The recent case of the two Indonesian men trialed for illegally selling their kidneys had sparked much debate over the issue of whether Singapore should legalize the sale of organs.  Opponents argue that legalization will benefit more the rich than the poor since the former would be able to out bid the poor for the organs.  Furthermore, legalization will also encourage people – especially the poor - to sell their organs for money; a notion that is morally wrong and therefore should not be supported.  However, if we look beyond the idealized principles, there are merits to the idea – such as a potential transfer of wealth from the rich directly to the poor – if it is properly managed.

Our group of characters were also in a hot debate on this issue recently during a get together party.  “Right or wrong?”  “Should or Should not?” and “How can it be done?”  We present their discussion:

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Sandra: Did you see the recent report on the two Indonesian men who sold their kidneys?

Mitchell: Yes.  For only $23k!

Sandra: What do you mean ONLY?!

Mitchell: Errrrhhh… I mean, it should cost more right?  Think about it, there are health risks both in the long and short term to having one less kidney.  Shouldn’t such risk be considered and priced accordingly?

Sandra: What! How can you say that? You are beginning to sound like your friend, the DISMAL ECONOMIST Maynard!  Our parents gave us our body and organs and it is our duty and responsibility to cherish it.  Not sell it for money!

Maynard: Thank you for the compliment.  Unfortunately everything has its price; the question to the buyer is if it is too low and to the seller if it is too high.

Sandra: Well excuse me for being the principle minded person here.  For some spiritual practices, possessing such thoughts would mean going to hell!  How can you sell your organs for money?  Even if organs are to be given, it should be given out of love and compassion.  If my love ones are in need of an organ, I will definitely not hesitate if I can and I won’t ask a single cent.

Maynard: “IF” you can?

Sandra: If it doesn’t lead to death.  “Yes” I am sure my love ones will not want me to lose my life to help them too.  I wouldn’t.

Maynard: and how do you define your love ones?

Sandra: Mom, dad, relatives.

Maynard: How about Mitchell? 

Sandra: If he is my husband… of course!

Maynard: and if he is not?

Sandra: I am sure he will be in the near future.  Right Hon? (smiles at Mitchell)

Mitchell: Yes dear. (smiles back)

Maynard: What about me?  Will you donate to me?

Sandra: Errrmmm… well… don’t take this the wrong way Maynard.  You are not a “love one”.

Maynard: I am your boyfriend’s best friend and a long time acquaintance.  We meet each other all so often for such session and I am not a love one?  Suddenly you are categorizing who you should help and who you shouldn’t?

Sandra: No.  My love ones are important to me.  Without them, I wouldn’t be what I am now.

Maynard: and Mitch?  He didn’t make you what you are now?

Sandra: But he will be the one who brings me my happiness.

Maynard: What about me? What happen to compassion?

Sandra: Be realistic Maynard… why should I help you?

Maynard: My point exactly!

Phillippe: Aiyah, what are you talking about?! Nonsense lah.  I won’t sell my organs for any amount.  Nonsense you all.

Sandra: Thanks for the support Phillippe!  You see, even the not so educated Phillippe has some principles.

Phillippe: I won’t sell mine but I will help people who need to buy find the people who need to sell!

Sandra: Huh?!

Maynard: You mean be a broker?

Phillippe:  Not a broker… a maker… hehehe.  Got money, why not make?  There are rich people who will argue that life is more important than money and poor people who find money more important than life.  So if the rich want to give up some money to buy life and the poor wants to sell some of their life for the money, why not help them?

Sandra: You are absurd.  And how much do you make out of it?

Phillippe: I am a matchmaker.  It depends on how much the “organ needy” wants to give and the “financial needy” wants to take. 

Sandra: And you profit from the difference?

Phillippe: No. Red packet.  Basically, the organ needy will give me a red packet to thank me for helping him, and I give another red packet to the financially needy to thank him for helping me.

Mitchell: and how do the buyer and seller know if they are getting their fair prices?

Phillippe: No price… it’s what the seller is willing to give and what the buyer is willing to take…

Maynard: Phillipee you are a broker in the black market.  That is illegal…

Phillippe: That’s why I say I don’t make profit!  I am no broker, I am a maker.  You know like match maker.  You don’t call them bad names right.  We thank each other for helping each other.  There is no profit.  There is no black or white market.  There is no market.

Sandra: This is atrocious!  They should throw you in jail.

Maynard: That’s why organ sale should be legalized and regulated to discourage black market operations and to make pricing of such sales fairer.  Black market operators thrive by such information asymmetry between buyers and sellers.  Restricting such operations further would just mean a further reduction in such brokers and thereby increasing the price of their service.  The result is that only richer people will have such access and more desperate people will be exploited.

Sandra: What about the morals? We must hold on to the principle that we cherish our organs from our parents and blessings from heaven.

Maynard: If that is the case, then you shouldn’t give your organs after you die.

Sandra: But that is a form of charity isn’t it?  I have no more use for the organ and should be given to others if others have the use for it.

Maynard: So you give only when you don’t need and charity is given only if it is by the way?  You can technically survive with one kidney so why can’t you just give it to someone who needs it now?

Sandra: Then I would have to take the health risk that comes with it.  Unless it’s a love one, the risk doesn’t make sense.

Maynard: But people are dying because too many of us think like what you just said.  It doesn’t make sense to give someone an organ and take a risk, which is a cost, in your life especially if the needy is not a “love one”.  What happen to charity and love and compassion?  Suddenly its about you and if it makes sense to you.

Sandra: Charity should be done only if there it doesn’t affect our personal safety.

Maynard: again, I rest my case.

Auntie Hua: Boys and girls, stop arguing over such matter.  If you look at it from an objective point of view, I can price my fish at a high price, but only if my customers are willing to buy it for whatever reason. If they don’t want to buy, I cannot sell it at that price.

Sandra:  You mean you are not against it Auntie Hua.

Auntie Hua: This is an objective view with regards to buying and selling. You know I price my fish quite a bit higher than the other fishmongers in the market. But yet customers still buy from me, because they know my fish is fresh. Actually this buying and selling of organs still goes on anyway. Besides this problem of a black market, where some people get cheated to sell their organs for small sums, there is also the other problem of organ robbing.

Uncle Bob: I guess your second problem exists even today just not as prevalent but really that risk can only be reduced by police diligence while the first problem can only be mitigated by a competent and proper regulator.

Sandra:  But shouldn’t people have equal rights to getting their rights to live?  A market will just mean rich people will get to those organs.  First come first serve or lucky draw systems are both random and not biased towards a certain group of people right?  And I still argue money should not be exchanged for such things.

Maynard: Let us look at this objectively rather than moralistically. Supply is definitely less than demand and any way of distributing the supply can be argued for and against.  The random allocation of resource can result in the organs going to people who are economically not productive or even disruptive.  Would you like to know that your kidney or liver was given to a murder or rapist?

Sandra: No, but that is not my point.

Uncle Bob: Well, we can argue till the cows come home but creating a market for organ sale may not be necessarily bad.  The system needs to ensure transparency and fairness.  There are always willing sellers and willing buyers and if a monitored system does not exist to help match these people, they would simply turn to the black market and help brokers like Phillipee thrive.

Phillipee: I am not a broker Uncle Bob.  I was just speaking hypothetically.  But the potential rewards are tempting.

Maynard: Exactly.  On top of making the brokers rich, there is no quality assurance in the black market.  How do you know if the seller has AIDS or other disease?  How do you know if the seller is selling you a health organ or one that is close to malfunctioning?  A regulated market may be able to at least create such transparency.

Sandra: But the poor would most likely be the seller of their organs.  What if some of them decide to sacrifice their life and sell all their organs so that their kids can live?  What if they are tricked by their kids or relative to sell their live away?

Maynard: We really cannot control how people can be cheated by their own family members but such situations exist whether or not a regulated market exists - since black markets do exist.  Laws and checks can be created to reduce the chances of such events but really, it is something we cannot control.

It will be hard for one to sacrifice oneself for the benefit his or her love ones since such sacrifice can be considered suicide and those who assist in such suicide can be considered murders.

You are right though to say that the poor would be the most probable suppliers of organs.  But really, if a transparent and properly regulated market exists, it is not to their detriment.

Sandra: What do you mean?

Maynard: Like what Phillipee said, given the right price, someone will give up something for the benefit of another.  For the one trying to buy an organ, life extension is more important, on the other hand, for one who is trying to earn a good amount of wealth, improve quality of life is more important.  A transparent pricing system will allow the seller to sell an organ to one who can pay the price.  Competition amongst the individual buyers and individual sellers and bargaining in the market between buyers and sellers would determine a fair market price for exchange.  Instead of $23k, the seller could have received $2mil for his kidney.

Sandra: Is that fair?

Maynard: Well, the seller has the rights to evaluate before deciding.  He has to consider the fact that he has transferred some health risk from the buyer to himself.  He must also consider a possibility that he may need more medical care in the future and also more importantly less years to live.  If the price is right after all these consideration, he would make the trade.  The seller really may not have $2mil even if he lives till 120 year old.  To the person who takes the trade, that is definitely fair.  Is it morally right?  Moral is really a manmade concept that has different definition between each individual.  Think about it, even if you give your kidney to Mitchell, you would have some expectations for him to take care of you.  Isn’t that why you don’t mind giving your organs to a love one and not me?  You do mentally and unconsciously evaluate the costs and benefits.

Mitchell: So this is not a bad idea.

Sandra: I am not so sure, I still feel that it is not right.  Why can’t it be done for a smaller amount but the government would take care of such caring people instead?  Like giving them free first class medical and even maybe take care of the family if the donator dies?

Maynard: Well, what is the difference between such a policy and money in the seller’s pocket?  The difference is that the receiver of the organ transfers the health cost to taxpayers.  The buyer or receiver of the organ has a healthcare cost which he can choose to transfer to another person – the donator – at a cost.  If we have such a policy of having the government takes care of the donator, the cost which should be originally incurred by the receiver would now be transferred the government who would then have to finance it from more tax.  So the cost is effectively transferred to taxpayers.  It is not acceptable to me.

Uncle Bob: Sounds rational and logical, if you can detach the moral issues.

Auntie Hua: We do not talk about moral issues when we take the lives of seafood when we consume them. But let’s get on with dinner, the food is getting cold.