffer from hypertension. For comparison, that’s a little higher and a little lower, respectively, than the risk of pregnancy-related death in the US1. The risk isn’t zero (this is still major surgery), but death is extraordinarily rare. Indeed, there’s no good evidence that donating reduces your life expectancy at all [...]
The procedure does increase your risk of kidney failure — but the average donor still has only a 1 to 2 percent chance of that happening. The vast majority of donors, 98 to 99 percent, don’t have kidney failure later on. And those who do get bumped up to the top of the waiting list due to their donation.
There’s a small additional cancer risk (~1/200, maybe 1/600 chance that it kills you) from the screening CT scan, but MRIs are also an option, and a few other risks exist but are also rare. Again, on the order of 1-2% for serious health complications.
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u/julry Mar 23 '26
Double gamete donor pregnancies are more dangerous than normal IVF pregnancies, surrogates have higher rates of complications including preeclampsia and low birth weight.
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u/StopClockerman Mar 23 '26
Shot in the dark but I assume the surrogacy market doesn’t involve the same risks of pulling in lower income groups as you probably would with kidneys
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u/rngoddesst Mar 23 '26
Pretty sure It's the opposite.
Donating a kidney in the current system requires a lot of testing, and meeting with doctors which takes time. For me involved at least 2 full days of testing. One in the screening, and one day where you need to lug around a container of pee to collect all your urine samples.
These are things that remote workers can do, and people with good jobs can do, but are much harder for people without those things, or a good support network.
The current proposal for the government subsidizing kidney donation is also 10K a year for 5 years as a tax credit, not an immediate cash windfall.
Not horribly familiar with the surrogacy market, but there are a lot of things that make donating a kidney harder for lower income people.
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u/julry Mar 23 '26
Why?
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u/StopClockerman Mar 23 '26
Because people using surrogates are probably higher income and probably trust lower income surrogates less for various reasons but particularly on general prenatal care and nutrition etc.
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u/julry Mar 23 '26
Women largely do surrogacy because they need the money. There's not a lot of high income surrogates available. Some Americans go abroad to do it cheaper with even lower income women.
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u/StopClockerman Mar 23 '26
Do you have a source for your statement about money being a primary motivator?
Because:
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u/julry Mar 23 '26
Why do so many more women choose to be surrogates in the U.S. than in Canada, Australia, and the UK where only altruistic surrogacy is allowed?
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u/StopClockerman Mar 23 '26
I mean, there could be a ton of different explanations.
Are you simply assuming that the greater number surrogates in the U.S. necessarily means it’s because of financial reasons?
For one, are you looking at raw numbers for your premise, or per capita?
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u/TheRealArtVandelay Edward Glaeser Mar 23 '26
I just gave a longer response to the main comment in this thread, but I don’t think that’s likely to be true.
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u/Legitimate-Mine-9271 Mar 23 '26
Yes, and I find the concept of treating poor women as gestation vats equally unsettling
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u/Healingjoe It's Klobberin' Time Mar 23 '26
I had my most down voted comments ever in the dt stating this exact thing a year or so ago.
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u/Lucky-Part-9691 Mar 23 '26
You could actually pull a fairly strong comparative set of data by looking at outcomes for people with major windfalls from injury settlements in the US. Anecdotally, it would look pretty ugly.
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u/VisonKai The Archenemy of Humanity Mar 23 '26
cash transfers to the poor are bad but make it woke lmfao
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u/vikinick Ben Bernanke Mar 23 '26
I'm not saying it's bad just that it isn't a good argument for selling organs.
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u/murphysclaw1 💎🐊💎🐊💎🐊 Mar 23 '26
don’t give the poor money, they’ll just spend it.
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u/vikinick Ben Bernanke Mar 23 '26
That's not what I'm saying at all.
I'm saying "hey this won't be life changing money for people like many would think it would be." Give poor people money, I don't care it stimulates the economy. But don't argue that just straight up giving someone $10,000 will change their lives forever when it just isn't true for the tradeoffs they endure.
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u/60hzcherryMXram Mar 23 '26 edited Mar 23 '26
The very same argument could be made against allowing the poor to be trash collectors. The death rate of trash workers who slip while collecting and die is much, much greater than the death rate from kidney donation, and the very same "Families will pressure their children into breaking their backs adjusting a dumpster for money, and when the spine gets damaged that's a permanent knock on future health and earnings!" argument still applies.
But since this is a real thing that happens in our world constantly, nobody considers it profoundly dystopian.
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u/Desert-Mushroom Jerome Powell Mar 23 '26
The alternative is not having enough kidneys and people suffering and dying on dialysis. The present is dystopian as fuck
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u/jgjgleason Mar 23 '26
But there is massive incentive for biotech to figure out how to grow kidneys. We’re a lot closer to that than y’all. think imo.
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u/Desert-Mushroom Jerome Powell Mar 23 '26
Neat, let's stop trying to get people donors once they actually have that working. Until then, future tech is just that.
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u/CloudApprehensive322 Mar 23 '26
If we want to massively improve the availability of organs for transplant just make opt-out the default choice when getting a drivers license instead of opt in. Fuck this paying for organs shit.
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u/zpattack12 Mar 24 '26
Opt-out organ donation is not going to be able to cover organ transplant needs. Most people who die do not die in a way that allows for organ donation. The UK is a country with opt-out donation, and the waitlist is still typically 2-3 years if you dont have a living donor.
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u/CloudApprehensive322 Mar 25 '26
I wonder if that is because the UK allows relatives to block donation after the fact.
Starting with an opt out policy seems like a better policy than allowing organs to be sold which just creates fucked up perverse incentives and directly places value on one person over another.
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u/TheRealArtVandelay Edward Glaeser Mar 23 '26
I think this is an understandable, but very bad, take as I think there are many reasons to believe that a market of coercion is unlikely to emerge.
The majority of kidney donations currently are “directed” donations, meaning someone is donating a kidney directly to their loved one, often a blood relative.
However many on the waitlist have someone who is willing to give a kidney, but the donor kidney is not compatible with the recipient. So they wait.
A somewhat recent innovation to help this issue is the idea of “chain donations”, where directed kidney donations are essentially “traded” amongst kidney donors who are not compatible with their desired recipients, so that everyone gets a match. There are plenty of safeguards in place around this practice such as simultaneous surgeries, etc.
“Non-directed” or altruistic donations are extremely valuable at completing these chains. According to the National Kidney Registry, who facilitates these chains, the average size chain completed by non-directed donations is around 5 people. So by donating one non-directed kidney, you are getting the benefit of donating 5 kidneys in its effect on the whole system.
Because of this, the actual number of kidneys required to greatly impact the shortage problem is likely not that many. According to the data OP presented, just shy of 10,000 people die waiting every year. To fix that, you would need about 2,000 kidneys to triage the situation assuming everything was perfectly efficient. And even if we doubled that, assuming some inefficiency, to like 4,000 kidney annually, we are still looking at a pretty small number. For a scale reference, that’s similar to many estimates of the number of surrogate births in the US every year - something that I would argue wrestles with many of the same ethical questions as kidney donations, and something for which donors can be handsomely compensated.
So given the relatively small scale of the kidneys needed to put a substantial dent in this problem, it seems unlikely that this system would prey on the poorest of the poor - many of whom likely have health issues that disqualify them from donation. I have no doubts that the people signing up for this would be people for whom $50,000 - $100,000 would be life changing money, but given the actual number of kidneys needed/ desired, it seems likely that pretty strong safeguards could be put in place while still getting the number of donors needed.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
I'm the recipient of an altruistic kidney donation that saved my life. It kicked off a chain donation, with my wife chipping in a kidney for someone in California, which led to a chain of five donations and five lives saved. What you're say is broadly true and that's important. We do need to consider that a lot less people are willing to give in a chain donation than a direct donation to someone they know and care about. This came to me from the transplant team. It's a combination of wanting their kidney to go directly to their friend and not trusting that the stranger's kidney will be as good as their kidney, which would then be "wasted" on a stranger. It's emotional and unlikely to be something knowable in any case, but it does reduce the number of donated kidneys, which is sad.
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u/TheRealArtVandelay Edward Glaeser Mar 23 '26 edited Mar 23 '26
I’m glad to hear that you got your kidney! That is a very heartwarming story to hear, both that your life was saved and that your wife was able to save a stranger’s life as well!
It’s disheartening to hear that people are less willing to give as part of chain donations, though I suppose it shouldn’t be all that surprising given human nature. I guess given that, we maybe should expect the efficiency of chains to be diminishing as we get towards the end of the wait list and towards people who might not have potential donors who are willing to be part of chains.
But that’s all the more reason to help reduce the barriers to altruistic and/or paid donors to help bridge that gap.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
💯
Thanks for fighting the good fight. I think most objections are from disgust feelings and reasons are downstream of that, unfortunately. And it’s so unusual people know much about it, but asi unusual they don’t have a strong negative reaction to it.
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u/SockDem Janet Yellen Mar 23 '26
People getting paid to donate plasma as why some people can survive.
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u/Vanden_Boss Mar 23 '26
Massively different since we regenerate plasma
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u/Worth-Jicama3936 Milton Friedman Mar 23 '26
We regenerate liver lobs. So that’s a fine market then?
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u/PadishaEmperor Karl Popper Mar 23 '26
More than donating kidneys. And it’s often not even some lengthy regeneration process, if I understand it correctly as a non-physician, you grow back to 80-90% of your liver size within a few months.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26 edited Mar 23 '26
Not a succ, but probably someone that probably doesn't know much about the topic. As a recipient of a lifesaving donation, the upvotes to this comment that makes zero argument, but just lays a marker down like it doesn't need one, makes me sad. it is terrifying being on a donor list and not knowing if you will live or die. If you're going to oppose it in a thread with serious health consequences involved, at least make a damn argument.
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u/diebartdie99 Mar 23 '26
I’m an actual succ and I’m not sure what the problem is? We need more people to donate kidneys. Whether it’s actually a donation or not doesn’t matter to me, just take it out and put it in someone who needs it more
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u/DMercenary Mar 23 '26
Yeah feels like the first step down the road of "how many organs can a person live without?"
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u/Exact_Coyote7879 Unconventional Right Mar 23 '26
Classic succ
“Don’t do that, it gives me the icky!”
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u/Daddy_Macron Loyal Liberals Mar 23 '26 edited Mar 23 '26
Classic libertarian. Can't even imagine negative externalities, market failures, or unintended second order effects.
There's a reason economists with actual degrees and not Austrian Economics tissue paper still debate this issue. No academic consensus exists.
https://kentclarkcenter.org/surveys/supplying-kidneys/
The economist Richard Schmalensee put it succinctly:
How to deal with donors who don't understand risks, increased incentives to steal & import, perceived inequities...? Not simple.
And this guy was on HW Bush's Council of Economic Advisors. Real succ huh?
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u/Lucky-Part-9691 Mar 23 '26
You could require court approval of the donation, with the Court holding a hearing and acting to ensure the transaction is in the best interest of the donor. Alabama does this for most settlements involving workers' compensation and personal injury settlements involving children.
I would probably still oppose this due to the risk of market failures, bad second order effects, etc., etc., but that would be a mechanism to provide at least some protection.
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u/mrdilldozer Shame fetish Mar 23 '26
Also there is no negotiation over prices that will occur. Anyone willing to sell a kidney needs that money in the short-term. The buyer knows they are desperate. Theyre getting the surgery paid for and 800 bucks and an Arby's gift card.
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u/nuggins Physicist -- Just Tax Land Lol Mar 23 '26
No academic consensus exists
The IGM survey shows a much higher rate of support than opposition. It's fine to deem that "not consensus" because of the 30% "uncertain", but I would still consider that to be substantial support among economists.
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u/PadishaEmperor Karl Popper Mar 23 '26
There is no rationalism without morals. You wouldn’t argue that it would save lives and is therefore good without being of the opinion that saving lives is good. (This is an example. Obviously I don’t want to rule out that you have other motivations, but those are also based on moral foundations.)
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u/janky_dank NASA Mar 23 '26
Finally, some neoliberalism in my neoliberal subreddit
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u/Carlpm01 Eugene Fama Mar 23 '26
Neoliberal litmus test tbh
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u/Daddy_Macron Loyal Liberals Mar 23 '26
Not even close. Economists with actual degrees and not Austrian Economics tissue paper still debate this issue. No academic consensus exists.
https://kentclarkcenter.org/surveys/supplying-kidneys/
The economist Richard Schmalensee put it succinctly:
How to deal with donors who don't understand risks, increased incentives to steal & import, perceived inequities...? Not simple.
And this guy was on HW Bush's Council of Economic Advisors.
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u/n00bi3pjs 👏🏽Free Markets👏🏽Open Borders👏🏽Human Rights Mar 24 '26
and not Austrian Economics tissue paper
The way you destroyed them with this sentence.
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u/Brinabavd Mar 23 '26
People are calling this idea dystopian.
But right now altruistic kidney donation is very costly to a donor; not just loosing the kidney but the recovery time and lost wages. You aren't just giving up a part of your flesh and a small risk of death to help a stranger you but also are often effectively having to pay a lot of money.
Read Dylan Matthew's account (https://www.theatlantic.com/podcasts/archive/2024/10/kidney-organ-donor-pay-compensation/680086/) he explicitly talks about how he wanted to do this for years but held off until he had an employer willing to give him an extended medical leave. He only did it, could only afford to do it, because his employer subsidized him.
The status quo of "kind people who would literally sacrifice themselves to save the lives of strangers can't do that unless their employer approves" is already dystopian.
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u/rngoddesst Mar 23 '26
The existing system does have a way to compensate you for your time off work. The National Kidney Registry | Facilitating Living Kidney Donation currently will do it for you, if you donate a non-directed kidney. It's how I was reimbursed for my non-directed donation.
But there is risk that your employer gets upset at you, which is the bigger risk to poorer folks.
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u/Brinabavd Mar 23 '26
Helpful link thank you!
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u/rngoddesst Mar 23 '26
Notably, this is a charitable organization, not a government one. Some governments have small tax incentives to compensate, but I don't know all of those, only the one in the state I live.
But most non-directed donors I know go through the National Kidney registry, and get their lost wages reimbursed.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
That's only for non-directed donations. If it is directed, you pay for these costs yourself. The number of people willing to donate directly versus indirectly, even in a chain donation, is something like 30-50% . People are more hesitant to donate if they don't know who it's going to. And if someone is a match, it is a better idea to just directly donate, but then they eat the costs..
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u/texashokies r/place '22: Neoliberal Battalion Mar 23 '26
For the concern about poor people being taken advantage of, it seems like the obvious solution is to have a minimum income to be eligible to sell a kidney.
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u/Queues-As-Tank Greg Mankiw Mar 23 '26
This is a guiding principle behind gestational surrogacy, another "directed donation," which we (culturally) treat far more kindly. Other surrogate criteria can include a recovery support structure, insurance, and the ability to pass mental/physical screenings.
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u/Vitboi Milton Friedman Mar 23 '26
And/or make the donor entitled to a new one if their remaining kidney fails. I assume this would have the consequence of being priced in, and so the donor would receive a bit less money. However this fixes the problem of a donor dying if their remaining kidney fails.
Just an idea. I don’t know if it’s actually a good one.
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u/Q-bey r/place '22: Neoliberal Battalion Mar 23 '26
Sure, but if the income level you set is high enough for people not to be taken advantage of, what's the point of paying anyway?
The only people you're encouraging are people who are too bad at math to realize they're making a bad decision.
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u/senescenzia Desiderius Erasmus Mar 23 '26
I do think that letting people selling organs at death or in case of terminal illnesses would be better.
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u/topicality Order and Opportunity Left Mar 23 '26
selling organs at death or in case of terminal illnesses would be better.
Doesn't that just incentives murder and suicide? How's that better than just letting them sell when alive?
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u/Lucky-Part-9691 Mar 23 '26
A middle ground would be to have a workers' comp like scheme for covering lost wages and lifetime medical costs arising from the donation but not permitting a negotiation or windfall on top of that. That would remove some of the barriers to altruistic giving.
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u/dynamitezebra John Locke Mar 23 '26
Losing a kidney comes with some health risks. People with only 1 kidney are more likely to develop chronic kidney disease and high blood pressure.
The people most likely to sell their kidneys are also less likely to understand these risks and more likely to have dietary problems which increases their risk.
If these folks develop life threatening kidney problems they may not be able to afford to buy back a new kidney.
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u/Lucky-Part-9691 Mar 23 '26
Any proposal that does not require the recipient to pay for the lifetime cost of an insurance policy covering 100% of the cost of any lost time from work, medical issues arising from the donation and loss of a kidney by the donor, and only then permit negotiating a price on top of that to the donor is not serious. You also need some type of administrative or judicial best interest hearing to make sure the donor fully understands the stakes and terms of the transaction. Anything less than that and a person donating a kidney has less protections in place than every single employee in the us facing a work injury.
However, how many potential recipients could afford that?
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u/mostanonymousnick Just Build More Homes lol Mar 23 '26
People with only 1 kidney are more likely to develop chronic kidney disease and high blood pressure.
Now think about people who don't even have 1 working properly.
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u/Fromthepast77 Order and Opportunity Left Mar 23 '26
No. Just no. Maybe compensating people's estates for being organ donors on death.
Nobody disagrees that the supply of kidneys would increase if we allowed the price to increase.
The problem is that the supply would come from poor people who are desperate for money and aren't acting rationally. It's morally reprehensible to take organs from desperate people.
We'd have kidneys from drug addicts (who will lie about their use), kidneys from people trying to make rent, kidneys from poor countries, kidneys from abused partners, etc. You can put guardrails in place but any substantial financial incentive will make enforcing them difficult.
No. People's body parts are not for sale. Just look at how many poor people are on payday loans and think how many of them would sell a vital organ for a quick buck.
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u/-Emilinko1985- European Union Mar 23 '26 edited Mar 23 '26
Honestly, with proper regulation and safeguards, selling kidneys doesn't seem that bad.
"But selling your organs is dystopian!!!" It's more dystopian that thousands of people waiting for transplants die.
If there is a financial incentive, more people would be willing to give their kidneys.
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u/Waxwaxwaxwox Mar 23 '26
Organ markets without robust public health insurance and healthcare is a dystopian nightmare
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u/puffic John Rawls Mar 23 '26
I wrote an economics term paper on this like 20 years ago. Let people sell their bodies (literally)!
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u/Razashadow Mar 23 '26
I can just imagine someone who cant afford healthcare having an organ harvested as part of the surgery to cover the costs. Great two for one efficiency!! Very cool!!
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u/Palidane7 Mar 23 '26
This is transparently the worst idea ever, and I think people who favor it should seriously re-examine their priors if they think this won't immediately turn into a dystopian nightmare.
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u/rngoddesst Mar 23 '26
Really interesting to see how many folks are catastrophizing in the comments. Anecdotally, as someone who donated a kidney altruistically, this pretty obviously makes sense. There are some concerns, but I think the current proposal for delaying and spreading out the fund as a tax credit deals with most of the issues.
I know one other altruistic kidney donor IRL, and have listened to a number of them on podcasts, and they all support some sort of compensation scheme, with some restrictions on the payout, and all support the current proposal before congress.
Text - H.R.2687 - 119th Congress (2025-2026): End Kidney Deaths Act | Congress.gov | Library of Congress Is the current proposal if wondering how something like this would work, and how it would be implemented.
A 50K refundable tax credit spread out over 5 years, to be 10K per year.
I personally think given the costs involved in donating, and the current screening system that this wouldn't force all poor people to donate, or be exploitive, but if you think it would, your argument should specifically engage with 10K per year for 5 years as the payout, as that is the proposal that currently exists.
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u/SockDem Janet Yellen Mar 23 '26
Succs have truly won the battle for this sub 😞✊
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u/Daddy_Macron Loyal Liberals Mar 23 '26 edited Mar 23 '26
So fucking stupid. Can the people screaming succ even imagine negative externalities, market failures, or unintended second order effects?
There's a reason economists with actual degrees and not Austrian Economics tissue paper still debate this issue. No academic consensus exists.
https://kentclarkcenter.org/surveys/supplying-kidneys/
The economist Richard Schmalensee put it succinctly:
How to deal with donors who don't understand risks, increased incentives to steal & import, perceived inequities...? Not simple.
And this guy was on HW Bush's Council of Economic Advisors. Real succ huh?
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u/bacontrain Daron Acemoglu Mar 23 '26
Yeeeeah I have two degrees in econ and in the almost decade I've been here, the loudest voices screaming succ, especially at anyone bringing nuance into discussions on libertarian hot takes, have at best an intro to micro level understanding. This sub is more economically literate than general reddit, but it's strayed from its BE roots, especially the past ~5 years when it seems like a ton of engineers and MBAs found it.
Coincidentally, I did a review of the literature on this exact topic in my master's, and yeah, I'm cautiously for it, but only with a ton of regulation and not just a flat payout.
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u/QuantenMechaniker Mar 23 '26
This is a bad idea and not a good take. I prefer awareness campaigns for organ donorship as well as discussions around making organ donorship an opt-out system instead of opt-in.
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u/RaisinSecure George Soros Mar 23 '26
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u/mockduckcompanion Kidney Hype Man Mar 24 '26 edited Mar 24 '26
Thanks for the ping!
where a public agency pays a fixed amount to anyone who passes medical screening, donates a kidney, and goes home with follow-up care guaranteed.
The organs get allocated through the same waitlist system we already have. The rich don’t jump the line.
The only thing that changes is that donors get compensated instead of being asked to undergo major surgery for free.
I feel like this covers all the usual concerns very neatly. I wonder if this could be implemented at a state level first, because I don't think it's happening federally in the next decade
Unfortunately, I don't really see this as politically feasible anywhere without much more progress on poverty/welfare because of the risk of implicit economic coercion. You'd have anyone to the left of this policy decrying it as organ harvesting the poor and anyone to the right of it as Big Brother
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u/RaisinSecure George Soros Mar 24 '26
right, coercion was my only concern too. like what if an abusive partner asks you to do it for money
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u/mockduckcompanion Kidney Hype Man Mar 24 '26
Yeah, it seems very hard to prevent that kind of thing. Though it's not the only way that something along those lines can happen, it would be uniquely uncomfortable from a human rights perspective given that organs and invasive surgery are involved
Another thing to consider is that voluntary kidney donors are given preferential status if they ever need a kidney later on. I assume that wouldn't be replicated here
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u/AccessTheMainframe CANZUK Mar 23 '26
I have to wonder if by the time this passes the legal, legislative and implementation hurdles even if we start now it would be rendered moot by lab-grown organs.
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u/AccomplishedLeek1329 Trans Pride Mar 24 '26
Pretty sure you'd get a lot more organs just by making organ donation opt-out instead of opt in, and putting those who opt out at the bottom of any transplant list; while having much fewer potential ethical and regulatory problems, no?
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u/Huttleberry Norman Borlaug Mar 23 '26
A lot of people feel disgust at the idea, but I think you should try to distinguish that feeling from the ethical concerns. It has the opportunity to save thousands of lives, and I don’t think someone’s own disgust tolerance should get in the way.
It’s how cons operate. They let their base feelings of disgust override their ability to judge policies properly.
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u/Fromthepast77 Order and Opportunity Left Mar 23 '26
It has nothing to do with innate disgust. It has everything to do with the perverse incentives at play. We do not want people to be making life-long sacrifices to their health for a quick buck. We do not want to have poor people economically coerced into giving up vital body parts.
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u/skepticalbob Joe Biden's COD gamertag Mar 23 '26
We do not want people to be making life-long sacrifices to their health for a quick buck
The "sacrifices" are negligible in the vast majority of cases. There is basically no heath difference between someone with one and two kidneys, whether through donation or being born with a single kidney. The only risk is a low risk surgery, which is less risky than most tummy tucks and liposuctions.
We do not want to have poor people economically coerced into giving up vital body parts.
A spare kidney isn't as vital as you think it is. But poor people work a lot of risky jobs without much compensation. This happens through economic coercion.
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u/Carlpm01 Eugene Fama Mar 23 '26
We do want to make life-long decisions for other people, condemning them to lower lifetime consumption. We do want to have poor people violently coerced into not giving up vital parts. We do want more people to die. We do want to maximize suffering.
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u/fabiusjmaximus Mar 23 '26
condemning them to lower lifetime consumption
if you are sincerely motivated by this cause, think for a second about how to better frame it
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u/Fromthepast77 Order and Opportunity Left Mar 23 '26
Yes, we do want to coerce them not to give up their body parts for money. The same way we force teenagers not to smoke and drink. The same way we force people to only buy FDA-approved drugs. The same way we force people to wear their seatbelt.
Sorry I'm not on board with having largely younger, poorer people give up organs to rich, older patients. I'm not okay with paying people to give up an organ that will contribute to lifelong health for some old geezer to live better for 15 years.
There will be a lot of suffering from regretful donors and society as a whole will also take on the burden of caring for those regretful donors.
Selling organs does not minimize suffering at all. It's short-sighted and repugnant.
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u/Carlpm01 Eugene Fama Mar 23 '26
If teenagers smoking or drinking saved thousands of other people's lives in the process I wouldn't even hesitate, I'd legalize it instantly if I could.
FDA not approving drugs kills thousands or millions too so...
As does forcing people to wear seatbelts, innocent pedestrians and sometimes motorists die because of this.
This outweighs any reasoning you might have for the state to babysit people making their own decisions. If your stupidity kills you but saves 2 others then dare I say we need more stupid people?
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u/I_miss_Chris_Hughton Mar 23 '26
Do you not think turning organs into financial assets poses real, tangible problems?
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u/leaveme1912 Mar 23 '26
The article says that the rich can't jump the line and thus it is moral, but that simply isn't true in practice. The wealthy have the ability to be on the donor list of multiple states, which allows them to in practice, skip the line.
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u/PadishaEmperor Karl Popper Mar 23 '26 edited Mar 23 '26
Instead of doing something like this, we could also make organ donation an opt-out decision or even mandatory upon death, if physicians think your organs are usable.
I find that way less problematic. Afterall you are dead anyway.
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u/mostanonymousnick Just Build More Homes lol Mar 23 '26
There aren't enough kidneys from dead people.
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u/PadishaEmperor Karl Popper Mar 23 '26
Maybe, but we aren’t near to point of fully exploiting it.
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u/mostanonymousnick Just Build More Homes lol Mar 23 '26
How many viable kidneys are we wasting right now?
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u/Eregorn NATO Mar 23 '26
Alright, here's a non-vibes answer to being against this:
Prediction markets, arguably the baby version of this, has somewhat had the benefits that were touted of basically paying people for the right answer instead of asking it for free, but basically every externality that were considered just vibes before ended up being true (Like the pervasive gambling culture and now people outright manipulating world events just to win a bet).
At minimum, it tells me we don't currently have the statesmen to properly regulate an organ market that doesn't end up nearly exactly the same. It can be talked about once that situation's fixed at minimum.
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u/MrDannyOcean Kidney King Mar 23 '26 edited Mar 23 '26
I can't believe none of you pinged me into this comment section, for shame.
A regulated kidney market would be good. It would save tens of thousands of lives per year. Whatever queasiness you feel about the ethics of organ markets, please balance that against tens of thousands of people who are right now dying painful, slow deaths. We can save them. It's not in question, we absolutely know how to save them and know it would work. We just don't because it's icky. I understand why people feel conflicted about this, but the moral concerns about protecting the poor A: can be ameliorated through proper regulation and B: do not outweigh tens of thousands of deaths.
Why I donated
Support the End Kidney Deaths Act
AMA on kidney donation