Moral Economics reviewed in American Journal of Transplantation

 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. 

The once and future market for prostitution in Rhode Island

 Kim Krawiec, the great legal scholar of repugnant transactions, has written that rare (almost never seen) book review that extends the empirical study of an important, well-studied social science event, namely Rhode Island's experience of legal prostitution. It provides an illuminating followup to the germinal paper by Cunningham and Shah. (Prostitution in R.I. is one of the controversial markets covered in Moral Economics, and I believe Krawiec's book review is headed for a forthcoming symposium on the book in Œconomia ­­.)

The Smallest State's Big Experiment by Kimberly D. Krawiec
 October 09, 2026

Abstract
Rhode Island’s accidental decriminalization of prostitution in 1980 is typically told as the story of a legal change that went unnoticed for more than two decades. This review of Alvin Roth’s latest book, Moral Economics, challenges that standard account and explores its implications for Roth’s argument that markets need social support to flourish. Drawing on court records, contemporaneous news reports, arrest statistics, and legislative proceedings, I show that the statutory change was noticed almost immediately. Prostitution-related arrests continued, not because police and prosecutors were ignorantly arresting and charging sex workers and clients under a statute that no longer existed, but because the legal system adapted using tools – primarily the loitering prohibition that survived the 1980 rewrite – that have long been used to police behavior and individuals considered repugnant. After a 2003 judicial ruling closed an important enforcement avenue against indoor sex work and vaulted the market into the open, a coalition formed around trafficking concerns that eventually paved the way for recriminalization in 2009. Rhode Island’s accidental experiment with decriminalized sex work provided neither the deliberately designed regulatory framework nor the political backing that could build the type of social support that Roth insists (correctly, in my view) markets need to function well. 

Peter Coy on Moral Economics in The Free Press

 The Nobel Laureate Who’d Buy Your Kidney
What is bad about prostitution? Why is it wrong to eat horses? Al Roth’s latest book asks the most provocative moral questions. He gave The Free Press some of his answers.
By Peter Coy 

"I was a little surprised to find out that Roth has a wide streak of provocation in his personality. It comes across in his new book, Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal about How Markets Work, published in May. In a mild, just-asking-questions tone, Roth digs into one prohibited or controversial activity after another: buying sex, eating horses, selling organs, assisting suicide, carrying a stranger’s baby. He asks why many of these activities are prohibited or restricted even though some people clearly want them. And he thinks about whether it’s possible to design markets for them in a way that preserves people’s freedom to transact while protecting those who don’t want to. 

...

"Roth entertains so many ideas that others strenuously resist that I asked if he calls himself a libertarian. No, he said. “People who call themselves libertarians often don’t like market regulation of any sort,” he said. “But I’m a market designer. I think that good regulations help markets work well.” Cigarettes and alcohol, for example. They can be sold, but not to children. That’s a reasonable balance. 

...

"If you want to design markets that enable beneficial exchanges while protecting the vulnerable, you may have to persuade people that a market in some repugnant good or service is tolerable. Roth seems to have taken on that task in Moral Economics. He never told me what to think. He just asked me what I think, and to think about what I think. It’s an economist’s kind of mischief—relentlessly, cheerfully inquisitive about the rules we’ve decided to live by but have never quite explained to ourselves.
Kidney transactions don’t seem so repugnant to me anymore. Would I sell a kidney to a stranger? Um, maybe, some day. Would I buy a kidney from a stranger if I really needed one? Hell, yeah."

Financial Times quick review of four new econ books

 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."
 

 

The Economist reviews Moral Economics

 It appears that even a week after book-publication week, I'm not finished with book news.

This week The Economist reviewed Moral Economics.  

Here's the short version, from the issue's overview in World in Brief.

"Alvin Roth investigates repugnant markets

"Would you like to buy a kidney? How about heroin? Or sex? Don’t worry: you haven’t wandered down the wrong alley—these and other morally questionable transactions are the subject of a new book by Alvin Roth, a Nobel-prize winning economist. Published in Britain on Thursday, “Moral Economics” looks at the murky world of “repugnant transactions”: deals in which buyers and sellers happily transact, but which onlookers would rather ban on moral grounds.

"For Mr Roth, moral economics is about trade-offs. Are the harms of allowing an activity greater than those of disallowing it? Policy, he argues, should weigh both. Two principles emerge. First, bans never fully work: motivated buyers and sellers find workarounds. Second, prohibition generally reduces the size of the market; it would be cheaper and easier to buy heroin if it was legal. It might also be safer. That leaves Mr Roth asking whether the restrictions or the market cause more harm. Here, too, the answer is that it depends." 

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And here's a link to the longer review, from the Free Exchange column. That column is unsigned, but others on the web have attributed it to Gavin Jackson, who did interview me about the book.  Here is the resulting review:

How should economists treat morality? 

 My review of the review is that it missed some of the nuances in my book, but many aspects of the big picture came through clearly:

"The picture that emerges from the book is of a deeply moral person, who believes in bodily autonomy, in not subordinating individual lives to a collective and in not accepting unnecessary deaths to spare some people from feeling squeamish." 

Felix Salmon, at Bloomberg, reviews Moral Economics

  Felix Salmon, at Bloomberg, reviews Moral Economics, which starting today is now sold in stores (at least in the U.S.):

An Economist’s Case for Selling a Kidney.  In a new book, Nobel laureate Alvin Roth argues that decriminalizing taboo markets can save lives.  

He tells this story from the book:

"Roth gave a talk in 2017 at the Organ Donation Congress in Geneva about one such chain that started in 2015. A woman from the Philippines, known in the literature as FW, was willing to give up one of her kidneys to save the life of her husband, FM. The two flew to the US, where FM received a kidney from an altruistic donor in Georgia, and FW’s kidney was transplanted into a man in Minnesota. A friend of the Minnesota man, who had been willing to give up one of her kidneys to save his life, instead gave one to a man in Washington, whose father-in-law gave a kidney to a woman in Georgia, and so on. By the end of the year there had been 11 successful transplants, and the chain was still continuing.

" After his talk, Roth was confronted by a Spanish doctor who was deeply concerned about the potentially problematic implications of the economic inequality between the Philippines and the US. Roth pointed out that without the transplant, the patient would surely have died. Replied the Spanish nephrologist: “He should be dead!” Spain’s National Transplant Organization later denounced Roth as an organ trafficker.

"Roth tells this story in his most recent book, Moral Economics (Basic Venture, May 12), which, at least in part, is an attempt to apply the empiricism of economics to domains that are often resistant to such analysis. The opposition to the 2015 kidney chain, for instance, comes from nephrologists who have no problem with chains but who draw the line at international chains, or at least chains linking poor and rich countries."

######

Much of the objection to cross-border kidney exchange appears to be fading, some of it was based on the idea that countries should be self-sufficient in transplants.

See earlier posts:

Friday, January 9, 2026  WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood by Krawiec and Roth (now open source)

 

Friday, September 11, 2020  Global Kidney Exchange supported by the European Society of Transplantation's committee on Ethical, Legal, and Psychosocial Aspects of Transplantation .

Moral Economics: a brief review in the Sunday Times ("fascinating and very different":)

 A column (on unemployment) in the Sunday Times by it's economics editor  David Smith, ends with a brief review of Moral Economics, as a postscript:

 PS
"A lot of economics books cross my desk, but a new one, by the Nobel prize-winning economist Alvin Roth, grabbed my attention. Called Moral Economics: What Controversial Transactions Reveal About How Markets Work, to be published soon by Basic Books, it is not a title designed to send it racing off the shelves.

However, it starts in an arresting way with a story I had not heard before of another celebrated Nobel prize-winning behavioural economist, Daniel Kahneman, known to many for his bestselling book Thinking, Fast and Slow. Two years ago, he celebrated his 90th birthday with family in Paris before flying to Zurich and ending his life in an assisted suicide clinic. “Danny,” Roth recalls, “was still in relatively good health, but he wanted to avoid the prospect of a long, disabling decline.”

...

It is a fascinating and very different economics book, from which I may bring you more as I find it."