Stephen J. Dubner and Steven D. Levitt (Freakonomics) “weigh the repugnance factor” in Flesh Trade:
How’s this for a repugnant situation? Take someone you love, perhaps your spouse or your sibling, and find a stranger who will accept a really big bet that your loved one will die prematurely — and if indeed that happens, you pocket a few million dollars.This, of course, is how life insurance works. And most Americans don’t find this idea repugnant at all. They used to, however. Until the mid-19th century, life insurance was considered “a profanation,” as the sociologist Viviana Zelizer has written, “which transformed the sacred event of death into a vulgar commodity.”
Obviously we’re not above all such irrational repugnance today:
In the space of just a few decades, transplant surgery has become safe and reliable (to say nothing of miraculous). But success breeds demand: as more patients get new organs, more patients want them. In 2005, more than 16,000 kidney transplants were performed in the U.S., an increase of 45 percent over 10 years. But during that time, the number of people on a kidney waiting list rose by 119 percent. More than 3,500 people now die each year waiting for a kidney transplant.To an economist, this is a basic supply-and-demand gap with tragic consequences. So what can be done to increase the supply of organs?
The obvious answer — put organs up for sale — is repugnant, so we need a clever solution:
Alvin Roth, even though he is an economist, is smart enough to realize that repugnance will keep Americans from embracing a true market for organs anytime soon. So, along with several other scholars and medical personnel, he has helped design a clever alternative, the New England Program for Kidney Exchange. Imagine that you have a wife who is dying of renal failure, and that you would give her one of your kidneys, but you are not a biological match. Now imagine that another couple is in the same bind. The kidney exchange locates and matches the couples: you donate your kidney to the stranger’s wife, while the stranger gives his kidney to your wife; the operations are performed simultaneously to make sure no one backs out. Although this system has yielded only a couple dozen transplants so far, it illustrates an economist’s understanding of incentives: if you can’t get someone to give an organ out of altruism, and you can’t pay him either, what do you do? Find two parties who are desperate to align their incentives.