The Faculty Lounge

If You Oppose Paying Kidney Donors, You Should Oppose Paying Football Players And Boxers Too

Having concluded that simply advocating for compensated kidney donation was not sufficiently controversial, Phil Cook and I are now turning our sights on professional sports – specifically, professional football and boxing. In a piece just posted to SSRN, we contrast the compensation ban on organ donation with the legal treatment of football, boxing, and other violent sports in which both acute and chronic injuries to participants are common. While there is some debate about how best to regulate these sports in order to reduce the risks, there appears to be no serious debate about whether participants should be paid. Indeed, for the best adult football players, college scholarships and perhaps a professional contract worth multiple millions are possible.

Phil and I will likely spend part of the winter break as television viewers contributing to the NFL teams’ collective $56 billion valuation. But our position on paying kidney donors saves us from hypocrisy. If, however, you are one of the many, many people who believe it is unethical to compensate kidney donors, then you should be out protesting the NFL. And don’t even think about watching the latest boxing or MMA matches.

Over the next couple of posts, I’ll outline the gist of our argument and evidence. We focus on the core argument for a ban on compensation for kidney donation, namely the paternalistic concern that even well-informed adults will sometimes be enticed by a financial reward to donate a kidney when in fact that is not in their “true” self-interest. In this view, the allure of money, especially for those who are in debt and struggling to make ends meet, will overcome good sense, leading to “exploitation” and even “coercion” to which people with less income and education are particularly vulnerable. But the same concerns apply with still greater force to participation in violent sports. Whatever one concludes about the ethics of regulating risky choices, and the problematic aspects of choices involving money and risk, the current circumstance – ban compensation for kidney donors, permit compensation for participation in violent sports – appears difficult to defend.

Over the next few days, I’ll touch on these key points: the medical risk to participants, the consent process, social justice concerns, and social welfare considerations. The medical risks to a professional career in football, boxing, and other violent sports are much greater both in the near and long term than the risks of donating a kidney. On the other hand, the consent and screening process in professional sports is not as developed as in kidney donation. The social justice concerns stem from the fact that most players are black and some come from impoverished backgrounds. Finally, the net social benefit from compensating kidney donors – namely, saving thousands of lives each year and reducing the suffering of 100,000 more receiving dialysis – far exceeds the net social benefit of entertaining the public through professional sports.

Download the piece here. And check back in over the next few days for subsequent posts.

Does Contract Law Need Morality? The Slave, The Digital Pedophile, and The Indebted Gambler

Wenhao Liu and I have just posted to SSRN a draft of our paper discussing Nate Oman’s book, The Dignity of Commerce.  For those of you who have not yet read the Dignity of Commerce, I highly recommend it. I adopted it for my Advanced Contracts seminar last year and have done the same for this year. The book might also be a useful addition to a first-year contracts course, depending on your coverage, but it definitely works well for me in the more advanced setting.

In brief, The Dignity of Commerce sets out an ambitious market theory of contract, which Nate argues is a superior normative foundation for contract law than either the moralist or economic justifications that currently dominate contract theory. One of the book’s most important contributions is its emphasis on the positive role played by markets and thus, by extension, of contracts. In an era rife with warnings about the market’s dangers to society, Nate’s cogent reminder of the market’s benefits is both refreshing and welcome. I was particularly drawn to the discussion of the market’s (and, therefore, contract’s) often forgotten role in organizing productive social interactions. These social benefits, Nate argues, are so important that it is these benefits—rather than a commitment to markets in and of themselves—that justify the use of state resources to support markets, and thus contracts.

Nate’s theory is also descriptively appealing: by recognizing that conceptions of morality and blameworthiness impact contract law, The Dignity of Commerce surely provides a descriptively more realistic account of contract law than theories that contend that contract law is explained solely by economic considerations or solely by moral ones. We find Nate’s market theory of contract less successful as a normative or prescriptive theory, however. To our mind, Nate makes moral judgments about the validity of certain markets (and, therefore, certain contracts) without providing a theoretical framework to replace either the moralist or economic theories he rejects. As a result, we don’t think the market theory can provide meaningful guidance to courts, policymakers, or scholars confronted with the more difficult questions facing contract law.

We illustrate all of these points using the examples of forced slavery, “The Digital Pedophile,” “The Indebted Gambler,” and taboo (or pernicious) markets, such as commercial surrogacy and sex work. And, hey, what could be more fun than that?!

So, all in all, The Dignity of Commerce is definitely a worthwhile read and can easily be incorporated into contract law courses and seminars, especially if you try to spend some time asking students to think about the normative foundations of contract law and how courts should resolve some of the thornier questions that emerge.

And, of course, you should make sure to read our critique of the book, as well!

Mail-Order Body Parts

A special report by Reuters details (here) how a journalist was able to buy a spine and two human heads after exchanging just a few emails with a representative of the non-profit organization Restore Life USA of Elizabethton, Tennessee. After learning of a death in the Tennessee, Virginia and North Carolina areas, the company approaches certain families with a "free" offer to pick up the body, cremate any parts not destined for sale for medical research purposes, and then return the ashes to the family.

In the Reuters case, the purchased spine belonged to a 24-year old male who had struggled with kidney and heart problems his entire life.  His family was too poor to afford a burial or cremation, so the offer from Restore Life had great appeal.

The "donation" cost the family nothing (financially). The purchase by Reuters apparently required just a few email exchanges and $300, plus shipping.  Here is an excerpt from the special report:

Whether Restore Life vetted the buyer is unclear. But if workers there had verified their customer’s identity, they would have learned he was a reporter from Reuters. The news agency was seeking to determine how easy it might be to buy human body parts and whether those parts would be useful for medical research. In addition to the spine, Reuters later purchased two human heads from Restore Life, each priced at $300.

The transactions demonstrate the startling ease with which human body parts may be bought and sold in the United States. Neither the sales nor the shipments violated any laws, say lawyers, professors and government officials who follow the issue closely. Although it’s illegal to sell organs used for transplants, it’s perfectly legal in most states to sell body parts that were donated for research or education. Buying wine over the Internet is arguably more tightly controlled, generally requiring at minimum proof of age.

To comply with legal, ethical and safety considerations before the purchases, Reuters consulted with Angela McArthur, who directs the body donation program at the University of Minnesota Medical School. She took immediate custody of the spine and heads for Reuters, inspecting and storing them at the medical school. * * *

[The family of the cremated 24-year old] said they believed this meant that Restore Life would merely remove small skin samples from Cody for medical research, cremate him and then return his ashes. The Restore Life consent form for Cody didn’t disclose that a donated body may be dismembered, as consent forms of most other brokers do. 

Incidentally, according to Restore Life's publicly available tax returns, Mr. Byrd recently received annual compensation of $116,000 last year. In the same geographic area of Tennessee, the median income is $30,000 per household.

The full Reuters article is available here.

GKE Debate in The Latest Issue of the American Journal of Transplantation

I’ve blogged a few times before about Global Kidney Exchange (GKE, formerly called Reverse Transplant Tourism). See, for example here, here, and here. The October issue of the American Journal of Transplantation (AJT) contains a news report and six letters to the editor about GKE (3 are replies by us to pushback on our original article in the March 2017 issue). You can see Al Roth’s discussion of the issue here.

The report, written by Lara Pullen, is very well done and worth reading in full here to get a sense of the debate.

As noted in the Report:

In a recently published paper, Dr. Rees and his colleagues stressed the financial inaccessibility of dialysis for most low-income individuals.[1] With the GKE, recipients from developing countries not only receive a kidney, but also financial support to help them pay for the medical costs of maintaining their organ after they return to their home country. “Because the GKE involves exchange, it benefits both the foreign pairs and the domestic pairs. It's a win for patients and the donors who love them in both countries,” says Alvin Roth, PhD, professor of economics at Stanford University in Palo Alto, California, and co-developer of the GKE.

. . .

In an editorial and series of letters, transplantation surgeons throughout North America have raised objections to GKE.[2-4] Among the concerns is that staggering numbers of financially incompatible yet biologically compatible pairs would desire entrance into the program, and would likely overwhelm it. Opponents also contend that cultural differences in developing countries will make it difficult to definitively determine potential donors’ motivations. The risk, then, is one of exploiting individual citizens in developing countries, as well as undermining national KEs that may be in their early stages in these countries.

Some have also raised concerns that kidney paired donation (KPD) transplants would violate the current U.S. law that limits paired donation transplants to biologically incompatible donors, as opposed to financially incompatible donors. Dr. Rees and colleagues voiced their opinion on this in a recent paper.[5] [Mike Rees and I address the legality of GKE at great length here]

Thus GKE remains the subject of very strongly held opposing points of view.

As I’ve already noted in a prior post, some of these concerns are valid, but addressable by proceeding carefully with GKE. Others are simply, in my opinion, ridiculous. In any event, we respond to these criticisms in our responses and I plan to say more on this in further posts.

My co-author (not on GKE, but on another paper concerning Advanced Donation – see here), Marc Melcher, is quoted in the Report and is characteristically thoughtful:

Dr. Melcher acknowledges the importance of cultural differences and corruption. He also suggests that these factors are not unique to transplantation, and that any time a non-governmental organization (NGO) enters a developing country to provide aid, there is risk of corruption and unintended consequences. This risk, however, does not stop NGOs from stepping in and trying to provide aid in a developing country. Dr. Melcher feels that Dr. Rees and the GKE should be viewed within the context of NGOs.

. . .

Perhaps Dr. Melcher best articulates the middle-of-the-road response. Noting that there are always unintended consequences in any such venture, he suggests a deliberate approach. “On a case-by-case basis it certainly seems like a win-win situation,” he says. “My bias would be to lead with ‘yes’ and go slowly.” 

The Report and Letters to the Editor are all free and available from the links below:

The AJT Report

Global Kidney Exchange: Overcoming the Barrier of Poverty (pages 2499–2500)

Lara C. Pullen

This month's installment of “The AJT Report” debates the benefits, ethics and sustainability of Global Kidney Exchange. We also look at efforts to shore kidney paired donation implementation in the United States.

Letters to the Editor

Kidney Paired-Donation Program Versus Global Kidney Exchange in India (pages 2740–2741)

1. Kute, R. M. Jindal and N. Prasad

Comment: Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation (page 2742)

1. S. Baines and R. M. Jindal

Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs (pages 2743–2744)

1. A. Rees, S. R. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig and T. B. Dunn

Opposition to irresponsible global kidney exchange (pages 2745–2746)

Francis L. Delmonico and Nancy L. Ascher

People should not be banned from transplantation only because of their country of origin (pages 2747–2748)

Alvin E. Roth, Kimberly D. Krawiec, Siegfredo Paloyo, Obi Ekwenna, Christopher L. Marsh, Alexandra J. Wenig, Ty B. Dunn and Michael A. Rees

Open dialogue between professionals with different opinions builds the best policy (page 2749)

Ignazio R. Marino, Alvin E. Roth, Michael A. Rees and Cataldo Doria

Law & Markets Volume Is Out!

I’ve posted a few times about the Duke Project on Law and Markets (see here, here, and here), which was led last year by Joseph Blocher and me. Like the Custom and Law Project that preceded it, this Project culminated in an edited volume, published this time by Law & Contemporary Problems.  

Those wanting a more detailed description of the Project and papers in the volume can read the Foreword, but here’s a taste:

We started the Law and Markets Project at Duke Law School in the summer of 2015 in an effort to better understand the relationship between the legal system on the one hand and markets on the other. That relationship is central to understanding the nature and practical impact of legal rules, the degree to which those rules are shaped by economic forces, and the ways in which law and markets should or can operate independently. Further, it inevitably raises foundational and difficult questions. What are (or should be) the limits of markets? When, and through what mechanisms, should the law restrict the free exchange of goods and services? To what extent, and how, should the legal system address market driven inequalities in income, wealth, or access to goods and services like health care and education?

By addressing these questions, we hoped to generate interesting conversations that would deepen people’s understandings of their own and each other’s work and set the stage for collaboration going forward. We chose to focus our efforts on the Duke community, so as to help build those conversations and relationships. Given our colleagues’ broad and deep substantive and methodological expertise, this hardly felt like a limitation.

* * *

We held a symposium in early May 2016, the proceedings of which are collected in this issue. Duke faculty authored or co-authored all of the pieces, and the breadth of the topics demonstrates some of the many facets of the relationship between law and markets—from the sale (and tax treatment of) body parts to moral economies in the early Chinese land market; from the supply and demand of anticorruption enforcement to evaluating financial regulation; from markets and the environment to markets for sovereignty itself.

The volume table of contents are below, and the papers can all be downloaded here. The photos throughout this post are highlights from the Project’s workshop and reading groups, which are described in prior posts: here, here, and here.

I’ll be back in due course with more to say about my contribution to the volume, coauthored with Wenhao Liu (Stanford University, Department of Management Science & Engineering; Strategic Decisions Group International) and Marc Melcher (Stanford University, Department of Surgery): Contract Development in a Matching Market: The Case of Kidney Exchange.

 

Morality, Markets, and Contract Law at William & Mary

I’m looking forward to this upcoming event at William & Mary, Morality, Markets, and Contract Law, celebrating the publication of Nate Oman’s new book, The Dignity of Commerce: Markets and the Moral Foundations of Contract Law (University of Chicago Press 2017). I used Nate’s book in my contracts law seminar this year and recommend it for those interested in contract law theory and, in particular, for those interested in the intersections among contract law, markets, and morality.

The event is free and open to the public.

Hope to see you there!

GKE Debate in Current Issue of The American Journal of Transplantation

Both Al Roth at his Market Design blog and Timothy Taylor on his blog, the Conversable Economist, have discussions today about our paper reporting the first Global Kidney Exchange (GKE) and the pushback it has received in the current issue of the American Journal of Transplantation. I’ve blogged about GKE (which Mike Rees and I previously referred to as Reverse Transplant Tourism or “RTT) before (see, e.g. here).

As Al says:

I've written earlier about the possibility of Global Kidney Exchange (GKE), in which foreign patient-donor pairs who cannot afford transplantation are invited to join American kidney exchange chains. The idea is that the cost of the foreign pair's surgeries and postoperative care can be paid for by the savings that result whenever an American is transplanted (because transplantation is so much cheaper than dialysis).

The March issue of the American Journal of Transplantation  contains a report of the first foreign pair, and the chain of exchanges that included them.

Curiously, the issue also contains an editorial that is profoundly ambivalent about GKE, in a way that makes clear that the issues of repugnance that surround organ donation, and incentives, and equity, and patients and donors from developing countries, are not vanishing in the face of the benefits that GKE provides to patient-donor pairs from developing countries. (emphasis mine)

Taylor also has a nice summary of our paper:

Basically, the notion is to involve pairs of people from low-income countries--one needing a kidney, one offering to donate a kidney--in these interlocking chains of kidney donation. For those in high-income countries, the advantage is potentially a lot more compatible kidney donors. Because getting a kidney donation saves money on dialysis, it is possible to use that saved money and provide the kidney donation for free to recipients from the low-income country. The result is healthier people, and overall cost savings.

And of the accompanying editorial:

The same issue of the journal includes a short editorial called "Financial Incompatibility and Paired Kidney Exchange: Walking a Tightrope or Blazing a Trail?" by A. C. Wiseman and J. S. Gill (pp. 597-98). As they write, "there are numerous considerations that require equipoise ..." They point out issues that could arise in how donors in other countries are identified, whether the benefits are equitably distributed, whether consent is freely given, how this might affect providers of transplant services in low-income countries, and more. All fair enough, and I suppose only a benighted economist could bristle against their request for "sensitivity to the ethical pitfalls." I would only point out that while we are being sensitive to ethical pitfalls of global kidney exchange, 2-7 million people are dying every year without access to treatment for their kidney disease, and we should spare a little sensitivity for them, too. (emphasis mine)

I would go even further than Taylor or Roth. The editorial is very thoughtful and worth reading in its entirety, here. It also raises some important ethical issues that have to be considered as GKE goes forward and I am grateful to the authors for having so carefully engaged our paper. At the same time, though, the argument that GKE may be ethically problematic because the benefits are unequally distributed between the US and developing world patients is, for me, just a nonstarter (and, to be clear, I speak for myself here and not for any of my coauthors).

As Roth says:

Here's one sentence that illustrates the power of repugnance (it suggests that maybe the Filipino pair who joined the kidney exchange were really being exploited...):

"At a societal level, American patients received a disproportionate share of the societal benefit enabled by the participation of the compatible Filipino pair in KPE, which may not be adequately remedied by the payment for transplantation and posttransplant care."

Given the Filipino patient’s lack of access to transplantation (and possibly even dialysis – we discuss this in the paper) GKE almost certainly saved his life. To paraphrase Taylor, perhaps only a benighted lawyer could question how this life saving transaction is exploitative of a Filipino patient, just because some Americans also benefit from the trade. The Filipino patient doesn’t care whether one or one hundred Americans were transplanted because of the chain he enabled – only that he received a healthy, compatible kidney that he otherwise could not have.

Here’s our full abstract:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation

by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo

American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

Abstract: Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy—even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient–donor pairs with immunological barriers and developing-world patient–donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange—a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.

And here's the accompanying editorial:

Walking a Tightrope or Blazing a Trail?

by A. C. Wiseman, J. S. Gill

Abstract: Engaging compatible kidney donor–recipient pairs from other countries for participation in a paired kidney exchange program in the United States poses a number of ethical challenges that deserve close scrutiny. Rees et al's article is on page 782.

Related posts:

Global Kidney Exchange (GKE) to Overcome Financial Barriers to Kidney Transplantation

Reverse Transplant Tourism

Reverse Transplant Tourism (cont.)

RTT Conclusion

Reverse Transplant Tourism Goes Live!!

More News Coverage Of Reverse Transplant Tourism

Guinea Pigs, Colonoscopy Artists, and Prostitution: A Typical Taboo Trades Valentine’s Day

What could be more fitting for a Valentine’s Day Taboo Trades class than some readings on commodification of the body?  For today’s class I chose:

(1) Martha Nussbaum, Sex and Social Justice, Taking Money For Bodily Services, pp. 276-298

(2) Carl Elliott, Guinea-Pigging, The New Yorker

(3) Cari Romm, The Life of A Professional Guinea Pig, The Atlantic (2015)

The concept of guinea pigging is one that I’ve written about here before, in Medical Research Subjects: Guinea Pigs, Laborers, Or Altruists?  According to the Oxford English Dictionary (as discussed by Romm), the first use of the word “guinea pig” as “human subject of an experiment” was in 1913, when George Bernard Shaw decried “the ... folly which sees in the child nothing more than the vivisector sees in a guinea pig: something to experiment on with a view to rearranging the world.”

As used here, guinea pigs are healthy, professional medical research subjects who make money primarily through Phase 1 clinical trials (the trials meant to assess the safety and possible side effects of medications, rather than their efficacy). As noted by Romm, “The members of this group call themselves guinea pigs, or lab rats. They also call themselves professionals.”  This notion, of course, flies in the face of the preferred ethicists’ understanding of human subjects research, which likes to conceive of subjects as motivated by altruism.  As noted by Elliott:

Of course, ethicists generally prefer that subjects take part in studies for altruistic reasons. Yet, if sponsors relied solely on altruism, studies on healthy subjects would probably come to a halt. The result is an uneasy compromise: guinea pigs are paid to test drugs, but everyone pretends that guinea-pigging is not really a job.

Kieran Healy and I make a similar point about egg donors in our forthcoming paper, Repugnance Management and Transactions in the Body (forthcoming, American Economic Review: Papers & Proceedings 2017, 107(5)). As we say there:

The fact that egg donor compensation occurs within a gift-based cultural account poses other problems as well. Payments of up to $10,000 are hard enough to square with a gift narrative, but participants managed it. Egg donation is physically risky, after all, and there was a general consensus that egg donors deserved something for their efforts. Besides, all market participants recognized that without some compensation there would be very few egg donors. But once incentives enter the picture they threaten to undermine gift framing entirely. Would fertility centers and patients compete for the most desirable egg donors? How do you square extremely large payments that vary with the donor’s beauty, intelligence, or race with the notion that payments to egg donors are mere thank-you gestures or a token in recognition of physical discomfort? (emphasis added)

So, how does Nussbaum’s chapter on prostitution fit into all this?  In some years, I opt to assign Nussbaum’s chapter together with readings on sex work, but in some ways I find it a better fit with the human guinea pigs readings because Nussbaum makes her points about prostitution by analogizing to the commodification of the body more generally. Many readers, for example, will be familiar with Nussbaum’s famous example of the “colonoscopy artist,” who “gets paid for having her colon examined with the latest instruments, in order to test out their range and capability.”  

When considered in this light, the job of guinea pig and that of prostitute (as with all cases of bodily commodification) share some similarities – and some differences as well. In the end, Nussbaum is skeptical of commodification critiques, concluding that:

We need to scrutinize all our social views about money making and alleged commodification with extra care, for they are likely to embed class prejudices that are unjust to working people.

Gift Cards For Blood!

In a fun coincidence, this Red Cross drive, offering a $5 Amazon gift card in exchange for presenting as a blood donor came across my Facebook feed this morning.  I say it is a coincidence, because my Taboo Trades seminar was reading about precisely this issue today, in “Rewarding Altruism? A Natural Field Experiment” by Nicola Lacetera, Mario Macis, and Robert Slonim. The authors conduct a natural field experiment involving nearly 100,000 individuals on the effects of offering economic incentives for blood donations. Because cash compensation is not permitted, subjects received either a $5, $10, or $15 gift card. As is the case with the Red Cross drive featured here, anyone presenting to donate would receive the gift cards regardless of whether they donated. (Presumably, to undermine any incentive to lie about health histories in order to receive the compensation, as suggested long ago by Titmuss -- who we read last week).

Lacetera, Macis, and Slomin find that providing material rewards led to a large and significant increase in the propensity to donate, and in a very standard way: the effect was increasing in the amount of the incentives. They also found that rewards led to some spatial (i.e. some subjects who would have donated at a particular center switched to a center offering a gift card) and short-term inter-temporal displacement (i.e. some subjects who would have donated later moved up the timing of their donations in order to take advantage of the reward offer). But the gift cards increased the likelihood of donation, even after accounting for these displacement effects. 

Interestingly, the current drive is offering a $5 incentive, but the optimal incentive in the study, if I recall correctly, was $10 (although $15 generated more donations, it also cost more and resulted in more displacement effects).  That’s my recollection anyway. 

So, give blood! And, for the moment anyway, earn money! (Oops, not money, a mere thank you gift, of course).

Some signs of world end are more palatable than others . . .

 

More signs the world is ending: a sociologist and a lawyer (@KimKrawiec) appear in the May American Economic Review. https://t.co/xp0scIV1kO pic.twitter.com/WphDtEUfnT

— Kieran Healy (@kjhealy) February 3, 2017

Understanding Moral Repugnance in Markets at AEA 2017!

For those who decided to freeze themselves in Chicago over the next few days rather than attend the much more pleasant AALS venue, make sure to check out this session tomorrow morning: Understanding Moral Repugnance in Markets.  It features some great speakers (and there's me!) and discussants. 

I've copied the program below (which may or may not work, given the idiosyncrasies of typepad) but you can follow the link to the program, with papers and abstracts, here.  

 

Understanding Moral Repugnance in Markets

Paper Session

Friday, Jan. 6, 2017 8:00 AM – 10:00 AM

 

Hyatt Regency Chicago, Grand Ballroom CD North

Hosted By: AMERICAN ECONOMIC ASSOCIATION

• Chair: Kimberly Krawiec, Duke University

 

The impact of pathogen-disgust sensitivity on vaccine and GM food risk perceptions: Some evidence for skepticism

Dan Kahan

Yale University

• View Abstract
• Download Preview (PDF, 393.53 KB)

Repugnance and Transactions in the Body

Kieran Healy

Duke University

 

Kimberly Krawiec

Duke University

• View Abstract
• Download Preview (PDF, 131.59 KB)

The Ethics of Incentivizing the Uninformed. A Vignette Study

Sandro Ambuehl

Stanford University

• View Abstract
• Download Preview (PDF, 193.27 KB)

Sacred versus Pseudo-Sacred Values

Philip E. Tetlock

University of Pennsylvania

• View Abstract
• Download Preview (PDF, 205.61 KB)
• Download PowerPoint (PPT, 493.50 KB)

Discussant(s)

Brigitte Madrian

Harvard University

 

Luigi Zingales

University of Chicago

 

Deirdre McCloskey

University of Illinois-Chicago

 

Muriel Niederle

Stanford University

JEL Classifications

• D4 - Market Structure, Pricing, and Design

Global Kidney Exchange (GKE) to Overcome Financial Barriers to Kidney Transplantation

Over at his Market Design blog, Al Roth has posted about our new article, forthcoming in the American Journal of Transplantation. From his post:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation

by

Michael A. Rees, Ty B. Dunn, Christian S. Kuhr, Christopher L. Marsh, Jeffrey Rogers, Susan E. Rees, Alejandra Cicero, Laurie J. Reece, Alvin E. Roth, Obi Ekwenna, David E. Fumo, Kimberly D. Krawiec, Jonathan E. Kopke, Samay Jain, Miguel Tan, Siegfredo R. Paloyo

Accepted manuscript online: 7 November 2016

"This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ajt.14106"

Abstract:

Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of end-stage renal disease patients in the developing world die because they cannot afford renal replacement therapy—even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds, prompts us to propose an exchange program utilizing each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient/donor pairs with immunological barriers and developing-world patient/donor pairs with financial barriers. By making developed-world healthcare available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange—a modality equally benefitting rich and poor. We report the one-year experience of an initial Filipino pair, whose recipient was transplanted in the US with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the US through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the US. We show that the logistical obstacles in this approach, although considerable, are surmountable.

*******************

And here's that first GKE chain to date: it started with an American non-directed donor (blood type A) donating to the Filipino patient, and this chart shows the first 11 transplants that resulted.

I blogged about GKE before (back when we were calling it Reverse Transplant Tourism – admittedly a less palatable name than Global Kidney Exchange).  Mike Rees and I floated the idea as a hypothetical in Reverse Transplant Tourism, part of the Law & Contemporary Problems volume, Organs & Inducements. Back then, we proposed that a simple 2-way swap could help US incompatible pairs and developing world pairs (whether biologically incompatible or not), while also saving money, by leveraging the cost savings of transplantation over dialysis.  In practice, though, and as shown by the figure posted by Al, the first GKE helped a Filipino patient unable to afford transplantation on his own, while also facilitating a chain that has transplanted 11 US patients so far. 

This video of the first GKE transplant is both informative and uplifting. 

 

Related posts:

Reverse Transplant Tourism

Reverse Transplant Tourism (cont.)

RTT Conclusion

Reverse Transplant Tourism Goes Live!!

More News Coverage Of Reverse Transplant Tourism

Gifts Versus Markets or Gifts Within Markets?

I’ll be giving a public lecture tonight at Washington & Lee University, as part of the Mudd Center for Ethics 2016-17 Speaker Series on Markets and Morals. The talk begins at 5:00 pm in Northen Auditorium, Leyburn Library and is free and open to the public. I’m honored to be included as a part of this great lineup of speakers, which includes Peter Singer, who discussed closely related issues. Singer’s talk, Permitting the Sale of Meat but not Kidneys or Sex? Some Questions about Markets and Morals, is available by video here.

Hope to see some of you there!

Paying Bone Marrow Donors Is Not Unethical

So says me and nearly two dozen others who work on questions of medical ethics, in a recent letter to The Department of Health and Human Services in response to an NPRM designed to reverse the decision in Flynn v. Holder.

Fellow Lounger Michelle Meyer and I have both written here a couple of times about current debates surrounding compensating bone marrow donors, as well as Flynn v. Holder (the 9^th Cir. case holding that bone marrow donors could be legally compensated for peripheral blood stem cells obtained through apheresis, and the HHS proposed rule that would overturn that ruling.

Now, a group of researchers (including myself and Michelle) have signed onto a letter in opposition to the proposed HHS rule. From the letter:

This Rule would effectively reverse the decision in Flynn v. Holder before the U.S. District Court of Appeals for the Ninth Circuit.1 That decision holds that compensating donors of hematopoietic stem/progenitor cells (hereafter: “hematopoietic cells”) through a procedure called apheresis was not contrary to the National Organ Transplant Act.

We oppose the Rule. We maintain that the ethical arguments against a compensatory model for hematopoietic cell donation through apheresis (hereafter: “the compensatory model”) fail. We further maintain that significant ethical considerations speak in favor of the compensatory model, and therefore against the Rule.

Below, we respond to the ethical arguments offered in favor of the Rule: that the compensatory model would result in wrongful exploitation (§2); that the compensatory model would promote the view that human beings, their bodies, or subparts thereof, are mere commodities (§3); and that the compensatory model would incentivize donation for personal gain over donation from altruistic motives (§4). Given the ethical importance of avoiding preventable death and the strong likelihood that the compensatory model would help avoid preventable death, as well as the ethical importance of free choice, we conclude that the Rule is unethical (§1).

Read the whole thing here.

Related Posts:

On To Bone Marrow

Flynn v. Holder – The Fight Continues

Flynn V. Holder Rehearing Denied

Cohen on Flynn v. Holder

HHS Proposes Rule to Amend NOTA, Nullify Flynn v. Holder

Periodic Tables, May 24 – Taboo Trades: Blood, Eggs, and Kidneys

I’ll be giving a “Periodic Tables” talk on Tuesday, May 24 at Motorco in Durham, so folks in the Triangle area should feel free to stop by. I’ll be discussing “Taboo Trades,” including blood, eggs, and kidneys. Hope to see some of you there!

Duke Law And Markets Grand Finale

I’ve blogged here a few times before about our tradition of a yearlong project dedicated to a particular (broad) topic. This year’s topic was Law & Markets, and we’ve hosted reading groups, a workshop series, and a student seminar on the topic. But May 6 is the grand finale: our Law & Markets symposium.

As was the case with the predecessor Custom & Law project, the symposium is designed to be a conversation (and subsequent volume) among our own faculty and a few colleagues from across campus or neighboring schools. The schedule is below. If you’re in the triangle area, make sure to stop by, especially for the sure to be standing room only discussion of “Contract Development In A Matching Market: The Case of Kidney Exchange” by Kim Krawiec, Wenhao Liu, & Marc Melcher, with commentary by Arti Rai.

 

Law and Markets Symposium Schedule

May, 6, 2016 - Room 3000, Duke Law School

8:00-8:30 a.m.	Breakfast
8:30-9:25 a.m.	Joseph Blocher & Mitu Gulati, “Expulsion in International Law”
	Commenter: Larry Helfer
9:25–10:20 a.m.	Sam Buell & Rachel Brewster, “The Market for Anti-Corruption Enforcement”
	Commenter: Maggie Lemos
10:20–10:40 a.m.	Break
10:40–11:35 a.m.	Kim Krawiec, Wenhao Liu, & Marc Melcher, “Contract Development In A Matching Market: The Case of Kidney Exchange”
	Commenter: Arti Rai
11:35–12:30 p.m.	Taisu Zhang, “Land Markets in Early Modern Economies”
	Commenter: Barak Richman
12:30–1:30 p.m.	Lunch
1:30–2:25 p.m.	Larry Zelenak, “The Body in Question: The Income Tax and Human Body Materials”
	Commenter: Gregg Polsky
2:25–3:20 p.m.	Steven Schwarcz, “The Market Convergence of Debt and Equity and its Relevance for Governance”
	Commenter: Lawrence Baxter
3:20–3:40 p.m.	Break
3:40–4:35 p.m.	Lisa Griffin, “Plea Bargaining, Indigent Defense, and the Potential for Market Effects”
	Commenter: Sara Beale
4:35–5:30 p.m.	Jonas Monast, Brian Murray, & Jonathan Wiener, “On Markets, Morals, and Climate Change”
	Commenter: Matt Adler

The Moral Limits Of Free Markets In Boulder

On Monday, I’ll be at CU Boulder’s Center For Western Civilization, Thought, & Policy, along with Jason Brennan (Associate Professor of Strategy, Economics, Ethics & Public Policy, Georgetown University) and Margaret Jane Radin (Michigan Law, Toronto Law) to discuss and debate the moral limits of free markets.

The event is free and open to the public, and I’ve copied the event information below. Although I’ll be back after the event with updates on the substance, I expect that Jason will take the position, consistent with his book, Markets Without Limits, that “if you may do it for free, you may do it for money.” I imagine that Peggy, consistent with her book, Contested Commodities, will argue that there should be some limits on markets, when necessary to protect nonmarket ideals important to personhood.

I plan to leave the normative debate to those two and take a more descriptive approach: regardless of whether or not market transactions actually degrade relationships and values, most people continue to believe that they do, at least in certain contexts. As a result, market advocates need to account for, and even accommodate, those concerns if the market is to exist at all.

As I explain in a piece I just posted to SSRN:

Students of markets from all disciplines are increasingly turning their attention to the cultural and psychological factors that affect market structure. In traditionally taboo markets, of which reproduction surely is one, those factors include cultural understandings of the moral limits of markets and our collective level of comfort with fully commodifying and subjecting traditionally sacred items and activities to the marketplace.

While it is easy to dismiss these cultural understandings as romantic, silly, or delusional, this severely underestimates their importance, not just to society, but to the market itself. By reframing traditionally unacceptable behavior as a more palatable and familiar transaction, society is able to accept a market that is otherwise socially problematic or even repulsive. Market architects ignore these cultural understandings--and, in particular, societal conceptions of the ethical limits of markets--at their peril. In a world unwilling to embrace the sale of female reproductive capacity for merely a price, the "priceless gift" of egg donation allows a market to flourish that otherwise might stagnate under the weight of social disapproval.

________________________________________________________________________________________________

The Moral Limits of Free Markets (4/4/16)

The "Western Civ Dialogue" series presents:

The Moral Limits of Free Markets

Monday, April 4, 2016

4 p.m. to 5:30 p.m.

British and Irish Studies Room

Norlin Library – 5th Floor

University of Colorado Boulder

Free and open to the public.

If you may do it for free, may you do it for cash? For instance, may you buy and sell votes? How about buying and selling kidneys? Or buying and selling children? What should be off-limits to the market economy? Or do genuinely free markets permit everything? Scholars representing a wide range of views discuss the issues.

Featuring:

- Jason Brennan, Associate Professor of Strategy, Economics, Ethics & Public Policy, Georgetown University

- Margaret Jane Radin, Professor of Law, Emerita, University of Michigan Law School & Distinguished Research Scholar, University of Toronto Faculty of Law

- Kimberly Krawiec, Professor of Law, Duke University Law School

Sponsored by the:

Center for Western Civilization, Thought and Policy (CWCTP)

http://www.colorado.edu/cwctp/

Co-sponsored by the:

Center for Values and Social Policy

http://www.colorado.edu/philosophy/center/

Who Gets What And Why? Photos And Video

Our communications folk were out in full force for Al Roth’s lecture on Wednesday and have already posted some nice photos from the event and uploaded a video of the lecture to YouTube. I’ve included a few below.

 

 

Our Day Of Market Design

As I mentioned in my last post, 2012 Nobel Prize winner Al Roth visited Duke Law School this week as a guest of the Law & Markets project. We basically worked Al to death while he was here – he gave three talks in a single day: a casual morning discussion over coffee with my Taboo Trades students and select faculty; a lunchtime public lecture about his book, Who Get’s What And Why: The New Economics of Matchmaking and Market Design; and an afternoon faculty workshop on Global Kidney Exchange (sometimes called Reverse Transplant Tourism). And that’s not counting the breakfasts, lunch, and dinner he had with faculty who wanted to hear even more about market design. I was exhausted from just watching him in action.

Those who know Al won’t be surprised by that, I suspect. As I’ve discussed before in prior posts (here and here), Al is deservedly well-known for his generosity in sharing his time and expertise with students, colleagues, and even know-nothings like me.

Whether by design or happy accident (I’m not sure which, though he is a market designer, hmm . . . ) there was little overlap in the content of the three talks, though each one built on the other and someone who attended all three (as many of us did) could gain new insight into market design at each stage. The morning session focused primarily on labor markets, especially the judicial clerkship market and market for summer associates and how that compared to the market for new medical residents. As Al discusses in the book, the market for judicial clerks, unlike the market for medical residents, is one in which attempts to prevent market unraveling have been largely unsuccessful. We talked a bit about why that might be and it was interesting to have that discussion among someone who has studied that market (Al), current market participants (the students), prior participants (law professors) and those who have negotiated some of the earlier (failed) agreements – law school administrators.

The lunch talk focused on the concept of market design more generally, but with an emphasis on school choice, kidney exchange, and high frequency trading as examples. The afternoon session was devoted to Al’s current work on repugnant transactions and Global Kidney Exchange, an issue we have both worked on with Mike Rees.

It was a really special day all around, but I was especially happy to get a chance to share Al in person with my Taboo Trades students. They have already spent more time thinking about repugnant transactions than most people ever will, and it was great for them to have a chance to meet “The Pied Piper of Repugnance,” as I referred to Al some years ago, in person. We memorialized his visit with us in the photo above.

Prior posts about Al Roth:

Tomorrow Is Al Roth Day!

Congratulations to Al Roth!

Al Roth: The Pied Piper of Repugnance?

Al Roth, Market Designer, in August Forbes

Scalping The Dalai Lama

Prior posts about Global Kidney Exchange/Reverse Transplant Tourism: collected here

Prior posts about the Taboo Trades seminar: collected here

 

Tomorrow Is Al Roth Day!

I blogged recently about our Law & Markets program (and earlier here) and tomorrow is one of the highlights of the year – 2012 Nobel Prize winner Al Roth is visiting Duke Law as a guest of the Law & Markets project and will deliver a public lecture about his work and his new book, Who Get’s What And Why: The New Economics of Matchmaking and Market Design. He’ll also give a faculty workshop on global kidney exchange. If you’re in the triangle area, stop by for one or both events (see the attached flyers for details).

You can read more about Roth’s work here:

What Al Roth Did To Win The Nobel Prize In Economics

And here: http://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/2012/roth-facts.html

I’ll be back later with a full report.