I wonder if this is the first time an economics book has been reviewed in the American Journal of Transplantation.
Poetic justice: A review of moral economics by Alvin E. Roth
Michael A. Rees
"Alvin E. Roth describes poetic justice as the Virginia state flag flying at half-mast in 2020 in honor of Bernie Cohen, who argued the US Supreme Court case Loving v. Virginia that made interracial marriage legal. Turns out Mildred and Richard Loving were convicted of interracial marriage in 1967, arrested by police at 2 AM at home in their bed, and sentenced to 1 year in prison but suspended on the condition that they leave Virginia for 25 years. Reading what the Virginia Court of Appeals judge wrote, side by side with what the US Supreme Court wrote, is, by itself, worth the price of the book.
"Those of us in the field of transplantation have felt—and will continue to feel—the impact of repugnance. In moral economics, Alvin E. Roth takes us on a grand tour of how repugnance shapes transactions across a wide spectrum of human activities. Take uterus transplantation, pioneered in Sweden, a country where repugnance to surrogacy has made it illegal. You can transplant a uterus into a woman with infertility in Sweden, but do not you dare use a surrogate’s uterus in her own body to help you achieve a baby! Alvin E. Roth defines repugnance as a morally contested market that some people would like to participate in, but others think should be outlawed. He goes on to call a transaction repugnant if “all parties to the transaction want to engage in it, and others think they shouldn’t be allowed to for moral or religious reasons, even though those others can’t detect that the transaction has taken place unless someone tells them.”1 I found it fascinating to walk through all the ways in which repugnance has shaped the world in which we live.
"The book starts with a clear example of a transaction that many people want to engage in: sex. Of course, I knew about the repugnance surrounding prostitution and pornography, but could hardly believe the stories of how far people go on either side of a repugnant transaction. I found my own views challenged by what I thought was right, especially when considering the outcome I desired from the controversy being described. It was interesting to have these stories told by the “Father of Market Design” and to think about sexual desire as a contested marketplace with good and bad outcomes that could be influenced by better market design.
"It is not the first time I have been surprised to think about a human desire for something like love or health as a transaction that economists could study. I first met Alvin E. Roth in about 2004 when he thought he could help us transplant professionals do a better job with kidney exchange. I made the mistake of thinking that economists only worried about money, albeit at both the microlevel and macrolevel. This book makes clear that if we want to have the desired outcome of helping as many people as possible through organ transplantation, we are going to have to think like market designers and overcome repugnance to innovation. Remember Richard Lower in 1968 being threatened with criminal charges for “wrongful death” for removing a donor heart prior to the establishment of brain death criteria?
"My favorite chapter was about reproduction. You would not believe all the interesting twists and turns that have happened as artificial reproductive technology has blossomed, and some people wanted to have babies using it, whereas others were morally aghast at their desire, working hard to stop them. It was interesting to see different sides of contraception, abortion, in vitro fertilization, egg and sperm donation, paternity, maternity, parenthood, and surrogacy. But Alvin E. Roth has such a nice way of distilling complicated concepts, such as this quote: “Some critics have said that looking for an egg donor who attends Harvard, for example, reeks of eugenics. In response to that, Professor Kim Krawiec, perhaps the leading legal scholar of “taboo trades,” gave a very cogent response: “Fertile people have been screening for beauty and intelligence for years and years. It’s called dating.”2
"If transplantation attracted you as a field in part because of the ethical challenges encountered when considering organ donors and recipients, Moral Economics provides a narrated guide through thorny issues. Near the end of the book, we find perhaps the best call to action for those of us who want to solve problems. The Persian poet Rumi invites us to navigate repugnance: “Out beyond ideas of wrongdoing and rightdoing, there is a field. I’ll meet you there.”3
1. Roth, A.E.
Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work. Hachette UK; 2026
2026
2. Jones, A. Putting a Price on a Human Egg.”
Wall Street Journal. July 26, 2015;
Accessed XXX www.wsj.com/articles/putting-a-price-on-a-human-egg-1437952456
3.Rumi, “Out Beyond Ideas of Wrongdoing and Rightdoing.” Poetry Society of America.
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