I post market design related news and items about repugnant markets. See my Stanford profile. I have a 2026 book : Moral Economics The subtitle is "From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work."
"Coffee consumption has been linked to a number of health benefits, such as reduced risks of dementia, head and neck cancer, and all-cause and cardiovascular mortality. According to data from the U.K. Biobank, a higher intake of coffee was associated with lower risks of cirrhosis, hepatocellular carcinoma, and liver-related mortality. These associations persisted for both caffeinated and decaffeinated coffee, and for unsweetened and sweetened coffee."
"Nearly all the 10 million tonnes of coffee beans consumed annually around the world come from two plant species: the strong and often bitter robusta (Coffea canephora) and the more delicate-tasting arabica (Coffea arabica). Unfortunately, arabica suffers or dies when temperatures rise just a few degrees1, and robusta requires massive amounts of water and its yields drop drastically in a drought.
...
"Tesfaye says that scientists, of all people, should care about coffee’s future, not just because science is good for coffee, but because coffee is good for science, too. “Many discoveries and knowledge are generated after having a cup of coffee.”
Abstract The ideal of the unpaid blood donor is nearly universal; the practice is more complicated. Whole-blood systems around the world preserve a formal commitment to voluntary, nonremunerated donation-and then provide donors with gift cards, sweepstakes entries, cash "expense allowances," paid leave, tax relief, priority service, medals, and, in some places, extra points on a child's school exam. This Essay maps the gap between label and practice. Drawing on examples from thirteen countries spanning five continents, it organizes donor benefits by institutional mechanism: gift cards and sweepstakes; direct monetary transfers; paid work leave; other material and recognition-based benefits; and replacement donation and the informal cash markets it can generate. We demonstrate that "voluntary, nonremunerated donation" frequently coexists with substantial material benefits. Whole-blood donors nearly always receive something of value in exchange for their generosity; what varies is how those benefits are structured, funded, routed, and legally classified.
Jurisdiction
Representative donor benefits
Legal classification / routing
United States
Nontransferable gift cards;
sweepstakes (e.g., Super Bowl LX trip; $5,000–$7,000 raffles); promotional
items (shirts, mugs, bags, movie tickets).
“Volunteer donor” label
retained where benefits are not readily convertible to cash; sweepstakes
framed as “no donation necessary.”
Patient-side payment
associated with replacement donation.
Nigeria
Tokens, certificates,
badges, transport refunds; in practice 68% family replacement and 12.2%
commercial donors.
Patient-side payment
associated with replacement donation; commercial donors openly reported in donor
categories.
Sierra Leone
Predominantly family
replacement donors (~90%); paid donors recorded as replacement donors.
Patient-side payment
associated with replacement donation; paid donors recorded as family
replacement donors.
Argentina
Post-donation meal; medical
certificate; 24-hour work-absence justification; 2026 shift away from
replacement model.
Statutory donor benefits
plus replacement-donation phase-out.
"If there is a lesson in this tour of the world’s whole-blood systems, it is that “voluntary, nonremunerated donation” is a phrase asked to carry a great deal of freight. It accommodates a $7,000 gift card, so long as the gift card is offered through a sweepstakes that does not require a blood donation to enter. It accommodates €60 in cash, so long as the cash is legally categorized as an expense allowance. It accommodates extra points on a child’s high-school entrance exam, paid leave, free public transit, priority service at the bank, and a tote bag—often all while the governing statute insists that blood may not be given for reward. "
A Nobel laureate in economics argues the bans we pass to protect our morals are quietly killing people and the data backs him up. Why the line between a market we allow and one we forbid is mostly an accident of disgust. Subscribe if you want science with evidence, not speculation.
My guest won the 2012 Nobel Prize for designing the systems that match kidney donors to patients who would otherwise die waiting.
We cover why it’s easy to buy heroin but hard to hire a hitman, what surrogacy bans actually do to the babies they’re meant to protect, why paying kidney donors could end a shortage that kills thousands a year, and the trade-off statement he wants every lawmaker to say out loud.
He has been called an organ trafficker. He explains why that’s the point.
What you’ll hear:
Why banning something that people want often makes it more dangerous
The kidney market America won’t build and what that silence costs
What the hitman vs. heroin ban asymmetry tells us about effective prohibition
The McCormick statement: the trade-off acknowledgment most policy debates refuse to make
How prediction markets are eroding the boundary between public and private information
Whether Milton Friedman was right to be embarrassed by the economics Nobel
There’s no such thing as a solution. There are only trade-offs.
CHAPTERS
00:00 Who gets called an organ trafficker?
02:26 What makes a transaction repugnant?
03:14 Why bans without support create black markets
03:36 Heroin is easy. Hitmen are not. Why?
04:44 Prohibition, NASCAR, and moonshine
07:26 Surrogacy: legal here, criminal in Europe
12:30 When money turns something legal into a crime
14:28 Can religion corrupt a market?
15:56 Who actually pays for college?
21:38 The Enhanced Games: drugs as a marketing platform
25:30 Adderall, Erd0151s, and the science of getting sharper
30:58 Why AI makes market congestion worse before better
35:00 100,000 kidney failures a year. 30,000 transplants.
36:44 Portland decriminalized heroin. It failed.
39:22 The trade-off statement politicians refuse to make
41:14 Can you legalize sex work and shrink trafficking?
47:42 Kahneman chose to die. Who should decide?
48:30 Should we put GLP-1 drugs in the water?
56:12 America is the Saudi Arabia of blood plasma
01:00:54 Prediction markets and inside information
01:01:34 Sports gambling is more addictive than it looks
01:11:40 Peter Nobel called economics a marketing stunt
01:13:32 Is economics a real science?
Get the transcript, fascinating bonus content, and my Monday M.A.G.I.C. Message: https://briankeating.com/yt
Have a .edu email and live in the USA? You automatically win a meteorite: https://BrianKeating.com/edu
India, which performs the third most kidney transplants in the world (after only the U.S. and China) is a natural location for international kidney exchange on a global scale. Here's a brief outline of the legal, administrative and procedural obstacles that need to be overcome on the way.
"The government’s indictment identifies four games during the 2023-24 season where it said Beasley agreed to participate in the scam. Beasley had allegedly accumulated millions of dollars in gambling losses and, at times, owed money to Davis, a retired forward who played with Beasley on the Minnesota Timberwolves during the 2020-21 campaign. In return for fixing his games, Beasley would have his bill to Davis reduced or eliminated, according to the indictment.
"The charges against the 29-year-old Beasley are yet another example of a prominent NBA player swept up in illegal gambling activities—and the implications for the league are chilling. On Jan. 26, 2024, the day Jontay Porter removed himself from a Toronto Raptors game with a fake injury so his conspirators would win bets, there was another game on the take 500 miles away. (Porter has since pleaded guilty to federal charges and is awaiting sentencing.)
...
"Once Beasley was on board, the next question was which games to target. The government says the gamblers specifically looked for non-marquee games—far from the NBA’s nationally televised showcases on ESPN and TNT—where Beasley could manipulate his performance.
“It’s better not to be on tv for us,” one defendant wrote in a group chat.
"There was also infighting among the group, with some bettors chasing big paydays while others settled for more modest wins. At one point, one defendant accused another of betting so much that he single-handedly altered the lines, which risked drawing suspicions from authorities. "
I was recently interviewed at the gambling hyper-site Covers.com about the growth of sports gambling both on dedicated sites and on prediction markets.
"It’s not often, or ever, you see a Nobel Laureate writing about his ties to match-fixing.
That is until you see Nobel Prize-winning economist Alvin E. Roth writing in his new book that he feels “a certain connection” to point-shaving. It's just for reasons that have less to do with economics or match-manipulation and more because of a shared name.
Another Alvin Roth, nicknamed "Fats," was banned from the NBA because of a college basketball point-shaving scandal that came to light in the early 1950s.
Roth spoke to Covers over the phone recently about his book and his framework for approaching “repugnant transactions,” which, yes, can include sports betting.
“Remember that when I say something is repugnant, I don't mean that I don't like it or that you shouldn't like it,” Roth said. “I mean that some people don't like it, and I think that gambling falls squarely into that category. Lots of people like to gamble, and lots of people, other people, think they shouldn't be allowed to, so it's a repugnant transaction, and there have been laws of all sorts allowing or banning it. And we've gone back and forth with the United States on lotteries, and more recently on sports betting.”
...
“I fear that online gambling will have much to teach us about addiction,” Roth writes.
...
Again, gambling is not the focus of Roth’s work. Nor are prediction markets, which critics often describe as a new form of gambling. Yet Roth says one of the things he writes about is that it is hard to ban something in a given jurisdiction when it’s legally available and within reach in another jurisdiction.
“And, of course, the internet makes everybody a neighbor to everybody else,” Roth says.
In other words, the fact that prediction markets have popped up offering de facto sports wagering in states that have yet to legalize sports betting is not some new phenomenon. It’s all in keeping with society’s ongoing tug-of-war with morally contested markets. You can ban, you can regulate, but somebody will probably be unhappy in the end with what you’ve done and may still seek out what you’ve forbidden or restricted.
Reading lists are interesting both for the books they describe, and for what they say about the list makers. Here are a dozen interesting-looking books from people at the venture capital firm Andreeason Horowitz (aka A16Z).
A reading list for the deeply curious Part one of our summer reading list: 12 books on technology, markets, AI, code, and the systems behind change. a16z crypto
Four of the twelve recommended books come under the heading How markets are designed.
These are those:
Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work by Alvin E. Roth
“My doctoral advisor, Al Roth, has been thinking for decades about ‘repugnance’ – why some people prefer that some markets should not exist. In Moral Economics, he tackles the motivation for these prohibitions and the trade-offs they force, head-on. And he explores, in particular, how such non-market norms emerge and sometimes later collapse — limitations on alcohol and drugs, and, in a completely different category, same-sex marriage have all been relaxed in recent years — and what this means for making markets in the future.” – Scott Duke Kominers, research
Why Nations Fail by Daron Acemoglu and James A. Robinson
“Acemoglu and Robinson’s central thesis, that inclusive institutions drive prosperity while extractive ones cause stagnation, maps surprisingly well onto crypto. Decentralized protocols are essentially an attempt to hard-code inclusive institutions: open access, no gatekeepers, rules enforced by code rather than by whoever’s in power. The book is a great lens for understanding why certain blockchain ecosystems thrive while others are captured by insiders. A must-read for anyone thinking seriously about governance, whether at the nation-state or protocol level.” – Kira Song, finance
An Engine, Not a Camera: How Financial Models Shape Markets by Donald MacKenzie
“Sociologist Donald MacKenzie’s An Engine, Not a Camera is nominally a book about financial economics, but its real subject is more provocative: What happens when theories stop describing the world and start changing it? MacKenzie traces how academic models of markets escaped the university and became embedded in the markets themselves. First published in 2006, it remains relevant today in a number of contexts — not least because of the recent interest from TradFi in crypto. But I wanted to read it again because of the book I’m working on with colleague Robert Hackett, about how computer science theories acted on the world.” – Tim Sullivan, editorial
A Man for All Markets: From Las Vegas to Wall Street, How I Beat the Dealer and the Market by Edward O. Thorp
“Growing up, I was obsessed with the movie 21 and the idea that you could actually use math to beat the house. This book is the autobiography of the man who essentially started it all. Edward Thorp went on to apply those same principles to Wall Street, becoming the father of quantitative investing. It’s an incredible story about using pure logic to disrupt rigged legacy systems, which perfectly captures the same builder mindset we see in crypto today.” – Ben Wu, talent
"The economist Al Roth, a professor at Stanford University, shared a 2012 Nobel Prize for his work in market design and matching theory. He spoke with Sarah Kessler about his latest book, “Moral Economics,” which offers a framework for understanding controversial markets, and how it applies to prediction markets. The conversation has been edited and condensed.
Your book explores what you call repugnant markets — meaning some people don’t think they should exist — like prostitution, surrogacy and drugs. How do prediction markets fit in?
When I think about repugnance and prediction markets, I think back to when Darpa proposed a policy prediction market that became characterized as a terrorist prediction market, and people really objected to that.
That objection was sort of misplaced. It would be great if terrorists who were planning attacks wanted to tip their hand by betting on them in advance. But also, if you were a terrorist who knew about the 9/11 attacks in 2001, and you wanted to make money, you wouldn’t bet on a prediction market. You would short United Airlines and American Airlines. What do you make of all the reports of insider trading on prediction markets?
The reason we forbid insider trading in securities markets is to give people confidence in them. Securities markets have an important financial function that is threatened by insider trading, and I’m not sure that prediction markets necessarily do.
What worries me about the current state of prediction markets and Washington insiders is more the blurring of private and public functions. I don’t think that being an associate of the president should allow you to bet on a Truth Social post by President Trump. That is very bad public policy, but not necessarily an indictment of prediction markets per se.
Do you have an opinion on whether prediction markets should be regulated by the C.F.T.C. or state gambling authorities?
Futures markets, like securities markets in general, play other roles in society. If you’re a farmer who’s growing wheat, a futures market allows you to sell your wheat before you’ve planted it, which allows you to buy the fertilizer and make plans. That’s one role for federal regulators.
The contract has a delivery date. It says on a certain day a freight car is going to deliver potatoes to me. If, for example, someone tried to corner the potato market by reserving all the freight cars so that you wouldn’t be able to deliver on the contract, the regulator could intervene. With prediction markets, there’s nothing that has to be delivered. It’s just that someone has to adjudicate whether the bet was a yes or a no. That requires maybe some kind of regulation, but that seems more like a customer relations thing.
Is there anything that you would change about the design of prediction markets?
I have some ideas about what we can do about gambling and addiction. An appropriate regulator or consumer protection agency could start to require that apps allow you to put a limit on your betting.
Before the game starts, you can say to the app: When I’ve lost a hundred dollars, shut down. Don’t let me make any more bets.
And that might help some people just the way bartenders are supposed to stop serving you if you’ve had too much to drink. "
A child receiving medical aid in dying clearly arouses more repugnance than when an adult accesses MAID. But surely that isn't because we think that a child dying in agony can tolerate it better than an adult. Difficult cases should make everyone think more clearly about their positions.
" A doctor in the Netherlands assisted in the death of a terminally ill child aged between 1 and 12 for the first time, a Dutch minister told lawmakers.
"Sophie Hermans, the minister of health, welfare and sport, disclosed the death in a letter this week to the Dutch House of Representatives. Assistance in death for children in this age range has been legal under certain rules since 2024.
"She wrote that it had been reported late last year to an expert committee that reviews such cases, and was its first notification for a child between 1 and 12.
"Ms. Hermans’s letter referred to “a termination of life” without giving specifics.
...
"In 2020, the Dutch government announced plans to allow doctors to end the lives of terminally ill children who are under 13 years old. Hugo de Jonge, the health minister at the time, predicted that the rule — which went into effect in 2024 — would facilitate the deaths of about five children a year. " Before the rule change, the country already allowed doctors to assist the deaths of people who are over 12 or less than a year old as long as their parents had consented.
...
"In Colombia, assisted death is allowed for children between the ages of 6 and 12, so long as the child understands the concept of death. Belgium also allows children to die with the help of a doctor."
The moral philosophers Peter Singer & Kasia de Lazari Radek interviewed me about Moral Economics on their podcast Lives Well Lived. At the end, they ask their guests to think about their own life, and to what extent their own life has been well lived. That's a bit like being asked what you would like to have inscribed on your tombstone. So I hedged a bit. But the conversation that followed was interesting, so if you scroll down you'll see the transcript of that last bit, which starts about minute 1:09 in the recording.
Jun 25, 2026 "Nobel Prize-winning economist Alvin Roth explains how innovative market designs can reduce exploitation and save lives. Drawing on his pioneering work in kidney exchanges, Roth explores some of society’s most contentious moral dilemmas involving organ markets, surrogacy, and unpacks the ethical tensions surrounding what he calls “repugnant transactions.”
"Lives Well Lived is hosted by Peter Singer & Kasia de Lazari Radek. Episodes consist of interviews with remarkable guests who have lived well, both in the sense of living an ethical life, but also in that they are fulfilled and happy with what they have achieved in their lives. Some of these guests will be well-known figures, but others who are doing extraordinary things will be unfamiliar to almost all of our listeners. The conversations will often cover ground that involves ethics, how to live well, and how to make a positive difference in the world. It will inspire and empower its audience to change their own lives for the better. "
Here's the transcript of the last few minutes of the conversation (starting around minute 1:09 of the recording).
PETER: We always asked our guests to think about their own life, and to what extent their own life has been well lived, and by what criteria they make that judgment? Would you like to comment on that, Al?
Al: Sure. Has my life been well lived so far? Well, first, I've had a very fortunate life so far. I am lucky in my family, and my children, and my grandchildren, and my friends. And when you talk about friends, one thing that's often not talked about are the relations that professors have with students. So I've made lifelong friendships with many students who are productively engaged around the world, and that's very gratifying, and I hope it helps make my life worthwhile.
But also, I'm a market designer, and market design is very outward facing part of, economics. And, one of its goals is, a phrase even older than effective altruism, which is tikkun olam (תִּיקּוּן עוֹלָם) mending the world. And one of the things that market designers try to do is fix markets when they're broken or create them when they're absent. When you think of something like kidney exchange, you know, in a different podcast, on a different subject, I could tell you about victory after victory, where thousands, many thousands of transplants have been done, and lives have been saved through kidney exchange, even though it's in a war that we're losing: the shortage of kidneys is growing faster than the increase in transplants as diabetes grows, and high blood pressure, things like that. So, I would hope that some of my life has looked well lived, not just from the inside, but perhaps also from the outside.
Peter: Absolutely sure that it has. You're right. And what you've done for kidney markets is just one example, where you've saved many lives, and I think that obviously would be an important part of living well. despite the fact that the problem, as you say, has not been solved as a whole.
Kasia: It must be very satisfying.
Al: People often say that to me, and it will be satisfying when I'm retired. Right now, it's still frustrating, right? There's so much left to do, and it's not so easy to do it. But the times are changing. In two weeks, I'm gonna be opening up the American Transplant Conference in Boston, and, you know, there are people who invite me to these things. I sometimes joke with my young colleagues that as the old people who feel a lot of repugnance die off, it'll be left to just us young people. And we'll see.
I was in a transplant conference in Cairo in November. in which we tried to reach consensus on the question of, should countries have to be self sufficient in transplantation, which is the traditional position of the World Health Organization and some other organizations. And, of course, it works against countries that don't have much kidney exchange, because you need a big pool of patient-donor pairs to find lots of exchanges. And in that spirit, incidentally, during COVID, I was in the United Arab Emirates for the first kidney exchange between the UAE and Israel. And, that had to overcome a lot of obstacles, but it makes a lot of sense, because the UAE and Israel each have only a population of about 10 million. And that's not enough to find kidneys in your domestic pool for the hard to match patients, for patients who have a lot of antibodies to human proteins. So, we would like to see much more cooperation and not just between rich countries, but also inviting patients from poor countries, patient-donor pairs, to take part in American kidney exchange. And that's something that remains very controversial, but I think that we might be on the verge of making some progress with that. That's something that Peter has written about also.
Peter: Yes, I certainly hope so, and because I'm now working as a regular visiting professor in Singapore, which is another small country, the population of about 6 million, there's a very good case for saying that Singapore should also get into international kidney exchanges, and perhaps assist some of the poorer countries in its region. So we're trying to make that argument, and let's hope we succeed. One thing I've tell you, there might be bad news. I don't believe that when you retire from Stanford, you're going to stop working on these issues and be able to relax and feel satisfied, because I know I retired from Princeton 2 years ago, but the issues that I'm concerned about, whether it's the factory farming or global poverty, or all these kidney issues as well, I'm still concerned about, I can't let them go just because I'm no longer paid to be a professor at Princeton.
#########
In terms of lives lived well and deeply, here's an earlier post of mine about teachers and students.
Here's a new report from Italy on initiating kidney exchange chains with a deceased donor.* In Italy to date, 34 deceased donor initiated chains generated 84 transplants (34 from deceased donors and 50 from living donors), including 56 among incompatible pairs and 28 to candidates on the waitlist.
"Integrating deceased and living donation through deceased-donor (DD)-initiated chains can expand kidney transplant access in small paired exchange pools. The Italian DEC-K program allocates a DD kidney to initiate a chain (chain-initiating kidney, CIK) among incompatible living-donor (LD) pairs, ultimately returning a LD kidney to the national waiting list (WL). We report the first long-term national results of this donor organ allocation model.
"Methods: All DEC-K chains performed in Italy (2018-2025) were retrospectively analyzed. Recipients were stratified by kidney source (CIK vs LD).
... "Results: Thirty-four DEC-K chains generated 84 transplants (34 DD and 50 LD), including 56 among incompatible pairs and 28 to candidates on the WL. Donor withdrawal occurred once. Four chains were terminated early after CIK transplantation due to newly developed contraindications to donation. At a median follow-up of 60 months, 1- and 3-year graft survival was 100% in both groups, while patient survival was 97.1% for CIK and 98.0% for LD. Three CIK and one LD recipients died with functioning graft (suicide, sepsis, urothelial carcinoma, and acute myocardial infarction, respectively). One CIK recipient experienced graft loss after 40 months due to chronic rejection. Adjusted eGFR trajectories were comparable between CIK and LD (P = 0.48). Chain-ending kidney recipients, with 4 graft loss overall (1 antibody-mediated rejection and 3 vascular thrombosis), showed outcomes comparable to LD (P = 0.64 for eGFR; P = 0.57 for graft survival).
"Conclusions: The DEC-K program proved feasible, safe, and effective in expanding transplant opportunities for incompatible and hard-to-match patients."
########
* Some earlier posts on deceased donor initiated chains:
The FT has brief reviews of four new economics books: Moral Economics, The Common Good Economy: A New Compass, We Need to Tax Billionaires, and Money: The Inside Story
The price of good intentions Four new books that examine the morals, markets and money behind modern capitalism. by Tej Parikh
Here are the remarks about the one of the four that I'm most familiar with:
"At a time when public outrage can shape policy decisions faster than ever before, Nobel Prize-winning economist and Stanford professor Alvin Roth makes a compelling case for evidence over instinct in Moral Economics: What Controversial Transactions Reveal About How Markets Work (Basic Books £25/Basic Venture $35). Roth, whose pioneering work in market design transformed systems for kidney donation, examines some of the most contentious exchanges in modern society, including prostitution, organ sales, drugs and medical aid for the dying.
"In the process, Roth delivers some eye-opening hard-truths to those who might think moral intuition ought to underpin all regulation and law. He shows why most policy decisions involve unavoidable moral trade-offs, and how bans of activities deemed objectionable can result in transactions being pushed underground (where they become harder to regulate). He also makes the case for treating markets in distasteful services as moral tools, not failures.
“My goal is not to tell you what to think, but to help you think,” Roth writes in the introduction. He largely succeeds. This is an entertaining and mind-opening read from start to finish. Some may find the discussions about morally “repugnant” topics somewhat offensive — but that’s the point."
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