We favor a freer market in kidneys.

• Author: Barnett, William, II
• Position: Reply

According to Michael Brooks in his article "A Free Market in Kidneys Would Be Efficient and Equitable: A Case of Too Much Romance" in this issue of The Independent Review, our case for a free market in kidneys founders on an overly romantic view of government. Our analysis, however, was not intended to justify the government's acting as a payer-of-last-resort for those who might benefit from a kidney transplant. Nor did we presume that government subsidies lead to efficient and equitable outcomes. We stated (Barnett, Saliba, and Walker 2001) that our primary purpose was to refute two arguments used to support the current prohibition on the purchase and sale of kidneys: (1) that "wealthy people ... would bid up the price.... Therefore, the `poor' would be priced out of the market" and (2) that "only poor individuals would sell kidneys, and such sales would be coercive in nature" (374). We made our proposal to repeal the prohibition on sales and purchases of kidneys in the context of the reality of the current situation, in which the government does act as the third-party payer-of-last-resort--a reality unlikely to change anytime soon.

Brooks does not disagree that, regarding the first issue, we established our point that the poor would not be priced out of the market. Instead, he makes the point that in his opinion some people should be priced out of the market. He does not consider the second issue, that only the poor would sell kidneys and that they would do so under coercive situations, which we also refute. (1) Our analysis shows that a "freer" market in kidneys would lead to greater efficiency and equity than is the case where the sale and purchase of kidneys are prohibited by law.

Under the current system, only donated kidneys are available for transplant, resulting in a shortage of transplantable kidneys. Moreover, in the current bureaucratic processes, these artificially scarce kidneys almost certainly are misallocated. Both of these factors result in inefficiencies. Our analysis indicates that permitting kidneys to be sold and purchased in markets would eliminate the current economic shortage of kidneys. Further, as long as the government continues to serve as payer-of-last-resort, the medical shortage of kidneys also would be eliminated, so anyone who could benefit physically from a kidney transplant would have access to one. The latter result may not be efficient, as Brooks notes. On the other hand, it may be! Given the increased...