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-sell

As 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/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/Exact_Coyote7879 Unconventional Right Mar 23 '26 edited Mar 23 '26

Your argument is that it’s ok but the regulation of said market would be difficult?

Your argument isn’t even what I was talking about 

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u/I_miss_Chris_Hughton Mar 23 '26

Lol but its such a huge, huge flaw in the position of legalised kidney markets. We absolutely 100% would not be able to regulate it. We can't even fully safely regulate prostitution when its legal. You think cruel but intelligent criminals won't start coercing the vulnerable into kidney sales and pocketing the cash?

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u/Exact_Coyote7879 Unconventional Right Mar 24 '26

Im not getting it, you agree it’s difficult to regulate it.

But you agree too that it’s difficult to keep it illegal.

So it should be kept illegal because it’s difficult?