The previous Activities have provided you with an economic and ethical basis for evaluating kidney-transplant policies. Now it is time for you

to be the policy maker. Read the following information and then decide which

policy you support. Be ready to justify your decision. Which policy saves the

most lives? Which conforms most closely to the ethical framework you find most

acceptable?

OPTION 1: THE CURRENT SYSTEM

A national law makes it illegal to sell human organs. Anyone who sells a kidney

faces jail, fines or both. People may donate kidneys, however, and doctors dis-

tribute donated kidneys on the basis of need. Some of the factors they consider

in allocating kidneys are the patient’s age and medical condition, how long the

patient has been on a waiting list and whether the donor is in the local area.

Under this system, there is a shortage of kidneys, and many people are on a

waiting list for years. During this time they receive costly dialysis treatment,

and many people die.

OPTION 2: AN OPEN MARKET

Create an open market in kidneys. People may sell their kidneys on the mar-

ket for the highest price they can get. They may sell and deliver a kidney while

they are still alive, or they may sell for delivery after they die. Brokerage firms

match buyers and sellers. People could even sell kidneys on eBay. Recipients

would pay for the kidney the same way they pay for other medical care: with

their own funds or through insurance, government programs and charity.
OPTION 3: A REGULATED MARKET

Create a market in which anyone may sell a kidney, but only authorized insti-

tutions such as hospitals may legally buy. This option reduces the possibility

of acquiring kidneys through involuntary means such as theft or murder. The

institutions would allocate the kidneys on a basis similar to the way kidneys

are allocated today using age, medical need or time spent on a waiting list.

Recipients would pay for the kidneys with private funds, insurance,

government assistance and charity.

OPTION 4: A COMMUNITARIAN APPROACH

This approach uses nonmarket mechanisms to increase the supply in

several ways.

A marketing campaign would increase people’s awareness of the issue and alter

their preferences for organ donation through moral persuasion. The slogan for a

national television campaign might be “Friends don’t let friends waste the gift

of life.” This is not an appeal to altruism but to people’s sense of moral obliga-

tion and duty.

A more authoritarian policy would legally mandate that when people die, all

their organs will be donated unless they indicate otherwise. People who don’t

want to donate must take the extra step to note this in advance on their driv-

er’s license. Today people must agree in advance for their organs to be donated.
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