Organ Trade: Should Human Organs Have a Price Tag?
During one of my summer economics classes at Bocconi University, my group debated whether organs should be bought and sold like commodities or remain outside the market's reach. Today, we will analyse whether organs should be allocated by the free hand mechanism or continue to operate on a donation basis.
17 people die every day waiting for an organ transplant, with almost 60000 people on the active waiting list. The main reason why so many people have to wait years for an organ transplant is the large imbalance in the supply and demand of organs. As of now, official transplant procedures must source organs from institutions like United Network for Organ Sharing (UNOS) to prevent the illegal sale of organs from organ or human trafficking. Besides the overwhelming demand for organs, there are also several issues on the supply side. First is the largest obstacle: the free-rider problem. People undercontribute as they assume others will donate enough, but the result could be disastrous if everyone thinks this way. The supply of organs would come to a halt, causing more deaths. Additionally, there are high administrative costs of donating organs. Due to the voluntary system, those who choose to donate have to go through rigorous testing, logistics, and coordination and pay for the fees for these procedures. This may lead to inertia, delaying willing donors from signing up due to bureaucratic or financial hurdles.
The extreme excess in demand leads to the establishment of a black market. Currently, the illegal organ trade industry is estimated at $1-2 billion annually. As mentioned, the trade of organs significantly increases the prominence of organ trafficking and the exploitation of low-income populations. Besides, these organ-harvesting surgeries are typically performed in subpar facilities that lack the necessary technology to prevent complications, thus increasing the mortality rate of organ donation. Even if the patient survives the initial operation, they are still not out of the woods yet. Post-operation complications are extremely common, especially in these illegal surgeries. With most low-income donors being uninsured, this puts an economic extra pressure on the healthcare system as hospitals generally cannot refuse to treat them simply because of their insurance status.
Legalising organ trade can bring several potential economic benefits. To begin with, market incentives can lead to a surge in organ supply. With a clear financial incentive, like direct payments, tax breaks, or healthcare benefits, people will feel better compensated for the risks taken during the procedure and also the necessary adjustments after the donation, subsequently becoming much more likely to donate. On top of the health aspect, the financial burdens can be lightened if the patients can find organs swiftly upon hospitalisation. For example, those awaiting kidney transplants have to be on dialysis to sustain their life, with medical fees adding up to US$90,000 per year.
Economics is rarely a matter of simple binaries; policies must be evaluated through multiple perspectives to weigh both intended and unintended consequences. One of the most long-standing ethical objections to organ trade is that treating organs as tradable commodities would deepen existing social inequalities. Under a market-based allocation system, organs could become luxury items, accessible primarily to the wealthy through exorbitant prices. Imagine a scenario where a life-saving kidney or liver is auctioned to the highest bidder—effectively turning healthcare into a "pay-to-win" game. In emergencies, affluent patients could secure transplants quickly by outbidding others, while low-income individuals, no less deserving of survival, would be excluded by financial barriers. This disparity would not only reinforce socioeconomic divides but also undermine the moral foundation of equitable healthcare. There’s also the risk that an organ market wouldn’t work well. When markets fail, they don’t distribute things fairly, and organs are already in short supply. Rare organs like hearts and lungs could become extremely expensive, making them impossible for most people to afford. Even with rules in place, there’s a danger of exploitation—people in desperate poverty might feel forced to sell their organs, or illegal trafficking could thrive. In short, while markets work for many things, treating organs like commodities raises several ethical and practical problems.
The organ trade debate presents a plethora of difficult trade-offs. While legalisation could address shortages and reduce black markets, it risks exploiting vulnerable groups and deepening inequality. A regulated system with ethical incentives may offer a middle path—expanding access without full commodification. In next week’s post, we’ll examine this issue through a case study of the world’s only legal organ market, further breaking down the practicality of a potential international organ market.
