Understanding moral repugnance: The case of the US market for kidney transplantation

Julio J. Elias, Nicola Lacetera, Mario Macis have an interesting paper:

….to accept a system based on private transactions, the median respondent would require about a 30 percentage point increase in supply, corresponding to 10,000 extra kidneys procured (which would reduce the shortage by more than 50%), and $1.26 billion in savings for taxpayers. This difference in the estimated trade-offs appears to derive from the fact that the public agency paid-donor system was considered less repugnant than the private transactions system along all of the morality features that we included. In particular, participants rated the public agency system as being equally ‘fair to the patients’ as the unpaid donor system (these two systems allocated organs to patients based on the same priority rules), whereas private transactions (in which the allocation is purely market-based) were considered highly unfair.
The issue of a kidney market is a very sensitive one and needs to be dealt with a lot of patience and humility.

Alvin Roth stresses that “we need to understand better and engage more with the phenomenon of ‘repugnant transactions’, which often serves as an important constraint on markets and market design.”[1] The prohibition on payments to kidney donors is one important example of this phenomenon. Our research suggests that individual choices based on repugnance considerations respond in a predictable ways to efficiency information, but also that ethical views play a crucial role in these preferences.

Supplying evidence and promoting studies on such sensitive topics might therefore lead to greater awareness and improved policy design based on the actual preferences of a population. In the case of introducing regulated payments for organ donors and their families in particular, the evidence is particularly strong that informing society about the potential benefits of economic incentives does impact the acceptability of this transaction.

Because individual preferences appear to depend on expected efficiency in addition to ethical considerations, pilot trials testing the outcomes of different arrangements may enhance the ability of a population to determine the preferred organ procurement and allocation system.

This topic of kidneys is really intriguing for this blog.

This post – Regulated market for kidneys in Iran – written in July 2010 continues to get comments till date. There is hardly a week when someone does not post a comment which is related to either demand or supply of kidneys. It currently says 60 responses but is much more as many have been deleted given the randomness of the comment.

So it seems this is one big missing market (if one can call it that) which is affecting a lot of people. How to make it work keeping sensibilities in mind is obviously a big issue to tackle..


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