Let there be MARKETS....in Kidneys?

A Cost-Benefit Analysis of Government Compensation of Kidney Donors 

Philip Held et al.
American Journal of Transplantation, forthcoming

Abstract: From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments — $1.45 million per kidney recipient — but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy — about $1.3 million per recipient. These numbers dwarf the proposed $45 000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100 000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year.

A euvoluntary exchange?  How could we tell?

(Nod to Kevin Lewis for the reference)

Organ Sales

Interesting piece in the Times about "organ brokers."

Money quote:  "Some physicians and ethicists question the relative morality of allowing thousands to die [waiting for organs] just because the means of saving them is considered repugnant. A regulated marketplace, they say, could all but eliminate the shortage. It is no accident, they argue, that the only country that allows compensation for donors — Iran — effectively has no waiting list."

So, to put it unfairly, is it just for people who don't need money, and who don't need organs, to prevent people who need organs from finding people who need money?  How much should we value the moral smugness of those so disinterested and insulated from the consequences of imposing value judgments on others that they can contemplate "ethics"?

With a nod to Kevin Lewis...

Medicine is not Euvoluntary: Juvenile Lung Transplant Edition

A federal judge in Philadelphia has ordered HHS head Kathleen Turner Sebelius to reverse her decision that a 10-year old girl be ineligible for a lung transplant from a donor above the age of 12.

The economics of the case are trivial (no market, no prices, so weird allocation decisions are the norm), so let's instead consider some of the moral intuitions that lead to the existence of an organization like HHS.

1. Conventional ownership/exchange
   For what I assume are mostly Rawlsian and Arielian reasons, folks object to spot transactions for vital organs. Roth-style matching algorithms seem to strike a balance between the nice thick market we'd like to see and the callous, mercenary sale of the components of life we'd like to avoid. But in the sense of plain jane alienability, we're pretty far from owning our own organs. This leaves open the extremely relevant question of who does? If it's some nebulous "society", or even "medical science", we're still left with a concrete puzzle of just who it is will make final allocation decisions. Is vesting a DC appointee or an elected official this responsibility a priori superior to the natural arrangement where my guts and lights are my own?
   
2. Regret
   Tissue rejection might be a reason to regret a transplant, but it's more likely that families will regret having to queue for organs, particularly when viable organs are available. One of the troubles here is that unlike markets for toilet paper (where you can buy as little as half a dozen squares in some places in the world), the unit under sale is more or less fixed. If the price of a kidney is $10,000, a patient can't just say, "well, I've only got two grand, so give me a fifth of a kidney." Renal systems don't work that way. I wonder if there might be something to Paine's aphorism here: "what we obtain too cheap we esteem too lightly" when we consider high-income patients. I apocryphally recall conversations with friends who claim that markets in organs would subsidize intemperate consumption by rich folks. Why bother taking care of yourself when you can just buy a new liver when your old one wears out? To the extent that this might be empirically true, it offends any reasonable sense of fairness.
   
3. Externalities
   None that I can think of.
   
4. Coercion
   Institutional coercion is what replaces market allocation, so there's that, I suppose. Is this morally preferable? Consequentially preferable?
   
5. BATNA disparity
   We tend to dislike debt issued under conditions of duress. Duress from crappy BATNA means that lenders can don a usurer's cap and pile on punitive interest rates. Or so it seems from third parties' perspective. Never mind I guess that organ transplants imply a somewhat stronger default risk. At any rate, it's a matter of perception: people on transplant waiting lists are desperate in an absolute sense and disparate in a relative sense. Voters and medical elites alike can adopt clinical detachment and prescribe a suite of organizational treatments. Who better to be an object of paternalism than the sick? And who better to be the paternalist than... a beltway bureaucrat in a nation of over 300 million people? Right?

I have a hunch that the ACA is going to turn out to be a hideous chimera that eats itself and within a decade or two we'll have EU-style single payer here in the US. Ask the Ollie Williamson question: is the ACA a crowbar to pry out a class of entrenched interests? Is it nothing more than a flurry-sheaf meant to overcome a transitional gains trap?

Altruistically Unbalanced Kidney Exchange

How interesting.  A "market" solution to the shortage of kidney donors.

Altruistically Unbalanced Kidney Exchange

Tayfun Sonmez

Boston College - Department of Economics

M. Utku Ünver

Boston College - Department of Economics

February 1, 2012 Abstract:      Although a pilot national live-donor kidney exchange program was recently launched in the US, the kidney shortage is increasing faster than ever. A new solution paradigm is able to incorporate compatible pairs in exchange. In this paper, we consider an exchange framework that has both compatible and incompatible pairs, and patients are indifferent over compatible pairs. Only two-way exchanges are permitted due to institutional constraints. We explore the structure of Pareto-efficient matchings in this framework. The mathematical structure of this model turns out to be quite novel. We show that under Pareto-efficient matchings, the same number of patients receive transplants, and it is possible to construct Pareto-efficient matchings that match the same incompatible pairs while matching the least number of compatible pairs. We extend the celebrated Gallai-Edmonds Decomposition in the combinatorial optimization literature to our new framework. We also conduct comparative static exercises on how this decomposition changes as new compatible pairs join the pool. 
Nod to Angry Alex

Constrained Euvoluntarity: Roth and Kidney Exchanges

The big news today is that Al Roth and Lloyd Shapely won the Nobel in Economics. The responses from my economist friends have been largely tepid. I mostly understand their reservations, though I do not entirely share them. To me, Roth is a directional euvoluntaryist.

For those of you who may not be familiar with his work, he is less an observational economist and more of an engineer: he's created kidney exchanges where folks who need kidneys can pool and match donors with recipients. Family and friends can join in. The matching algorithms these exchanges use are suitable for a whole host of applications, from online dating to custom-made reduction gear replacement and even farming. For our purposes here, the interesting application is the kidneys. We've pointed out before that organ sales are aesthetically unpleasant and the resulting popular opposition can generate ugly consequences. Dialysis is not fun. Rather than shaking his fists at the misdirected moral intuitions of the median voter, Roth put his nose to the grindstone and created a matching algorithm that increased the number of transplants without offending  folks' anti-mercenary moral foibles.

So, is Roth a destination euvoluntaryist? If he were, he'd be pounding the pulpit for the freedom for people to do as they wished with their own bodies, including voluntary sales of vital organs, decrying exchanges as mere half-measures. No, I think he's a directional euvoluntaryist, interested in consequences, but willing to admit that the first-best solution is out of the field of play. I am quite confident that the people who have been able to obtain life-saving transplants thanks to his hard work certainly appreciate everything he's done. I for one favor his practical approach to expanding the freedom of association in a world of very real political constraints. Bravo.

Brother, can you spare a tissue?

Driving home from work yesterday, I caught a minute or two of an NPR piece on tissue donation. In case you're not completely familiar with the practice, it's much like organ donation, except that instead of whole organs like kidneys, hearts, corneas or lungs, donations are smaller bits and bobs, like heart valves, earlobes or, more commonly, skin.

Here's Part 1 of the series, and I apologize, but I have no idea what segment I caught yesterday. What struck me was the interviewee's remarks on his own participation as a donor. The gentleman being interviewed, a former tissue harvesting technician, had removed himself from the donor list. He acknowledged that deserving patients (I think the example was a father of four waiting for a heart valve or a four-year old burn victim or some other heartstrings-tugging thing) might run the risk of privation, but that he did not feel comfortable donating skin if it meant that it could end up as part of a penile enhancement procedure.

Morality of Organ Sales?

An interesting article.  Thanks to Kevin Lewis for the citation...

Are Bans on Kidney Sales Unjustifiably Paternalistic?

Erik Malmqvist, Bioethics, forthcoming

Abstract:  This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is, that they unduly deny people the freedom to make decisions about their own bodies in order to protect them from harm. I argue that not even principled anti-paternalists need to reject such bans. This is because their rationale is not hard paternalism, which anti-paternalists repudiate, but soft paternalism, which they in principle accept. More precisely, I suggest that their rationale is what Franklin Miller and Alan Wertheimer call ‘group soft paternalism’. Group soft paternalistic policies restrict the freedom of autonomous individuals, not for their own good (hard paternalism), but as an unavoidable consequence of seeking to protect other, non-autonomous individuals from harms that they have not voluntarily chosen (soft paternalism). Group soft paternalism supports prohibiting kidney sales on three conditions: (1) that such sales are potentially harmful to vendors, (2) that many vendors would suffer impaired autonomy, and (3) that distinguishing between autonomous and non-autonomous vendors and interfering only with the latter is unfeasible. I provide reasons for thinking that these conditions will often hold.

The New Kevorkian?

News Story:

Levy Izhak Rosenbaum was sentenced today by U.S. District Judge Anne Thompson in Trenton, New Jersey. He pleaded guilty in October to three counts of organ trafficking and one of conspiracy.
“It’s a kind of trading in human misery,” Thompson said of black-market kidney sales. Rosenbaum “charged a fee” for kidneys and “used a complicated web of transactions” to finance his business.

“He corrupted himself,” the judge said.

Three ailing people in New Jersey paid Rosenbaum a total of $410,000 to arrange the sale of kidneys from healthy donors, and an undercover FBI agent paid him $10,000. A 1984 U.S. law bans the sale of human organs.

Rosenbaum told a federal agent that he began brokering kidney sales around 1999, recruited Israelis to sell their organs and charged Americans as much as $160,000 a kidney. He told the agent that he had arranged “quite a lot” of transplants, according to a criminal complaint.

I have a question.  Who was harmed, exactly?  Let's be careful.  It's likely that none of the people who donated for pay would otherwise have donated for free.  That means that no one who felt that society owed them a free kidney was denied anything.

And though we can't know, it's likely that the people who donated all thought themselves better off.  Likewis the people who got a kidney, and were able to resume a life not tied to daily dialysis.

So....who was harmed?  Why is this man who brought together willing buyers and sellers being punished by 30 months in jail?  At our expense?  I don't get it.  The judge corrupted HIMself.

Food Donations are NOT Euvoluntary; Should State Regulate

Wow, Titus Landegent recognized something I had missed.

Here's the story: Mayor Bloomberg has decided that the homeless need a better diet. So he is cutting off food donations, because the state cannot control them adequately.

Glenn Richter arrived at a West Side synagogue on Monday to collect surplus bagels — fresh nutritious bagels — to donate to the poor. However, under a new edict from Bloomberg’s food police he can no longer donate the food to city homeless shelters.

It’s the “no bagels for you” edict.

Okay, so that's funny, Mayor Bloomberg is the bagel nazi. But what's really going on here?

Before, the homeless were getting donated food of uncertain quality, and it was quite possibly high in fat and salt. The homeless were likely dependent on this food, because their BATNA was even worse, perhaps even starvation.

Hard to see how anyone was "exploiting" the homeless by donating food. But it is an interesting point: should we prevent donations to people who desperately need those donations? Isn't that pretty similar to telling the guy who wants to sell his kidney to get medicine for his daughter that he can't do it?

In other words, I can donate food to people, but only if they don't need it.

Credit Default Swaps on Human Lives

One of the objections* to credit default swaps was that you could buy a bet on an asset, even if you don't own the asset.

Interestingly, there is an emerging trend that is disturbingly similar, only moreso. EE buddy G. Rossman sends a link to a paper that describes the practice of buying life insurance policies....on strangers. The analogy is disturbing, perhaps, but not inaccurate. There is little moral hazard in me having a life insurance policy on ME, because I "own" me. But what if I have a contract that pays me a lot of money if YOU die? And I am a complete stranger...

It is certainly an interesting question, and disturbingly similar, now that I think on it, to selling organs. Consider:

1. I decide that capital markets are imperfect, and that a considerable benefit will accrue upon my death to some person who gets my kidney. But I want access to those funds NOW. So I make a market to solve the imperfection, selling a right to my kidney, or selling my kidney now, to someone who needs a kidney and will pay a lot of money.

2. I decide that capital markets are imperfect. I have a fully paid up whole-life insurance policy that will pay a substantial sum to my designated beneficiary upon my death. But I want access to those funds NOW. So I sell a portion, or all, of the death benefit to the highest bidder, almost certainly a stranger.

Now, #1 is illegal. Should #2 be illegal? On what grounds? Is it because we would say that such a transaction is not euvoluntary, because the person selling the rights to the life insurance benefit must have no other viable means of raising capital?

(*The other objection to credit default swaps was that cds's were treated as insurance policies, but there were no requirements on reserves or laying off risk. So, AIG famously took $500 billion in bets that the housing market would never decline even as much as 5%, as was made famous in the movie, "Margin Call." A real bookie NEVER makes a bet, and uses the line or odds or something to clear the market on both sides of any bet, so the bookie's position is neutral with respect to risk. Then the bookie makes his cash from the vig. AIG did NOT act like a bookie, but instead had a huge position on one side of a bet. Efficient markets theory would say only an idiot would do that, and so no regulation is necessary. The cds and AIG incident raises the question, "But what if smart people hire physics grads who are actually idiots when it comes to understanding real markets?" Again, efficient markets theory says they WON'T do that. But.... they did.)

Markets in Body Parts: Podcast

In this Kosmos Podcast, the controversial Dr. James Stacey Taylor, author of Stakes and Kidneys: Why Markets in Human Body Parts Are Morally Imperative, dives into the philosophical and moral details of the recent court decision legalizing compensation for bone marrow donations. Dr. Taylor (shockingly) thinks this is a good result for everyone involved, and provides an outlook for markets in organs in the near future.

Stimulus "Recovery Act" and Kidney Transplants

Not making this up. Actual problem of rationing kidneys by region (article here), causing large differences in access across the nation.

Excerpt:

During his most recent hospital stay, Reginald Baker received bad news from his doctor. Over many years, his kidneys had gradually lost their ability to function, and now he would need a transplant. Reginald’s doctor said he would be added to a transplant list, but the waiting period for a kidney could be years. Reginald would be joining the approximately 80,000 people who are awaiting a kidney, while the annual number of transplants peaks at only about 17,000.

Reginald was especially surprised to learn that one of the factors adding the most time to his wait for a new kidney wasn’t his blood type or the severity of his disease but, rather, his geographical location. The closest transplant center to where Reginald lived served the large metropolitan region of the San Francisco Bay Area. His doctor explained that the area faced a particularly severe organ shortage due to the number of residents in need of transplants. Smaller towns in the Midwest, for example, have less competition for organs and are better supplied with kidneys for transplantation.

Reginald didn’t have the resources or the health to relocate himself and his family or to travel far from his home and his hospital to try to improve his chances of getting a kidney. He would just have to wait and hope.

ARRA May Help Improve Organ Allocation
Dr. Krista Lentine, associate professor of medicine at Saint Louis University, is addressing the plight of the thousands of Americans awaiting life-saving organs, particularly kidney and liver transplantations. With support from NIH and the American Recovery and Reinvestment Act (ARRA), Lentine and her team are highlighting geographical disparities and working to develop improved systems to ensure fairness in organ allocation.

Lentine’s motivation stems from her observation that patients with similar illness severity experience different waiting times due to imbalances in geographical supply and demand. For example, the average waiting time for a blood group O kidney varies from 2.8 years in a well-supplied Midwest region to more than 6 years in a West Coast region.

The United States currently is divided into 11 geographic organ-sharing regions that direct organ distribution. Operating within this geographical system are nationally agreed-upon rules that define priority among transplant candidates. For liver transplants, priority is determined based on illness severity using a scoring system that predicts the patient’s risk of death without a transplant. For those awaiting kidney transplants, however, priority is mostly determined by how long the patients have been waiting.

“These regions were not developed by any scientific method, but the intent was to divide the country in a way that would place organs quickly and encourage local donation,” said Lentine. “However, the current regions are heterogeneous in size and population, leading to mismatching in available organs with waiting candidates.”

(Nod to Michael Hartwell)

"Altruistic" Donations: In Fact, Payments are Allowed for Kidneys

Perhaps the most controversial kind of organ donation is the live donation, where the organ is harvested from a healthy human and given to someone whose organ has failed, or is about to. Obviously, live donations of a heart is impossible (I did once get back a referee report on a paper where the anonymous reviewer suggested I must have been the first successful live brain donor...). But other kinds of live donation, either a kidney or a portion of a liver, lung, or pancreas, are possible and relatively safe.

The problem is that the person who wants to donate is very unlikely to be a match for the person who needs it. You need a kidney, I want to donate mine, but you can't accept mine. And so we need to build a chain. But the chain is composed of people who, after the first altruistic donor, are all compensated in the sense that they are giving a resource to a family member. As this news story notes, it's actually a "swap," not a voluntary donation. Some background....

This video is quite good. It illustrates the importance of the payments implicit in the chain system, and also the naive insistence that there are no payments.

This letter from the Durham Herald Sun (Dec 10) is quite insightful:

***********
In your editorial "Gift of Life, no death required" (December 6) you appropriately celebrate the rare willingness to be an altruistic kidney donor. You then say that more like the first recipient's daughter "help because someone they love was helped."

A very substantive issue is overlooked in both the editorial and the news stories covering this remarkable event, an event I, as a practicing nephrologist, also celebrate. The Duke transplant of two kidneys is often called "chain donation" and has been as many as 14 donor / recipient transplants of kidneys in other centers. This has become a popular but difficult method of improving the important opportunity to transfer patients away from dialysis to a better life.

But note that both the government and most ethicists have expressed deep concerns about payment to donors, a concern that I think needs reexamination. In these "chains," only the first donor is "altruistic." The others are "bridge donors." These are people who have made a contract to benefit a friend or family member...Clearly this is also a form of payment...I hope that experts will [analyze] the very thin line between this form of payment [and monetary compensation] and perhaps open the possibility of early transplantation for the tens of thousands of dialysis patients currently waiting years.

I am aware of the concern that poor people will be made "vulnerable" by the promise of money, but I also believe that safety and protection could be built into such a system.

Robert Gutman, Durham
***********

A perfect illustation of the problem of euvoluntary exchange. Poor people are made "vulnerable," in point of fact, by being POOR. Selling a kidney would be a way to be less poor. But the medical establishment considers all incentives to be coercive. Poor people must be forced to remain poor, in a kind of human museum of poverty and misery. So they die with healthy kidneys. And wealthy people who would gladly pay hundreds of thousands of dollars for a healthy kidney and a better life must be doomed to live miserably and die young

All so doctors can feel good about themselves as being "ethical?" I just don't get it. Literally no one is benefitted by this system except the consciences of doctors who themselves make huge salaries, but dictate that no one else can get paid because incentives and medicine don't mix.

My good friend Virginia Postrel pretty much nails it here.

NYT: Why Kidney Sales Should Be Legal

Guest op-ed by Excerpt:

On Thursday, I will donate one of my kidneys to someone I’ve never met. Most people think this sounds like an over-the-top personal sacrifice. But the procedure is safe and relatively painless. I will spend three days in the hospital and return to work within a month. I am 21, but even for someone decades older, the risk of death during surgery is about 1 in 3,000. My remaining kidney will grow to take up the slack of the one that has been removed, so I’ll be able do everything I can do now. And I’ll have given someone, on average, 10 more years of life, years free of the painful and debilitating burden of dialysis.

If kidney donation is this easy, why do the stereotypes about heroic sacrifice persist? Part of the problem is history: before modern medical advances, organ donation used to be quite painful and dangerous. But organ donation advocates also deserve some of the blame. In a misguided attempt to make the families of brain-dead patients consent to the posthumous donation of their organs, advocates treat donors like saints. But deifying donors only serves to make not donating seem normal. When I first told some friends and family that I wanted to donate a kidney, they assumed I’d gone off my rocker. They saw it as a crazy act of self-sacrifice, rather than what it is — one of the many ways a reasonably altruistic person can help others.

This is a serious problem, because there aren’t nearly enough saints in the country to tackle the growing waiting list for a kidney. More than 34,000 people joined the waiting list in 2010; fewer than 17,000 received one. Thousands of people die waiting each year.

This is a tragedy, but it doesn’t have to be this way. The people waiting for kidneys aren’t dying because of kidney failure; they’re dying because of our failure — without Congress’s misguided effort to ban organ sales, they would have been able to get the kidneys they desperately needed.

It has been illegal to compensate kidney donors in any way since 1984. The fear behind the law — that a rich tycoon could take advantage of someone desperately poor and persuade that person to sell an organ for a pittance — is understandable. But the truth is that the victims of the current ban are disproportionately African-American and poor. When wealthy white people find their way onto the kidney waiting list, they are much more likely to get off it early by finding a donor among their friends and family (or, as Steve Jobs did for a liver transplant in 2009, by traveling to a region with a shorter list). Worst of all, the ban encourages an international black market, where desperate people do end up selling their organs, without protection, fair compensation or proper medical care.

A well-regulated legal market for kidneys would not have any of these problems. It could ensure that donors were compensated fairly — most experts say somewhere in the ballpark of $50,000 would make sense. Only the government or a chosen nonprofit would be allowed to purchase the kidneys, and they would allocate them on the basis of need rather than wealth, the same way that posthumously donated organs are currently distributed. The kidneys would be paid for by whoever covers the patient, whether that is their insurance company or Medicare. Ideally, so many donors would come forward that no patient would be left on the waiting list.

What Can You Sell?

If there is complete self-ownership, why should selling babies be illegal?

Suppose you think there should be a market in organs. Suppose you think prostitution should be legal.

Then why would adoption be allowed only as a donation? Why not pay women to have babies so other people can adopt them? We DO allow surrogate motherhood. In fact, you can pay a surrogate mother a lot.

Where is the line between surrogate motherhood and payment for adopting a baby? Is the fact that there was a prior agreement really that much of a difference, ethically? If a mother can sell an unborn baby, on a future contract, why can't she sell a baby at 1 month old? A year old? Fifteen years old? What is the principle that guides us here?

The LMM wants to know... Because a mother in Miami was just arrested for trying to sell her baby.

(Part Two, with some larger questions, tomorrow!)

New Conditions on Organ Donations

what is the ethical trade-off in ensuring the safety of donated organs? What probability is "acceptable," since zero risk is unachievable? Well, there are new rules: you can't have had more than two sexual partners in the past year. Excerpt:

“With the new guidelines, every college student in America will be high risk,” said Dr. Harry Dorn-Arias, a transplant surgeon at the University of Virginia. “Right now, it's probably a prostitute or a guy with a needle in his arm. Next time, it will be just a young guy."

Under the new policy proposed this fall by the Centers for Disease Control and Prevention, deceased and living donors who were not monogamous in the previous 12 months would be considered at increased risk of transmitting HIV, hepatitis B and hepatitis C -- even if they had no other risk factors

CDC officials say the proposed guidelines are aimed at making the organ supply safer and preventing accidental transmission of life-threatening infections. The policies wouldn’t absolutely ban anyone from donating, especially in an exceptional or life-saving situation, but they would call for more scrutiny and testing.

Bone Marrow Transplants: $$ is okay because....what?

A-Tab deals. I have nothing to add.

ATSRTWT.

Kidney Sales: A Moral Case

A moral case for allowing kidney sales...


(Nod to IHS for sponsorship...)

Just the sort of thing John D Already Mentioned

In comments to an earlier post, commenters "John D." and "Anonymous" had an exchange about whether legalizing organ sales would increase illegal kidnapping and theft of kidneys.

It is likely an empirical question, I suppose, but here is a story of such theft, not hypothetical but real.

I think both sides have a point here. First, it is quite true that in societies with poorly developed property rights and government protection, making organ sales illegal won't protect anyone. If you can get away with kidnapping, you can get away with a lot of things.

But John D. has a point also. Kidneys don't come with bar codes identifying their source. If the trade is international, it is quite possible that legalizing the purchase of kidneys by a first world buyer will result in more kidnapping in third world countries. One cannot assume that the act of legalizing sale will also create effective police protection and other civil institutions.

I don't think this is a good argument against legalizing kidney sales WITHIN the US (i.e., US donor, signs consent, euvoluntary exchange). But it is pretty good argument against legalizing purchase by Americans of kidneys "harvested" in the third world.

Selling Kidneys: A Sting Operation

Ilya Somin is very sure of himself here. And everywhere else, also.

While I agree with him for the most part, I no longer believe the issues are quite so clear cut. If someone sells an organ because s/he is desperate, that's something we should worry about.

But in any case Levy Itzhak Rosenbaum has been convicted of brokering organ sales, for profit.

Ilya Somin's strongest point, of course is this: Where's the harm? Compare the two states of the world, one where sales are allowed and the other where they are prohibited. Who is better off under prohibition? To favor prohibition you have to answer "the society," since no individual is better off.