Years ago, shortly after joining the Marines, I signed up for the bone marrow donor registry. I almost forgot about all that as the year went on, until one day in June 2020, I got a call from my dad. He had received a call from the registrar’s office. (When I first registered, I didn’t have my own cell phone, so I put my old home phone number as a contact.) It turns out I’m the ideal person for someone suffering from leukemia. I did. Need for bone marrow transplant. My father passed on the information he had collected and I contacted the registry office.
My only concept of how bone marrow transplants work came from what I remembered from medical shows. Usually, a huge needle was driven into the bone to extract the bone marrow. It turns out that this requires a different method. In the days leading up to the donation, a nurse came to my house every day and administered filgrastim injections. This causes my body to overproduce bone marrow stem cells, which flow into my bloodstream. It was also said that common side effects of filgrastim injections are significant muscle, joint, and bone pain with headache, weakness, and nausea. After a week of these injections, I spent several hours hooked up to what is essentially a dialysis machine that filters these cells out of my bloodstream and makes them available to those who need them.
It all seemed like a lot. To further complicate matters, this was June 2020, still in the early stages of the COVID-19 pandemic. I was already cautious about this disease because I was worried that my past as a heavy smoker might make me more susceptible to respiratory illnesses. Taking further risks certainly seemed risky. To complicate matters, my wife and I had just welcomed our first son into the world just a few weeks earlier, in mid-May 2020. As any parent can attest, we never slept more than a few hours in a row after that. Spending a week working, caring for a newborn, and experiencing the side effects of these shots seemed like a lot.
In the end, I decided to go ahead and do it. I was already feeling pretty shattered and it was going to be a long wait to donate, plus the added discomfort of the donation process. But I wasn’t dead. And someone else was dying and I could help save them. I’m glad I did it. However, at the time, I felt that I had made the right decision. If I had been a little more cautious about the coronavirus and its possible complications, a little more tired from the newborn stage, and a little more worried about the painful side effects of injections, I could have been on the other side of the line. Very expensive. .
What economists have in mind when they talk about “sleep” is this stage, right on the edge, at the tipping point of moving from one option to another. When I made that decision, I was a marginal donor and someone who was on the verge of going through with it willingly. The cost was a complication with all of the above, but the benefit was to satisfy the general desire to help those in need. For me at the time, the benefits barely outweighed the costs. But suppose that wasn’t the case. Suppose my general desire to help people was a little lower, or that I valued some or all of those costs a little more at the time. In that case, I would have been barely on the other side of the line. I’m almost willing to donate, but not completely. In such cases, do you know what can make a difference and apply the balance to a donation? Expect to be paid.
If my desire to donate had been marginally met, being offered a small payment would have been enough to get me over the line. If my reservation had been stronger I would have had to pay a higher amount. and so on.
In the United States, it is against the law to accept payment for organ donation. Everyone else involved in the surgery, such as the hospital and medical staff, may be paid for their part in the kidney transplant, for example, but the person who actually lost the kidney received some compensation for their part in the process. If a crime has been committed. As a result, only willing donors can donate their kidneys for free. The number of such people is not zero – Scott Alexander is one of them – but the number is clearly much less than the number of kidneys that a sick person needs. This creates a huge waiting list for a kidney donor, and thousands of people die each year before a donor is found.
There aren’t enough people with Scott Alexander levels of altruism. But what happens to those who are right on the border? People who aren’t perfect, but are altruistic enough to donate a kidney for free. For these people, it may take a small payment to go from being an unwilling donor to a willing donor. And when those people cross the line, a new group of people will emerge who are on the very edge of this new line. Altruism combined with small payments is enough to motivate people to donate, but not enough. Even after a small payment is offered, if the number of people needing a kidney is greater than the number of people willing to donate it, prices could rise and push the next group of people over the edge. there is. This process can continue until the price is high enough that the last person needed crosses the line from “not very happy” to “barely happy.” This means that the final price for a kidney donor will ultimately be set by the margin. .
According to this website, as of September 2024, approximately 90,000 people are waiting for a kidney transplant in the United States. About ten of them will die waiting for that day. A total of approximately 27,000 kidney transplants were performed in the previous year. More than 60,000 kidneys are in short supply. The question is: How much will it cost to convert 60,000 people from not wanting to donate to being willing to donate? It may be lower than you think. Prices are not set by what most people want, even though most people would not consider donating a kidney for less than $1 million. Prices are set generously. So you start with those on the edge of giving for free, and only need to pay high enough to motivate the 60,000 people who are already the most likely to donate. I wouldn’t be surprised if the payments required to close the gap turned out to be quite small.
Many people dislike the idea of paid organ donation. Debra Satz makes many arguments against this idea in her book Why Some Things Should Not Be For Sale: The Moral Limits of Markets. It’s an absolutely wonderful book. But none of those arguments are convincing enough to overcome the simple fact that more than a dozen people today will die waiting for a kidney. Tomorrow, the day after tomorrow, and Christmas, another dozen every other day until we get more kidneys. By contrast, all of Satz’s concerns about “nasty deals” are just a storm in the teacup.
