Moral views about organ sales can change

"People may find the sale of organs less offensive after they have considered data about factors such as waiting lists, those who die while waiting for a transplant, and the savings in long-term medical care that can result from transplants," says Mario Macis. (Credit: iStockphoto)

Evidence about the practical costs and benefits of our deeply held moral beliefs can sway what seemed like rigid opinions, report economists.

They reached their conclusion in a study of public sentiment regarding sales of organs for transplant, a practice banned in the United States since 1984. Some argue that individuals should be allowed to sell, for instance, one of their two kidneys in order to save more lives.

“Some people’s ideas of what’s moral and acceptable may be changed by evidence, once the costs associated with these moral positions are taken into account,” says Mario Macis, assistant professor at the Johns Hopkins University Carey Business School and an author of the study.

“People may find the sale of organs less offensive after they have considered data about factors such as waiting lists, those who die while waiting for a transplant, and the savings in long-term medical care that can result from transplants,” he says.

The study had a two-fold purpose combining health care policy and economics, Macis says.

First, it calls attention to the desperate shortage of organs for transplant: More than 120,000 people in the United States are on waiting lists for organs (mainly kidneys). Each year only 29,000 procedures are performed, and 10,000 people die or become too ill for a transplant.

Second, the study tests whether individuals’ moral beliefs can be affected by rational calculations of costs and benefits.

Okay to sell organs?

Widely held moral positions against the sale of organs for transplant stem, in part, from deep concern about potential exploitation or coercion of vulnerable people and from fear of corruption of society’s moral values, the researchers say.

They conducted an online survey of about 3,400 US residents. One group was asked if they would approve of payments for transplanted organs. Less than 52 percent of respondents said yes.

The other participants were asked the same question, but only after reading about the social and economic consequences of the US organ shortage and strategies for closing the gap. Of this group, more than 71 percent said they would approve of organ sales—almost 20 percentage points more than in group not exposed to the written information.

“This told us that some people’s moral beliefs can be changed by evidence. Their attitudes don’t necessarily reflect immutable values,” Macis says.

Kidney market

In the paper, the authors point to other researchers who have laid out some of the benefits of a payment system: Compensation of $15,000 to $30,000 per transaction would likely induce enough sales to bridge the current gap between the low supply and the high demand for organs. Additionally, a kidney transplant saves about $250,000 in dialysis treatments that would otherwise be necessary.

“The vast majority of organs are donated by the recipients’ family members,” Macis says. “But matches aren’t always possible, and the supply, as we’ve seen, is grossly inadequate. Having a system of payments for organs from unrelated people could dramatically increase the supply.”

How would such a market be organized? Macis advises against private deals or negotiated prices.

“The obvious way would be through a government agency, with firm regulations about price and other aspects of the transaction,” he says. “A wide-open market with buyers and sellers exchanging kidneys for cash is not how it should work.”


The research team plans at least two follow-up studies, Macis says. One would examine the effect that emotion and poignancy—as in, say, a video about a declining transplant candidate or an impoverished person hoping to raise cash by selling a kidney—might have on those who find organ sales objectionable.

Another would dig more deeply into why so many people in the first study—30 percent—continued to oppose organ sales after reading the information about the impact of the organ shortage.

Macis and his coauthors, economists Julio Elias of Universidad del CEMA in Buenos Aires and Nicola Lacetera of the University of Toronto, presented their findings at the 2015 annual meeting of the American Economic Association. Their paper will be published in the American Economic Review: Papers and Proceedings.

The study was funded in part by the Research and Scholarly Activity Fund of the University of Toronto-Mississauga.

Source: Johns Hopkins University