While much of the world is discussing the aftermath of the Iranian nuclear deal, the country's normally backward looking theocracy is showing how free markets can end shortages:
In every country that does transplants — except one — patients have two legal ways to get a new kidney. One is to have a friend or relative who is a blood and tissue match donate a kidney. The other is to get on the waiting list for a deceased donor. In America, the average time on that list varies from 3 years to 10, depending on geography, blood type and other factors.
It is not the case, however, in Iran. There, people wait to donate a kidney. That’s because donors are paid.
Iran’s system has many deficiencies — not least that the very idea clashes with ethical norms observed in many other countries — and the program varies greatly from region to region. But its chief advantage is this: People who need kidneys get them rapidly, rather than die on the waiting list.
The payments offered by the government are comparative small, about $350 American, but are topped up by "gifts" from the recipient that reach $5000. Much of the middle man work is handled by a private charity that carefully screens both patients and donors. Male donors are also exempted from military service. It's not surprising that after adopting this approach it took Iran only a few years to eliminate its kidney transplant waiting list.
The idea of selling human body parts, even from consenting adults, strikes many as being morally obscene. Yet another step in the commodification of human life. But it works. The paid model of donation has likely saved the lives of thousands of Iranians. This begs the obvious question: If Iran can do this why not the United States?
There are understandable objections about the exploitation of the poor. The black market organ trade in India and Philippines is often deeply corrupt. Many donors are left sicker and poorer for their considerable pains. The selling of organs from dissent Chinese - in some cases on demand - is a perfect embodiment of the cynicism of the country's nominally communist oligarchy. But few of these objections would apply in an American context.
Even desperately poor Americans have access to food, shelter and basic health care at taxpayers' expense. A paid organ donor system would have to survive the notorious litigiousness of the American trial lawyer. Abuses both real and imagined would quickly become the fodder of investigative journalists and politicians. The remarkable transparency of America's economic and political system could make such a system work far better than anywhere else in the world. So why not try it?
That it can work is not in question. American entrepreneurial and technical zeal can make it work as it has overcome countless other social problems. We are left instead with the basic moral question: Can you sell human body parts without losing some portion of your humanity?
When I first came across this story my libertarian instincts kicked in perfectly: Willing seller meets willing buyer. The state has no role beyond that of neutral referee making sure that the traditional rules of contract are observed. Whatever one's private queasiness at the idea of kidney markets, I have no right to interfere in private actions that materially impact no one but the participants.
Still the idea makes me uncomfortable. I haven't been able to pin it down exactly. What am I missing? Paying for organ donations would clearly help thousands of desperate people. In such a light it seems silly to object. What are the secular and religious objections to paid organ donations in America? And if you do believe that paid organ donation is wrong what do you say to someone suffering on a waiting list that could, with some legislative changes, vanish almost overnight?