This morning the Washington Post published my op-ed online (which is scheduled to appear in the print edition on Sunday). 800 words is hardly enough to explain why I think what I do...I could write a whole book about that.
But here's the op-ed:
With 90,000 patients waiting for a kidney, compensating living donors would save lives.
Disputes about medical aid in dying are as contentious in Britain as in the US. Here's some discussion on VoxTalks Economics, in connection with my (imminently) forthcoming Moral Economics.*
The Right to Choose to Die Alvin Roth interviewed by Tim Phillips 1 May 2026
"Content note: this episode discusses assisted dying, end-of-life choices, and suicide. Some listeners may find the content distressing.
...
"This week Tim Phillips talks to Al Roth of Stanford University about how economics can contribute to the debate on medical aid in dying (MAID). Roth, a Nobel Prize laureate, has written a new book that argues this, and similar debates, often miss the key insight: the binary choice of “allow” versus “ban” rarely reflects reality. For example, in the United States, he explains that physicians in jurisdictions where assisted dying is illegal are familiar with the practice of administering doses of drugs that will relieve pain, but also end life.
Roth's argument is not that assisted dying is always right. It is that a moral position that ignores the costs of a ban is not more ethical — it is less honest. Economists, he says, bring one specific thing to this debate: the insistence that trade-offs be made explicit. "
The right to choose to die Season 9 Episode 27 May 1
And here's the (automatically generated) transcript...
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The UK version of Moral Economics is here.
Is the state of Louisiana harmed if women living there can receive abortion pills by mail?
Federal Appeals Court Temporarily Halts Abortion Pill Access by Mail The court order, in a lawsuit by the state of Louisiana, pauses a Food and Drug Administration regulation that greatly expanded access to the abortion pill mifepristone.
By Pam Belluck
"A federal appeals court issued a ruling on Friday temporarily halting the ability of abortion providers to prescribe pills using telemedicine and send them to patients by mail, blocking what has become a major avenue for women seeking abortions in recent years.
"The order comes in a case in which the state of Louisiana is suing the Food and Drug Administration, seeking to sharply curtail access to the abortion pill mifepristone. In the order, a panel of the U.S. Court of Appeals for the Fifth Circuit granted Louisiana’s request for a temporary stay of the F.D.A.’s decision several years ago to remove a requirement that patients see a medical provider in person before the pills could be prescribed.
"The court order, citing Louisiana’s claims that making pills available by mail has allowed patients there to access the medication despite the state’s near-total abortion ban, said that “Louisiana has shown that it is irreparably harmed without a stay.”
"In April, a Federal District Court in Louisiana had declined to pause the availability of pills by mail, instead saying that the proceedings should be delayed until the F.D.A. completes a safety review of mifepristone that is underway and is expected to take until late this year."
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And here's the NYT on the appeal by pharma companies to the Supreme Court:
Supreme Court Asked to Restore Access to Abortion Pill by Mail By Ann E. Marimow and Pam Belluck
"Administration officials recently told The New York Times that the review would not be finished until the end of this year, a time frame that would fall after the midterm elections.
"The mifepristone case puts the Trump administration in a politically tricky position, given that many of President Trump’s supporters oppose abortion."
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."
In the Netherlands, not only is it legal to receive medical aid in dying (MAID), but a growing number of MAID patients are able to successfully achieve their desire to become deceased organ donors.
From the American Journal of Transplantation:
Wijbenga, N., Gan, C.T., Ruigrok, D., Berg, E.M., Hagenaars, J.A.M., Siregar, S., van der Kaaij, N.P., Mathot, B.J., van Pel, R., Seghers, L. and Manintveld, O.C., 2026. The Increasing Contribution of Organ Donation after Euthanasia to the Lung Transplantation Donor Pool in the Netherlands. American Journal of Transplantation.
"Abstract: The number of organ donation after euthanasia (ODE) procedures in the Netherlands has grown substantially, yet their contribution to the lung-donor pool remains unclear. There is no clinical consensus on how these potential ODE lung-donors should be assessed. We aimed to describe the total contribution of ODE to the lung-donor pool in the Netherlands and describe the assessment of potential ODE lung-donors.
We collected data from all ODE procedures performed between 2012-2024 in the Netherlands. We assessed the number of ODE-lungs offered, rejected, accepted, and transplanted, comparing characteristics of discarded and transplanted lungs.
Of 1166 lung-donor, 664(60%) were DCD donors of which 154(23%) were ODE lung-donors. The total proportion of donor lungs from ODE lung-donors acceptable to offer for lung transplantation was 117 of which 104 (89%) were transplanted. Evaluation prior to donation was highly variable, with medical history and chest CT most affecting acceptance decisions. Short-term outcomes were excellent, with 1-year survival of 84%.
Our findings indicate that ODE lung donors are increasingly important in the Netherlands, with high acceptance rates, despite highly variable evaluation methods. Standardizing the assessment of potential ODE lung donors could further improve acceptance rates and enhance the contribution of ODE to the lung-donor pool."
In the run up to the May publication date, I've been interviewed on a variety of podcasts about my book Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work. Here's one from the podcast Passion Struck: Nobel Laureate Alvin Roth: How Incentives Shape Your Life | EP 757
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Earlier:
At the Armchair Expert podcast, Dax Shepard interviewed me in anticipation of the May publication of my book Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work
Here's the video (which was recorded last month at their studio in LA):
x
Here's the invitation to a discussion I'll have in May with Ray Fisman, about Moral Economics.
Some of my Boston/Cambridge friends asked how to get tickets now because they're afraid it will sell out (the price is right), and others because they're afraid that if they don't come Ray and I will be speaking to an empty hall...
Alvin E. Roth at the Cambridge Public Library Monday, May 11 at 6 pm
You can get tickets at this link.
"Harvard Book Store and the Cambridge Public Library welcome Alvin E. Roth—Nobel Prize–winning economist, the Craig and Susan McCaw Professor of Economics at Stanford University, and the George Gund Professor of Economics and Business Administration Emeritus at Harvard University—for a discussion of his new book, Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work. He will be joined in conversation by Ray Fisman—who holds the Slater Family Chair in Behavioral Economics at Boston University.
Ticketing
RSVP for free to this event or choose the "Book-Included" ticket to reserve a copy of Moral Economics and pick it up at the event. Following the presentation will be a book signing."
Axel Ockenfels forwards the good news. He writes: "It passed! The Bundestag voted today to permit kidney exchange in Germany. The CDU/CSU, SPD, and Greens voted in favor."
(More steps will have to be taken before kidney exchanges occur regularly in Germany, but this is a giant step forward.)
Here's the official announcement:
Parlament weitet Regeln zur Lebendorganspende aus
Parliament expands rules on living organ donation
"On Thursday, March 26, 2026, the Bundestag expanded the possibility of living kidney donations to increase the circle of possible organ donors and organ recipients. A corresponding bill of the Federal Government "to amend the Transplantation Act – Amendment of the regulations on living organ donation and further amendments" (21/3619) in the version amended by the Health Committee was adopted by the majority of the CDU/CSU, SPD and Bündnis 90/Die Grünen against the votes of the parliamentary group Die Linke, with the AfD abstaining. In the future, this will also enable so-called cross-over living kidney donations between different couples.
...
"Despite numerous initiatives to promote organ donation, there has been no trend reversal so far. At the end of 2024, around 6,400 people were waiting for a donor kidney, according to the information. At the same time, the number of kidney transplants fell to 2,075. A total of 253 patients died in 2024 who were on the waiting list for a kidney.
"Opening up further therapy options
"Therefore, it is important to open up further therapy options that have long been established internationally. The goal of countering the danger of organ trafficking remains decisive in the amendment of the regulations, according to the draft.
"In the future, living kidney donations will be possible "crosswise" by another organ donor partner in the case of immunologically incompatible organ donor couples. The organ donor couples do not have to know each other. However, the so-called close relationship of the respective incompatible partners should remain mandatory.
"Principle of subsidiarity is repealed
"The so-called principle of subsidiarity, according to which organ removal from living persons is only permitted if no suitable organ from a deceased donor is available, will be repealed. Non-directed anonymous kidney donation, i.e. a donation to an unknown person, is also made possible. The donor should have no influence on the recipient.
"The plan is to establish a program for the mediation and implementation of crossover living kidney donation, including anonymous kidney donation. A center for the placement of kidneys is to be established. The conciliation procedure is laid down by law.
"Care in the transplant center mandatory
"Mandatory independent psychosocial counselling and evaluation of donors before a donation will be introduced. In addition, care in the transplant center will be mandatory throughout the entire donation process.
"If a living kidney donor later falls ill himself and needs a kidney transplant, this should be taken into account when arranging kidneys donated postmortem. Institutions that remove tissue postmortem should be able to be connected to the Register for Declarations of Organ and Tissue Donation (OGR) so that they can clarify for themselves whether there is a willingness to donate tissue in a potential donation case."
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It's been a long campaign, and Axel and a number of others played a critical, tireless role, both in public and in private consultation with lawmakers and interested parties. It's notable that the legislation looks forward to allowing nondirected donors (not every European kidney exchange program does.) It's also notable that the current bill expects that compatible pairs will not be eligible to participate in kidney exchange to seek a better match. That's a battle that hasn't yet been won, despite the fact that compatible pairs are important in a number of ways in U.S. kidney exchange.
Still, this is a significant victory in a campaign that has been going on for at least a decade. I may have written the first German newspaper editorial on the need to legalize kidney exchange in Germany, almost exactly ten years ago:
Der Volkswirt Hoffnung durch Tausch by Ágnes Cseh, Christine Kurschat, Axel Ockenfels und Alvin E. Roth
There will be more steps to take to establish effective regulations and institutions to make kidney exchange readily available in Germany, but this is a big step in that direction.
The American market for guns is among the most complex of controversial markets, since gun purchases are regarded by many Americans as repugnant, while to many others (and in the eyes of the law*) they are protected. So the US debate about guns is conducted in a restricted space.
Here's a new paper that takes an unusually nuanced, empirical approach to understanding possible paths forward. In particular, it introduces non-lethal firearms into a survey and experiment.
The Universal Pursuit of Safety and the Demand for (Lethal, Non-Lethal or No) Guns, by Marcella Alsan, Joshua Schwartzstein & Stefanie Stantcheva, NBER Working Paper 34962, DOI 10.3386/w34962, March 2026
Abstract: "Lethal firearm ownership is deeply polarizing in the United States. We show that beneath this polarization, owners and non-owners share a common objective — safety — but disagree sharply about whether lethal firearms achieve it. Using an original survey of more than 5,400 respondents combined with randomized experiments, we document that owners feel safe and confident with firearms, while non-owners on balance feel less safe around them and perceive large private costs and social harms. Demand for lethal firearms is nonetheless potentially large and growing: one-third of non-owners express interest in acquiring one — these individuals report the lowest day-to-day safety — while very few owners would consider reducing their holdings. Persuading owners to relinquish firearms without any replacement appears unrealistic; the more tractable margins may be safe storage and non-lethal substitution for additional purchases. We organize these patterns through a framework centered on a perceived safety possibilities frontier (SPF) — the safety outcomes a household believes achievable with different combinations of lethal and non-lethal tools. Households may differ in firearm demand because they face different risk environments, weigh protective benefits against harms differently, or hold different beliefs about the frontier. Our descriptive evidence points to heterogeneous beliefs as important drivers, suggesting that levers such as information could shift the perceived frontier. These patterns motivate three experimental treatments: one on the private legal/medical costs of lethal firearm ownership, and two on a non-lethal firearm (NLFA), with and without a conservative pundit’s endorsement. The private-cost treatment increases concern about harms among all respondents and support for safe storage policies, and modestly raises stated willingness to keep lethal firearms locked. NLFA treatments raise willingness to pay for an NLFA, to keep lethal firearms locked, and support for incapacitating over lethal firearms and for policies encouraging NLFAs. These effects are largely persistent. Importantly, NLFA information does not increase willingness to reduce lethal firearm ownership but does increase willingness to store lethal firearms safely. Our results suggest that many owners perceive the SPF differently from nonowners, neglecting harms or less-lethal alternatives, yet remain open to such tools. Overall, individuals share a common goal — safety — yet disagree about the means. Although these disagreements appear entrenched, people remain receptive to alternatives that might command broader agreement."
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*The 2nd Amendment to the Constitution says
"A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed."
(Only the part in bold seems, to my unlawyerly eyes, to have played much part in American jurisprudence.)
Strategy sets are big, so we’re not going to be able to end illegal drug use by spraying defoliants on fields of poppies, or arresting dealers, or attacking speedboats. If we can’t stop the spread of drugs even in prisons, the chance of purely police/military solutions for stopping drugs on the streets isn’t looking good.
The NYT has the story:
No Pills or Needles, Just Paper: How Deadly Drugs Are Changing
Lab-made drugs soaked into the pages of letters, books and even legal documents are being smuggled behind bars, killing inmates and frustrating investigators. By Azam Ahmed and Matt Richtel
" Today, fringe chemists are ushering in a total transformation of the illicit drug market. Operating from clandestine labs, they are churning out a dizzying array of synthetic drugs — not only fentanyl, but also hazardous new tranquilizers, stimulants and complex cannabinoids. Sometimes, several unknown drugs appear on the streets in a single month. Many are so new they are not even illegal yet.
"Nearly all of them are harder to trace than conventional drugs, less expensive to produce, much more potent and far deadlier, according to scientists and law enforcement officials across the globe.
...
"After that first death in the Cook County jail in January 2023, it took months for Mr. Wilks’s team to realize that these mysterious new drugs were being sprayed onto the pages of the most innocuous-seeming items: books, letters, documents, even photographs.
"The sheets of drugs, worth thousands of dollars a page, were being torn into strips and smoked by inmates
...
"But the traffickers were cunning. When regular mail got checked more closely, smugglers began lacing legal correspondence. Soon, officers discovered sealed packages that looked as if they had been shipped directly from Amazon, with drug-soaked books inside. "
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It’s hard to shut down markets that people want to participate in.
Someone should write a book about this.
The NYT has the story:
The Middle-Class Suburbanites Who Sell Their Blood Plasma to Get By. Across the United States, plasma centers are opening in wealthier areas as more people struggle with the high cost of housing, groceries and health care. By Kurtis Lee and Robert Gebeloff March 20, 2026
"Every day, an estimated 215,000 people donate plasma, the yellowish liquid component of blood. Mr. Briseño is among them. He is not jobless or facing eviction, but, like many in the American middle class, he is caught in the vise of rising expenses and wages that aren’t growing fast enough to cover them. So he is turning to a method more commonly associated with the lowest-income Americans. For people like him, an extra $600 or so a month can mean making a mortgage payment or covering increased health-insurance costs.
"A recent study by researchers at Washington University in St. Louis and the University of Colorado, Boulder, observed that while older plasma centers are clustered in low-income areas, newer centers were increasingly likely to open in middle-class neighborhoods. A New York Times analysis shows the trend has continued: Centers have sprung up in more than 100 such neighborhoods, in suburbs and wealthier sections of cities, since researchers finished collecting their data in 2021."
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Here's an earlier post on the study that sparked the NYT report:
Some controversies are familiar all over the world.
The NYT has the story:
The Faroe Islands Are Changing Some of Europe’s Strictest Abortion Rules
A new law allowing abortion up to 12 weeks will be a major shift in an archipelago of 55,000 people, and there are strong feelings on both sides. By Amelia Nierenberg and Regin Winther Poulsen
"The Faroes, a self-governing part of the Kingdom of Denmark in the North Atlantic hundreds of miles from Copenhagen, allowed abortion only in rare cases.
...
"The Faroes have had a near-total abortion ban, one of Europe’s most restrictive, under a law that dates back to 1956. Like Ms. Jacobsen, some women lied to their doctors to get around the restrictions and end their pregnancies, doctors, lawmakers and advocates on both sides of the issue have said.
...
"But late last year, the Parliament in the archipelago of 55,000 people ratified a law that allows women to end a pregnancy within its first 12 weeks, a major shift in a place that has long been more religious and socially conservative than its Nordic peers. The law is set to take effect in July.
...
"But a parliamentary election is set for late March and polls suggest that power could pass to a conservative coalition that may try to block implementation of the law or change it."
Another small adventure in publishing:)
Here's the pre-publication review of Moral Economics from Publisher's Weekly. "
TL;DR "Bringing balanced, evidence-based analyses to emotionally fraught debates, Roth reveals the power of markets to inspire solutions. This is trailblazing"
Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work
Alvin E. Roth. Basic Venture, $35 (368p) ISBN 978-1-5417-0201-1
"Nobel Prize–winning economist Roth (Who Gets What—and Why) delivers a stimulating study of morally contested products and services, such as abortion, assisted suicide, and marijuana. He refers to these as “repugnant transactions,” as they spark objections primarily on religious or moral grounds but don’t cause easily measurable harms to those seeking to ban them. Viewing these transactions as markets, or systems that can be designed to “allocate scarce resources efficiently and equitably,” can help people make progress on challenging topics, he argues. For example, analyses of legal prostiution show it can increase the market for paid sex but can also reduce rape and the spread of sexually transmitted disease. Another topic discussed is kidney donation. There is a nearly universal ban on compensating donors based on the concern that payments might lead to poor or vulnerable people being coerced into selling their organs. Meanwhile, there is an extreme shortage of donors, and loved ones are often incompatible with those they want to help (kidney disease runs in families). Roth and his colleagues designed a kidney exchange, in which incompatible patient-donor pairs exchange kidneys with other such pairs. Because no money changes hands, the problem of paying donors can be avoided. Bringing balanced, evidence-based analyses to emotionally fraught debates, Roth reveals the power of markets to inspire solutions. This is trailblazing. (May)
Peter Jaworski collects the statistics from Europe and North America:
Plasma donation is safe
And commercial plasma donation is not less safe than non-commercial donations
Peter Jaworski
Mar 16, 2026
"Source plasma donation (also called “plasmapheresis”) is inordinately safe (so is whole blood donation). And the best publicly-available donation safety data give us no reason to think that commercial plasma collection is less safe than non-commercial plasma collection.
" That claim may be surprising in light of the recent heartbreaking deaths reported after plasma donations in Winnipeg. These tragedies have raised questions about the safety of plasma donation in general, with some critics suggesting that commercial plasma donation is inherently less safe than non-commercial plasma donation.
"The evidence for the claim that plasmapheresis, including commercial plasmapheresis, is safe can be found in countries with the largest plasmapheresis programs, which publish annual reports on serious donor adverse events. Some of these countries have exclusively non-commercial plasma collection, while others have predominantly commercial systems. "
Here's a story from the NYT, about the recent regularization of paid plasma donation in (some provinces of) Canada.
How Safe Is Plasma Donation?
Two recent deaths tied to for-profit clinics in Canada raised concerns about the health effects of having plasma drawn as often as twice a week. By Roni Caryn Rabin and Vjosa Isai
"Donating plasma, which is used to make lifesaving medicinal products, is widely perceived as low-risk. But questions about the safety of the practice arose this week when Canadian health authorities confirmed they were investigating two recent deaths of people who gave plasma at for-profit clinics in Winnipeg operated by Grifols, a Spanish health care company.
"Millions of people donate frequently in North America. An estimated 60 to 70 percent of plasma-derived medicinal products worldwide are made from plasma donated in the United States.
And demand for plasma is growing. The market for plasma-derived medicinal products is valued at $40.35 billion and is expected to double over the next eight years, as the products are used to treat an expanding number of conditions, including immune deficiency syndromes and bleeding disorders.
But the health impact of frequent plasma donation on the donors themselves has not been well studied, and there is no consensus among health regulators about how long donors should wait between plasma draws.
In both Canada and the United States, companies can pay people an honorarium for donating their plasma, and health regulations say that people can donate up to twice a week.
...
"A 2020 investigation by the F.D.A. into 34 deaths reported as being associated with plasma donation did not determine that donation was the cause of death in any of the cases. It ruled donation out entirely as a cause in 31 cases. "
The New York Times editorial board thinks about the current environment for (now legal) marijuana, and calls for more careful regulation, and federal taxation:
It’s Time for America to Admit That It Has a Marijuana Problem
"Thirteen years ago, no state allowed marijuana for recreational purposes. Today, most Americans live in a state that allows them to buy and smoke a joint. President Trump continued the trend toward legalization in December by loosening federal restrictions.
This editorial board has long supported marijuana legalization. In 2014, we published a six-part series that compared the federal marijuana ban to alcohol prohibition and argued for repeal. Much of what we wrote then holds up — but not all of it does.
At the time, supporters of legalization predicted that it would bring few downsides. In our editorials, we described marijuana addiction and dependence as “relatively minor problems.” Many advocates went further and claimed that marijuana was a harmless drug that might even bring net health benefits. They also said that legalization might not lead to greater use.
It is now clear that many of these predictions were wrong. Legalization has led to much more use. Surveys suggest that about 18 million people in the United States have used marijuana almost daily (or about five times a week) in recent years. That was up from around six million in 2012 and less than one million in 1992. More Americans now use marijuana daily than alcohol.
...
"The unfortunate truth is that the loosening of marijuana policies — especially the decision to legalize pot without adequately regulating it — has led to worse outcomes than many Americans expected. It is time to acknowledge reality and change course."
When a national monument is designated around a private business in a liberal state, the ability of the President to alter its message is at least partially circumscribed.
Trump Administration Removes Pride Flag From Stonewall National Monument The enduring symbol of LGBTQ+ liberation has been taken down from the historic site.
By James Factora and Quispe López February 10, 2026
"Manhattan borough president Brad Hoylman-Sigal told the New York Times that the directive to remove the Pride flag came from the Trump administration. The monument itself was designated in 2016 to honor the origin of Pride in the United States, and was also the first U.S. national monument dedicated to LGTBTQ+ rights.
"But like the 1969 rebellion that cemented Stonewall into history books, queer and trans people are not taking it without a fight. While the park and monument across from the original Stonewall Inn is now a federal park, the business itself is private property.
“Bad news for the Trump Administration: these colors don’t run,” Human Rights Campaign Press Secretary Brandon Wolf said in a statement. “The Stonewall Inn & Visitor’s Center is still privately owned, their flags are still flying high, and that community is just as queer as it was yesterday. While their policy agenda throws the country into chaos, the Trump administration is obsessed with trying to suffocate the joy and pride that Americans have for their communities.”
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N.Y.C. Officials Reinstate Pride Flag at Stonewall After Federal Removal By Liam Stack and Olivia BensimonUpdated Feb. 13, 2026, 2:40 a.m. ET
"A group of New York elected officials gathered on Thursday to replace the Pride flag that was removed from the Stonewall National Monument after a directive from the Trump administration, mounting a defiant response to the government’s assault on diversity initiatives at a federal site honoring the L.G.B.T.Q. rights movement.
"The plan to re-raise the flag in the center of the small park outside the historic Stonewall Inn in Greenwich Village had been widely publicized on social media, and hundreds of spectators cheered as its rainbow colors made their way back up the flagpole under a cloudy winter sky."
I now know what blurbs will likely be on the back cover of Moral Economics when it comes out in May. They are by Peter Singer, Abhijit Banerjee & Esther Duflo, Claudia Goldin, and Paul Milgrom & Bob Wilson, all people whose work I admire more than I can say.
“Alvin Roth received the Nobel Prize for work in economics that has saved thousands of lives. In Moral Economics, Roth applies his open-minded, evidence-based thinking to controversial issues at the intersection of markets and morals, where his way of thinking could save even more lives.”
Peter Singer, author of Ethics in the Real World
“A surprising large part of economics is about things money can't buy, for many good and bad and complicated reasons. This wonderful book by the leading scholar in that area of economics is something else that just money could never buy. It's a labor of love, a testament from a lifetime of thought and research.”
Abhijit V. Banerjee and Esther Duflo, Nobel laureates and authors of Poor Economics
“With clarity and compassion, Al Roth explores the transactions society cannot escape—surrogacy, the purchase of body parts, the sale of sex, and a host of ‘repugnant’ relationships. What should be regulated? What should be banned? What are the limits of using price in the marketplace? Be prepared to think in new ways and gain from the insights of a great market designer.”
Claudia Goldin, Nobel laureate and author of Career and Family
“From the right to sell a kidney to the cost of a surrogate birth, our sense of ‘right and wrong’ shapes the economy more than we realize. Nobel laureate Alvin Roth—the world's leading ‘philosopher-economist’—unpacks the hidden moral codes that govern our most intimate transactions. This is a clear-eyed guide to understanding where the market ends, where morality begins, and how we can design a world that honors both.”
Paul Milgrom and Robert Wilson, Nobel laureates, Stanford University
Here are two overviews of repugnance, one by economists in a forthcoming book chapter, and one from xAi via its large language model, in Grokipedia.
First, here's the human report, by three veteran scholars of repugnant transactions and controversial markets:
The Morality of Market Exchanges: Between Societal Values and Tradeoffs by Julio J. Elias, Nicola Lacetera & Mario Macis
NBER Working Paper 34647 DOI 10.3386/w34647 January 2026
"Certain behaviors in markets are unambiguously unethical. In other cases, however, voluntary exchanges that can create gains from trade remain contested on moral grounds, because of what is traded or of the price at which the exchange occurs. This chapter offers a framework to analyze these contested markets and provides examples of two general instances. First, we examine “repugnant” transactions involving the human body—such as compensated organ donation and gestational surrogacy—where concerns about dignity, exploitation, and inequality conflict with welfare gains from expanding supply. Second, we study price gouging in emergencies, where demands for a “just price” clash with the incentive and allocation roles of price adjustments under scarcity. Across both cases, we synthesize evidence on societal attitudes and highlight how support for policy options depends on perceived trade-offs between autonomy, fairness and efficiency, and on institutional features that can separate compensation from allocation."
And here's the first sentence of a long overview of repugnance at Grokipedia, an Ai generated encyclopedia launched in October 2025:
Repugnancy costs
"Repugnancy costs denote the multifaceted disutilities—including reputational harm, social sanctions, moral distress, and enforcement expenses—that emerge when voluntary transactions clash with dominant cultural or ethical norms, effectively rationing or prohibiting markets even among consenting parties. "
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