Incentives and organ donation

Dan Salomon, the president of the American Society of Transplantation, posted this last year on his presidential blog.
Encouraging organ donation: Removal of Disincentives and Consideration of Incentives

It said in part
"But a new possibility for the AST to creatively reconsider the current situation in the US was suggested by recent discussions with the ASTS regarding a joint response to the follow-up conference in April organized by the TTS and their partners in Doha, Qatar on the 5-year impact of the original Declaration of Istanbul. The Declaration outlined an international position on the ethics of paid organ donation intended to send a clear message that exploitive, paid living donation practices that were sometimes even criminal in nature, were not acceptable. The AST signed a letter supporting the Declaration. In the intervening 5 years, the Declaration had a significant impact on reducing and marginalizing these exploitive practices.

"However, even at the time, concerns were raised here that opposing those specific practices as documented then in developing countries was not equivalent to banning any future consideration of examining financial incentives for living organ donation in the United States. I now think the time has come for a joint AST/ASTS effort to review the current status of living organ donation in the US. I think this effort should consider the problem from the perspective of disincentives that can be removed and from incentives, including but not limited to financial ones that could be acceptable. The effort should harmonize with the ethical principles embodied in the Declaration of Istanbul, but should reflect the real situation of clinical practice and ethics in the US today. The effort should be inclusive of all the major stakeholders in transplantation, not just the AST and ASTS. It is way beyond me to advocate for any particular outcome at this point, but I will be actively exploring the principle of organizing the effort next. "

I'm in Chicago today at a workshop sponsored by the AST and the ASTS on this topic.

Black markets for kidney transplants

miscellaneous black market links I've been collecting, of different vintages:

Nancy Scheper-Hughes in the New Internationalist magazine, May 2014: Human traffic: exposing the brutal organ trade

Arabianbusiness.com reports, April 2014: 410 Saudis said to buy organs on black market
"As many as 410 Saudis have bought organs – mainly kidneys – from the black market for illegal transplantations over the past two years, Makkah daily reported.

Dr Faisal Shaheen, director of the Saudi Center for Organ Transplants, was quoted as saying: “A total of 220 Saudis bought organs for transplants from markets in Pakistan, China and Egypt in 2013 and 190 did the same in 2012 at their own personal expense.”

CNN, March 2014: Lebanese mayor arrested in Spain, accused of attempted organ trafficking
"A wealthy mayor from Lebanon has been arrested in Spain for allegedly offering to pay $55,000 to poor people to obtain liver tissue for his liver transplant, police and a government official announced Wednesday.
...
"The mayor's alleged accomplices recruited and later paid for nine poor people -- eight immigrants and a Spaniard -- to have specialized liver compatibility tests at a clinic in Valencia last summer, police say. The combined tests cost $16,000, which the mayor's aides allegedly paid. Some of the nine people also received small sums of money for taking part, police said.

Just one man, a Romanian immigrant, met the medical criteria for the liver tissue removal and, posing as a legitimate donor, he accompanied the Lebanese mayor last summer to a Barcelona clinic that specializes in liver transplants. But medical workers there, following strict protocols against human organ trafficking, prevented it."

(same story here from another source: http://www.thelocal.es/20140312/police-thwart-first-illegal-organ-sale-in-spain )


Frank Delmonico's 2011 slides: WHO Perspective on Self-sufficiency--Accountability on the National Level calling for countries to develop organ donation sufficient to cover their national needs for transplantation.

The Guardian, in Dec 2010 (with various Eastern Europe mentions): The doctor at the heart of Kosovo's organ scandal As Kosovo's prime minister denies links to organ trafficking, 'Doctor Vampire' is the subject of an international manhunt
"Azerbaijan's prosecutor-general's office said last month that an investigation prompted by information from Ukranian police found "citizens of various countries" had been brought into the country for illegal kidney transplants. Four Ukrainian doctors have been arrested in connection with the alleged racket. Azerbaijani press reported that Sonmez was "involved" in the ring, which also did operations in Ecuador. "

AzeriReport.com reports, August 2010, on Illegal Organ Transplant Mafia Exposed
"The group has been disclosed by the Trafficking Prevention Department of the Ukrainian Ministry of Internal Affairs. The trans-national criminal group was involved in illegal transplantation of kidney and it included 12 members. Yurii Kucher, representative of the Ukrainian Ministry of Internal Affairs, said over three years the group has recruited online and transported Ukrainian, Russia, Moldavian, Belarus and Uzbek citizens to Azerbaijan and Ecuador.
...
The Azerbaijan law enforcement agencies are unavailable for comments. It has been established that the operations were performed in a private clinic inBaku. The lawyers claim if the donors sold their kidney voluntarily, this is not a crime and any accusations are groundless. Many people are ready to sell their internal organs to make money.  A few days prior to the arrests in Ukraine, Yeni Musavat, an Azeri newspaper, sent a journalist to an area in downtown Baku where the illegal organ donor recruiters gathered and formed a market. The Yeni Musavat journalist was offered to go to a hospital to negotiate terms for the kidney removal.  In the clinic, the journalist was asked to consider selling part of his liver."


Yosuke Shimazono, "The state of the international organ trade: a provisional picture based on integration of available information, Bulletin of the World Health Organization Volume 85, Number 12, December 2007, 901-980


HT: various correspondents

The NY Times on market approaches to reducing greenhouse gases

This graphic is from A Price Tag on Carbon as a Climate Rescue Plan, May 30.

How a Carbon Market Works

Governments around the world are experimenting with issuing permits that allow industries to emit carbon dioxide and other greenhouse gases, then restricting those permits to rein in carbon emissions.

CAP

CAP LOWERED

Purchased or

traded permits

Carbon

dioxide

emissions

Carbon

permits

Remaining

carbon

permits

Freely issued permits

CAPPED INDUSTRIES

INDUSTRY A

INDUSTRY B

CAPPED INDUSTRIES

CAP AND PERMIT

The government imposes a cap on the total amount of greenhouse emissions allowed from major industries, then issues permits to match the amount of the cap. Each permit allows the emission of one ton of carbon dioxide, or equivalent.

ISSUE, BUY AND TRADE

Initially, most of the permits are given to industries at no cost. The remaining permits can be bought at a government auction or traded in a carbon market set up for that purpose.

LOWERING THE CAP

The government gradually lowers the carbon cap by a few percent a year, which reduces the number of available permits and cuts the total amount of pollution allowed by the industries under the carbon cap.

No reduction

in emissions

Offset credits

Steep reduction

Investment

CARBON-REDUCING

PROJECT

INDUSTRY A

INDUSTRY B

INDUSTRY A

REDUCING TOTAL EMISSIONS

Industries can reduce their emissions by spending money to upgrade their facilities and equipment, or they can use the carbon market to purchase the carbon permits needed to cover their emissions — whichever is cheaper.

CARBON OFFSETS

Industries can also invest in projects elsewhere that lower carbon emissions, like forestry or burning methane from dairy cows. These projects create “offset credits” that can be used or sold, usually at a lower price than government-auctioned permits.

By The New York Times

Source: California’s Air Resources Board

AER Papers and Proceedings: 2 sections on market design

In January I blogged about these two sessions at the AEA meeting, and now they are published, except for the paper by Milgrom and Segal, which ran into some kind of embargo before the still to be conducted FCC auction...
[The links below go to a page that requires AEA membership to fully access, but you can see the article abstracts by clicking on "Show Article Details"]

Frontiers of Market Design

Implementation Details for Frequent Batch Auctions: Slowing Down Markets to the Blink of an Eye (#72) Eric Budish, Peter Cramton and John Shim

Full-Text Access | Supplementary Materials

Getting More Organs for Transplantation (#73) Judd B. Kessler and Alvin E. Roth

Full-Text Access | Supplementary Materials

Mechanism Design in Large Games: Incentives and Privacy (#74) Michael Kearns, Mallesh M. Pai, Aaron Roth and Jonathan Ullman

Full-Text Access | Supplementary Materials

Investment Incentives in Labor Market Matching (#75) John William Hatfield, Fuhito Kojima and Scott Duke Kominers

Full-Text Access | Supplementary Materials

Market Design for Auction Markets

The VCG Auction in Theory and Practice (#76) Hal R. Varian and Christopher Harris

Full-Text Access | Supplementary Materials

Market Design and the Evolution of the Combinatorial Clock Auction (#77) Lawrence M. Ausubel and Oleg V. Baranov

Full-Text Access | Supplementary Materials

The Continuous Combinatorial Auction Architecture (#78) Charles R. Plott, Hsing-Yang Lee and Travis Maron

Full-Text Access | Supplementary Materials

A long non-directed donor chain in Australia

Here's the story fro;m the Melbourne Herald Sun (with nice pictures):
IN AN incredible medical marathon, a dozen Victorians went under the knife in ­Australia’s largest live kidney ­donation and transplant swap.

"The Australia-first paired ­kidney exchange, if successful, will give six people who have been languishing on dialysis a second chance of life.

"Twelve operations to remove and transplant the organs were performed in four major hospitals across Melbourne yesterday.

"The extraordinary chain of events was triggered by Victoria’s first altruistic donor giving a ­kidney up to a stranger.

"That selfless act set off a domino effect that became the ­nation’s first six-way paired kidney transplant exchange attempt.

"Five other Victorians gave up a kidney to a suitably matched stranger.

"A loved one of each donor who was in need of a kidney received a donated organ in return."

When does sperm donation equal paternity?

There are lots of issues to be settled about transactions related to reproduction, such as surrogacy, and egg and sperm donation. Some of these are illustrated by a case going through both the courts and the media in California. Here's the NY Times story: Does ‘Sperm Donor’ Mean ‘Dad’?

Here's a relevant paragraph about the existing laws:

"California, like many states, according to Professor Cahn, has conflicting statutes. One provides that any man can establish parentage if he “receives the child into his home and openly holds the child out as his natural child.” But another statute holds that a man who provides his sperm to a doctor for the purpose of inseminating an unmarried friend is “treated as if he were not the natural father” — unless there is a specific written agreement ahead of conception."

NAS research briefing--Market Design: The Economist as Engineer (short video)

The six NAS research briefings are available at NASonline.org at the link for the 151st annual meeting, on (one, long) video: six Research Briefings by new NAS members

They are all worth listening to. (You have to scroll down to get to the Research Briefings.)

My lecture starts at 47:30 (and you can get there directly by clicking on the link "Market Design: The Economist as Engineer. Alvin E. Roth" It's 20 minutes (it was supposed to be 15, with 5 minutes for questions, but I wasn't the worst offender...).

Not shown in the rush is the final slide from my Nobel lecture, about market design being a team sport:

**************
Update: here's a link that should take you directly to my lecture

Bob Wilson has been at Stanford 50 years

A small celebration was hosted this weekend by Dave Kreps and Anat Admati to note why Stanford is great: Bob Wilson came here in 1964 and never left:

Tayfun Sonmez and Utku Unver in Boston College Magazine

BC celebrates the work of Sonmez and Unver in the Spring 2014 issue of Boston College Magazine: Matchmakers, by Charles A. Radin

Ely and Baliga and Northwestern's purple pricing

ChicagoBusiness.com has an article on The game theorists who dreamed up Purple Pricing for Northwestern about Jeff Ely and Sandeep Baliga, who convinced Northwestern U's athletic department to sell tickets by a descending auction. (I blogged about that here.)

Now the idea is for sale:

The duo is marketing their idea — renamed “Ticker” — through their Evanston-based company, Cheap Talk LLC, to other universities, professional teams and even concert venues that may be interested in hiring them as price consultants.

But unless ticket vendors know more about which customers are buying at what prices, it will be a hard sell, says Nels Popp, an assistant professor in the sports administration program at the University of North Carolina who researches team and school ticket sales. Bargain-hunters, for instance, may be less likely to become repeat customers. “They're there, but they're not who you're going to build your (ticket sales) base around,” he says. “That might be a challenge.”

Mr. Ely concedes Purple Pricing has been a tough sell. “But if we can have a few successes in different contexts under our belt, that would be huge.”

Budish, Cramton and Shim paper on high frequency trading wins AQR prize

The Budish et al. proposal for replacing continuous double auctions with very frequent call markets has gotten some (more) well deserved recognition. Here's the announcement: 3 win AQR Insight Awards for high-frequency trading paper

 "Three academics were named co-winners of the $100,000 prize in AQR Capital Management's Insight Awards, for their paper on market dynamics and structure in an era of high-frequency trading, outdoing four other finalist papers, including one co-authored by a Nobel laureate.

 

Eric Budish, Peter Cramton and John J. Shim were recognized for what AQR called their “path-breaking” paper, “The High-Frequency Trading Arms Race: Frequent Batch Auctions as a Market Design Response.” Their research uses “millisecond-level direct-feed data from exchanges.” The authors propose an alternative to the “arms races” employed to exploit trading opportunities.

The three — Mr. Budish, associate professor of economics,University of Chicago Booth School of Business; Mr. Cramton, professor of economics, University of Maryland, College Park; and Mr. Shim, Chicago Booth School Ph.D. candidate in finance — will share the prize equally.

In their paper, the authors contrast important costs and benefits of continuous trading when traders transact virtually instantly in ever smaller increments of time and trading in discrete intervals of time, say, every 100 milliseconds, and conclude discrete interval trading better serves market participants.

In total, 248 papers, all unpublished as required by the competition, from 26 countries were submitted in AQR's third annual competition.

AQR plans to post the papers on May 28.

The winning paper was among five finalist papers. Authors from each finalist paper presented and discussed their research April 24 before a gathering, including the 19-member AQR award selection committee and some AQR clients.

The authors of the other finalist papers were recognized with honorable mention awards, which carry no cash prize. They are:

• Robert F. Engle III, winner of the 2003 Nobel prize in economics and the Michael Armellino professor of finance, Stern School of Business, New York University, and Emil N. Siriwardane, Stern School Ph.D. candidate in finance, co-authors of “Structural GARCH: The Volatility-Leverage Connection”;
• Dong Lou, assistant professor in finance, and Christopher Polk, professor of finance, both of the London School of Economics, co-authors of “Comomentum: Inferring Arbitrage Activity From Return Correlations”;
• Torben G. Andersen, the Nathan S. and Mary P. Sharp professor of finance, Kellogg School of Management, Northwestern University; Nicola Fusari, assistant professor, Carey Business School, Johns Hopkins University; and Viktor Todorov, associate professor of finance, Kellogg School, co-authors of “The Risk Premia Embedded in Index Options”; and
• Samuel M. Hartzmark, Ph.D. candidate in finance and business economics, Marshall School of Business, University of Southern California, author of “The Worst, the Best, Ignoring All the Rest: The Rank Effect and Trading Behavior.”

The award, sponsored by AQR, seeks to encourage innovation in academic research that can be applied in investment management, said David Kabiller, AQR founding principal and a member of the committee, in an interview.

AQR set a large cash prize to draw attention to the competition and encourage top submissions because “we believe the market responds to incentives,” Mr. Kabiller said.

Submissions for papers for the fourth annual AQR Insight Award competition are due Jan. 15."

Previous posts on Budish et al. are here and here.

Opt out system for organ donors? Scotland opts to wait for evidence

The Scotsman has the story: Warning over opt-out organ system in Scotland

"MOVING to an opt-out system of organ donation in Scotland would “not necessarily” lead to more transplant operations taking place, the public health minister has said.

Michael Matheson insisted the Scottish Government was still “unconvinced” about making such a change.

He spoke out as Holyrood debated a petition backed by more than 20,000 people calling on ministers to introduce an opt-out system for organ donation.

Wales is introducing an new system of deemed consent at the end of next year, where organs can be taken for transplant unless people have made it clear they do not wish this to happen after their death.

Mr Matheson told MSPs the Scottish Government would monitor the situation in Wales to see what impact the change had.

But he stated: “It would be fair to say we remain unconvinced that we should make any move to introduce an opt-out system right now.

“I want to make sure that we keep this issue under review and learn from what happens in Wales, but we are making great progress here in Scotland with the programme of activity we have under way.”

The minister added: “People believe opt-out will mean more organs will become available but our own experts tell us this is not necessarily the case.

“Opt-out means increasing the proportion of the population on the organ donor register but you don’t need to be on the organ donor register to be a donor. Over the last five years, 62% of all donors in Scotland are not on the donor register.

“The real issue that limits the number of donors is the number of people who die in circumstances where donation is possible.

“Unfortunately, to become an organ donor you really have to die in intensive care, and only about 1% of deaths in Scotland occur in these circumstances. Sadly that’s something opt-out in itself can not change.”

Mr Matheson said the US had a higher organ donation rate than Scotland but did not have an opt-out system while Sweden has an opt-out system, but has a lower donation rate than Scotland.

“There is no single thing that will bring about the revolution in donation rates,” Mr Matheson said.

He stressed the Scottish Government was “committed to increasing organ donations in Scotland”, adding: “I don’t believe any other country in the UK can say it has done more on this agenda in the last five years than what has happened here in Scotland.”

He told how Scotland had almost doubled the number of organ donors in the last six years, adding there had been a 62% rise in transplants being carried out - the highest increase in the UK.

Meanwhile, there has been a 25% reduction in the transplant waiting list since 2006-07, Mr Matheson said.

He told MSPs: “We’re making the best progress in the UK. We’re seeing more donors and we’re delivering more transplants and we’re saving more lives as a result.

“We will keep on review how the opt-out process progresses in Wales, but while we are making the sort of progress we have delivering here in Scotland over recent years, I believe it is prudent and appropriate that we should wait to see what happens in Wales before we start to introduce significant legislative change here in Scotland.”

Loan sharks and kidney markets

From the Israeli press:
Head of Israel's debt collection agency: Debtors selling organs to make payments
In letter to deputy attorney general, David Madioni says black market moneylenders using threats, extortion to force debtors to sell organs abroad.

"Israelis who owe money to loan sharks are being forced to sell organs abroad in order to pay back their debts, the head of Israel's Enforcement and Collection Authority has warned the deputy attorney general, in a letter obtained by Ynet.

"The letter by David Madioni to Avi Licht paints a dark picture of black market moneylending in Israel. Known debtors are requesting permission to leave the country, he claims, with the express intention of selling organs.

"Madioni notes in the letter that a number of debtors have recently visited his office in Tel Aviv, seeking to abolish restrictions on them leaving the country. These people, Madioni writes, told him their trips are expressly in order to sell organs to clear their debts.

""I clarified that each is in debt to loan sharks in addition to existing debts (dealt with by the state)," reads the letter to Licht. "Black market elements 'recommended' that they sell their kidneys abroad so as to repay their debts, while threatening their lives if they do not comply."
...
"These cases point to a frightening phenomenon, which are offenses under the law on organ transplants," Madioni wrote. "Beyond this, there appear to be far more serious offenses of extortion through threats, exploitation and physical harm for payment of debts."

International trade and customs unions, in Baku

To make a long story short, I'll be speaking at  the conference of the International Network of Customs Universities (INCU),  “Trade Facilitation Post-Bali: Putting Policy into Practice," in Baku.

The Inaugural INCU Global Conference 2014 "Trade Facilitation Post-Bali: Putting Policy into Practice" will take place from 21 to 23 May 2014 in Baku, Republic of Azerbaijan and will be hosted by the State Customs Committee of the Republic of Azerbaijan.

Here's a draft of the program. It will be a chance for me to meet Chris Pissarides, and to reconnect with Tom Sargent. 

Credentials and degrees (and, I'm now almost a high school grad)

I visited my old high school this past weekend, Martin Van Buren High School in Queens, in New York City. It was fun on a number of different levels. But it reminded me that credentials are complicated. The powers that be inquired into the possibility of giving me a high school diploma, but found, not surprisingly, that I'm still not qualified.  But I got to add an honorary high school diploma to my growing collection of unusual honorary degrees. And I found out that I had been included in the 1969 Yearbook with the rest of my class, although I didn't graduate with them.

FCC Adopts Rules for Incentive Auction

Here's the news from the FCC:

"The Federal Communications Commission today adopted rules to implement the Broadcast Television Incentive Auction. The two-sided auction will use market forces to recover spectrum from television broadcasters who voluntarily choose to give up some or all of their spectrum usage rights in exchange for incentive payments, in order to auction new spectrum licenses to wireless providers."

May 15, 2014 - News Release

FCC Adopts Rules for First Ever Incentive Auction

- Related Upcoming Proceedings

- Staff R&O Summary

- Wheeler Statement

- Clyburn Statement

- Rosenworcel Statement

- Pai Statement

- O'Rielly Statement

and here's a news story: The 4G incentive auction rules are set, and a lot of people aren’t happy with them.

Here's my previous post on the incentive auction... 

Martin Van Buren High School, in New York City

My old high school--which was a giant city school when I attended, with well over 1,000 students graduating each year--hasn't been thriving, and a group of alumni are hosting a Celebration to help revive it.

It turns out that I am the second, not the first Nobel laureate to have attended.
Here are the details.

Saturday, May 17, 2014   •   1:30pm – 12:00 Midnight

A Day of Celebrating Martin Van Buren High School’s
Past, Present and Future!

at Martin Van Buren High School, Queens Village, NY


BASKETBALL CLINIC:  1:30pm – 3:30pm

MVB Alum, and Head Coach of Fordham University’s Basketball Team, Tom Pecora, and his team will conduct a clinic for 6th-8th grade youth from community schools.

 MVB OPEN HOUSE:  3:00pm – 5:00pm

Learn about MVB’s new and exciting programs,
Visit with former teachers, Tour the school, Meet today’s students

Everyone is welcome. There is no charge for this event.

MVB SHOWCASE:  5:00pm – 6:00pm

The Best Of MVB,
Showcasing our band, chorus, and dance troupe.
Everyone is welcome. There is no charge for this event.

HALL OF FAME:  6:00pm – 8:00pm

Honoring Distinguished MVB Alumni

Alvin Roth, Nobel Prize Economics

Frank Wilczek, Nobel Prize Physics

MVB’s 1958 Championship Baseball Team

Ray Kurzweil, Inventor and Futurist

 Donny Deutsch, Media Personality


Attendance is free for this event, but space is limited. Please sign up in advance by email at mvbhsalumns@gmail.com


All-CLASS REUNION: 8:00pm – 12:00 midnight

Join the 55 graduating classes for the first ever all-class reunion at MVB!

Here's some news coverage of the run-up to the event, which includes this:

"After the city lifted zoning restrictions more than 10 years ago, students left Van Buren en masse for schools like Francis Lewis, Bayside and Cardozo high schools. Van Buren received a “D” on its most recent city progress report and received a below-average rating on last year’s school survey.

But under the leadership of new Principal Sam Sochet, the school is poised for a turnaround, Wilson said, and part of the celebration day’s schedule includes an open house promoting a handful of new programs."

Future Directions in Paired Exchange

I'm in NYC for
The 2nd  Annual  Future Directions in Paired Exchange, Friday May 16th 2014
New York Academy of Medicine

Health insurance for kidney donors?

Writing in The Atlantic, transplant surgeon Joshua Mezrich proposes compensating living kidney donors with health insurance, which he points out would not be expensive since those who qualify as donors are unusually healthy: Why we need more kidney donors, and how to get them

Cook and Krawiec on compensating organ donors

How best to encourage organ donation: Research brief -

 Where could more kidneys come from?

In considering where to look for more kidneys, we begin with basic demographics. The criteria used to identify suitable deceased donors have the effect of ruling out donations from all but a fraction of the 2.5 million people who die each year in the United States. Our research provides some detail on this “winnowing” process for the year 2010:

• Almost 2/3 of all deaths happen to people over age 70, almost all of whom are deemed medically unacceptable donors.
• Most remaining deaths happen outside of hospitals in uncontrolled settings like auto accidents, or occur inside the hospital from causes like cancer, diabetes, and renal disease that ordinarily rule out kidney donations.
• The bottom line is that, in 2010, only about 9,000 deaths happened to “eligible” donors — in the sense that the deceased person had healthy organs and was declared dead due to cessation of electrical activity in the brain after the hospital had arranged to preserve blood circulation in the patient. In 70% of those cases the kidneys were in fact donated. An additional 928 donations happened after cardiac deaths (only rarely possible because successful preservation of kidneys under that circumstance is difficult).

Why monetary compensation should be considered

Basic arithmetic shows that even if everyone in the United States had signed an advance consent form allowing donation of organs, and every family honored that agreement at the time of death, only an additional 2,751 donors — yielding roughly 5,500 kidneys — would have been available in 2010. In short, the kidney shortage cannot be eliminated simply by measures aimed at increasing rates of donation from the deceased. Additional kidneys from people who die would be welcome, but will not be nearly enough to satisfy current need, let alone reduce the backlog of sick patients awaiting a life-saving kidney donation. Barring a major breakthrough in recovering organs from deceased patients currently deemed unsuitable, the only plausible solution is to increase donations from the living.

There are other advantages to using more living donors. More transplantable kidneys from live donors would improve health outcomes for those with end stage renal disease and reduce the annual cost per patient. Donating a kidney is no walk in the park, but the medical risks are very low. People can do just fine with a single kidney.

Currently, most people who donate one of their kidneys do so to help someone they know, usually a family member. Education and public outreach might increase the number of altruistic donors willing to make an organ gift to a stranger. But in 2012, only 182 people made such “nondirected” donations — and the trend is downward, not up.

The high and increasingly unmet need for transplantable kidneys prompts many observers — including us — to believe that the time is ripe to reconsider financial incentives. An unregulated market in kidneys would be open to abuses and corruption. A better alternative would be a public agency with sole authority to provide financial incentives for organ donation, after would-be donors are screened not just for good physical health but to ensure that they are making an informed decision after careful reflection. Even with safeguards, some say that putting a price on body parts is bound to be dehumanizing. But markets already exist for blood plasma, eggs, sperm and hair. At the end of the day, objections to compensation for kidney donors must be weighed against the growing loss of health and life caused by our current inadequate system.

Related research: An in-depth paper by Cook and Krawiec, “A Primer on Kidney Transplantation: Anatomy of the Shortage,” is forthcoming in Law and Contemporary Problems, Vol. 77, No. 3. A working version of the paper is available on the Social Science Research Network.