The Medium of Exchange Paradigm: A Fresh Look at Compensated Live-Organ Donation

For over twenty years, human live-organ sales have been banned in the United States and most of the rest of the world. Observations and data arising from black market transactions and the few legal markets for organs suggest that permitting and regulating organ sales leads to more humane conditions than outlawing sales. Despite the data, opponents of organ sales still argue that selling human organs devalues human life. This article examines the panoply of organ markets - white, grey, and black - and identifies the source of this cognitive dissonance. Recognizing that there is a fundamental paradox in ethical objections, we identify the true sticking point - found in the principles of social norms and market norms. Opponents of compensated organ donation harbor a feeling of repugnance that makes them not only wish to personally abstain from the procedure, but also to ensure that no one else may participate in a compensated live-organ transaction. In other words, they do not think the practice is wrong, so much as they feel it is wrong. This repugnance hypothesis explains the failure of market-based arguments to persuade lawmakers and other market-opponents to rethink the organ ban. Rational, logic-based arguments increase the repugnance and reinforce the opposition, rather than alleviating it, because they involve cognition, not emotion, and therefore fail to address market-opponents fundamental concerns. We see that we can circumvent this feeling of repugnance by taking advantage of the behavioral economic principles of social and market norms. By adding a non-currency medium-of-exchange between donor and recipient we can harvest the open-market benefits of increased organ supply while staying clear of the moral repugnance that frequently accompanies cash-for-organ exchanges